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Could stimulating the senses help comatose patients recover?

Under the leadership of Dr. Karine Diserens, a unique facility has been created within the Centre Hospitalier Universitaire Vaudois (Switzerland): the Acute Neurorehabilitation Unit, which is dedicated to the stimulation of patients awakening from a coma. Since its inauguration in 2011, the center has used sensorineural therapy in its treatment. Indeed, certain coma patients can show signs of life when presented with water, smells and other elements. So how does the unconventional neurologist Karin Diserens and her team do it?

It was during the summer of 2014 that the Acute Neurorehabilitation Unit was given an opportunity to see its work in the limelight. It was at this time that the unit received its most famous patient: Michael Schumacher. The Formula 1 champion (critically injured during a skiing accident) benefited from the care of a team of neurologists, physiotherapists, occupational therapists, speech therapists, and specialized nurses.

With recent advances in neuroimaging that can assess consciousness in a comatose patient, the multidisciplinary unit is specialized in detecting the slightest signs of brain activity. According to Karin Diserens, when interviewed in the newspaper 24 heures: “just because we have the impression that a patient is comatose doesn’t necessarily mean that they are.” And the stakes are high: it appears that 40% of vegetative states are misdiagnosed. Catching any sign of consciousness is thus crucial for patients arriving in the Unit.

But evaluation isn't the only thing that matters to this atypical neurologist. She also wants the center to focus on treatment and neurorehabilitation, including the senses. The work has already seen some notable successes: a patient (who is now able to walk) that was overwhelmed with emotion upon being reunited with her dog; another exclaiming “it's cold!” upon contact with water.

Karin Diserens is convinced that early mobilization can offer therapeutic benefits. But doing so often means going against popular beliefs firmly held by much of the medical profession. For example, the belief that patients that are waking up should rest and not be moved to a vertical position too quickly, as it could be dangerous. In Doctor Diseren's center, placing patients upright is possible and can be accomplished with the help of a robot.

One year ago, a therapeutic garden was created; and the head of the Department of Clinical Neurosciences was already reporting positive results as of August 2015. Sensorineural therapy has proven to have beneficial effects on motivation in patients and their ability to regain communication skills. The therapy integrates an understanding of the specific lesions suffered along with the person's tastes. Do they like nature? Music? Painting? Soccer? Etc.

To date, 90 patients have been treated in the Acute Neurorehabilitation Unit, and Karin Diserens wants to create a network for sharing experiences with other university hospitals.
Source: Marie Nicollier, Une voix pour les patients dans le coma, 24 heures, article published on April 18, 2016.


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