Consciousness to Awareness
Consciousness to Awareness
Segment 2 – Consciousness to Awareness
Overview:
Segment 2 encompasses three levels—2a, 2b, and 2c—signifying a transition from higher dependency to increased awareness and functionality. Patients in this segment have moved beyond the deepest coma stages, showing varying degrees of responsiveness and mobility. The focus shifts to intensive neuro-rehabilitation, targeting specific complications, and fostering functional improvement.
Common Characteristics:
1. Higher Dependency Progression:
– Level 2a: Patients in a high dependency ward, improved arousal level, responding to simple or single step verbal commands, and showing signs of increased activity.
– Level 2b: Continued responsiveness, improved speech (if not tracheostomized), and increased level of mobility and overall functional independence.
– Level 2c: Enhanced responsiveness, improved orientation, awareness of problems, mood fluctuations, and motivation for rehabilitation.
2. Airway and Feeding Tubes:
– Maintenance of Airway patency, protection of feeding tubes persist, requiring ongoing management for their removal.
– Tracheostomy closure and the transition from Ryle's tube to oral feeding become crucial milestones.
Treatment Goals:
1. Assessment of Brain Injury:
In Segment 2, the primary treatment goal is a thorough assessment of the severity and extent of the patient’s brain injury. This involves evaluating the functioning and non-functioning areas of the brain, providing essential insights into the potential for recovery. By understanding the intricacies of the brain injury, the rehabilitation team can tailor interventions to address specific neurological challenges, laying the foundation for targeted and effective care.
2. Prevention of Complications:
A crucial aspect of treatment in Segment 2 is the proactive prevention of secondary complications. The focus is on addressing issues such as deep vein thrombosis (DVT), HO, Bed sores and joint stiffness. By implementing strategies to manage hypertonia and mobility challenges, the rehabilitation team aims to minimize the risk of complications, fostering a conducive environment for the patient’s ongoing recovery.
3. Respiratory Therapy:
The implementation of respiratory therapy, particularly through the ‘VOST’ protocol, takes center stage in this segment. The goal is to manage chest-related issues, facilitate tracheostomy closure, and instill safe swallowing techniques. By assisting patients in keeping their airways clear and progressing towards normal respiratory function, the therapy sets the stage for improved respiratory health and reduced risks of associated complications.
4. Mobility and Muscle Tone:
Early mobilization is a key treatment goal to promote improved mobility and assess changes in muscle tone. Whether addressing sitting, walking, or bed mobility, the rehabilitation team strives to enhance the patient’s movement capabilities. Simultaneously, efforts are made to identify and manage hypertonia, ensuring a balance between muscle tone restoration and the prevention of complications such as foot drop.
5. Speech and Language Therapies:
The initiation of speech and language therapies is tailored to the patient’s level of comprehension and behavior. From functional communication to language comprehension assessments, the goal is to address neurogenic speech and language disorders. These therapies play a pivotal role in facilitating effective communication, leveraging aided Augmentative & Alternative Communication (AAC) when necessary.
6. Cognitive Assessments:
Comprehensive cognitive assessments form a critical component of treatment in Segment 2. These assessments guide the initiation of cognitive therapies based on the patient’s level of responsiveness. By understanding the cognitive abilities and limitations, the rehabilitation team can implement targeted interventions to enhance cognitive function and support the patient’s engagement in daily activities.
7. Nutritional Support:
Aggressive nutritional supplementation remains a consistent focus to prevent muscle mass loss and minimize infection risks. Regular monitoring ensures that the patient receives adequate nutrition, addressing the hypercatabolic state. This proactive nutritional support contributes not only to physical recovery but also helps in restoring lost muscle mass and maintaining endurance during rehabilitation.
8. Pressure Point Care:
Preventing bedsores is a critical aspect of care in Segment 2. The treatment approach emphasizes a focus on potential pressure points, with efforts to both prevent new bedsores and provide appropriate treatment for existing ones. This is executed with meticulous attention to detail, ensuring patient comfort and well-being while maintaining the integrity of therapy delivery.
Conclusion
Segment 2 emphasizes transitioning patients to higher functioning levels by addressing specific complications and intensifying neuro-rehabilitation efforts. The multidisciplinary approach aims to optimize conditions for recovery, improve functional outcomes, and prepare patients for greater independence in daily activities.
Segment 2 – Consciousness to Awareness
Overview:
Segment 2 encompasses three levels—2a, 2b, and 2c—signifying a transition from higher dependency to increased awareness and functionality. Patients in this segment have moved beyond the deepest coma stages, showing varying degrees of responsiveness and mobility. The focus shifts to intensive neuro-rehabilitation, targeting specific complications, and fostering functional improvement.
Common Characteristics:
1. Higher Dependency Progression:
– Level 2a: Patients in a high dependency ward, improved arousal level, responding to simple or single step verbal commands, and showing signs of increased activity.
– Level 2b: Continued responsiveness, improved speech (if not tracheostomized), and increased level of mobility and overall functional independence.
– Level 2c: Enhanced responsiveness, improved orientation, awareness of problems, mood fluctuations, and motivation for rehabilitation.
2. Airway and Feeding Tubes:
– Maintenance of Airway patency, protection of feeding tubes persist, requiring ongoing management for their removal.
– Tracheostomy closure and the transition from Ryle's tube to oral feeding become crucial milestones.
Treatment Goals:
1. Assessment of Brain Injury:
In Segment 2, the primary treatment goal is a thorough assessment of the severity and extent of the patient’s brain injury. This involves evaluating the functioning and non-functioning areas of the brain, providing essential insights into the potential for recovery. By understanding the intricacies of the brain injury, the rehabilitation team can tailor interventions to address specific neurological challenges, laying the foundation for targeted and effective care.
2. Prevention of Complications:
A crucial aspect of treatment in Segment 2 is the proactive prevention of secondary complications. The focus is on addressing issues such as deep vein thrombosis (DVT), HO, Bed sores and joint stiffness. By implementing strategies to manage hypertonia and mobility challenges, the rehabilitation team aims to minimize the risk of complications, fostering a conducive environment for the patient’s ongoing recovery.
3. Respiratory Therapy:
The implementation of respiratory therapy, particularly through the ‘VOST’ protocol, takes center stage in this segment. The goal is to manage chest-related issues, facilitate tracheostomy closure, and instill safe swallowing techniques. By assisting patients in keeping their airways clear and progressing towards normal respiratory function, the therapy sets the stage for improved respiratory health and reduced risks of associated complications.
4. Mobility and Muscle Tone:
Early mobilization is a key treatment goal to promote improved mobility and assess changes in muscle tone. Whether addressing sitting, walking, or bed mobility, the rehabilitation team strives to enhance the patient’s movement capabilities. Simultaneously, efforts are made to identify and manage hypertonia, ensuring a balance between muscle tone restoration and the prevention of complications such as foot drop.
5. Speech and Language Therapies:
The initiation of speech and language therapies is tailored to the patient’s level of comprehension and behavior. From functional communication to language comprehension assessments, the goal is to address neurogenic speech and language disorders. These therapies play a pivotal role in facilitating effective communication, leveraging aided Augmentative & Alternative Communication (AAC) when necessary.
6. Cognitive Assessments:
Comprehensive cognitive assessments form a critical component of treatment in Segment 2. These assessments guide the initiation of cognitive therapies based on the patient’s level of responsiveness. By understanding the cognitive abilities and limitations, the rehabilitation team can implement targeted interventions to enhance cognitive function and support the patient’s engagement in daily activities.
7. Nutritional Support:
Aggressive nutritional supplementation remains a consistent focus to prevent muscle mass loss and minimize infection risks. Regular monitoring ensures that the patient receives adequate nutrition, addressing the hypercatabolic state. This proactive nutritional support contributes not only to physical recovery but also helps in restoring lost muscle mass and maintaining endurance during rehabilitation.
8. Pressure Point Care:
Preventing bedsores is a critical aspect of care in Segment 2. The treatment approach emphasizes a focus on potential pressure points, with efforts to both prevent new bedsores and provide appropriate treatment for existing ones. This is executed with meticulous attention to detail, ensuring patient comfort and well-being while maintaining the integrity of therapy delivery.
Conclusion
Segment 2 emphasizes transitioning patients to higher functioning levels by addressing specific complications and intensifying neuro-rehabilitation efforts. The multidisciplinary approach aims to optimize conditions for recovery, improve functional outcomes, and prepare patients for greater independence in daily activities.
