The scientific work is devoted to the extremely topical issues of medical (physical) rehabilitation of patients with long-term consciousness disorders in the post-coma period of the severe traumatic brain injury. The work is based on the analysis of 220 patients with traumatic post-comatose disorders of consciousness. It details the features of the clinical-neurological status, kinesiology testing, neuroimaging, neurofunctional / neurophysiological diagnostics, depending on the stages of restoration of consciousness with Dobrokhotova T. A., both at the beginning and at control points of the rehabilitation route. A prognostic model of the dynamics of consciousness recovery after a post-traumatic long-lasting coma, constructed for the first time on the basis of multifractal EEG properties is presented, and EEG correlates and EEG criteria of objectifying the presence of integrative brain activity are determined. Neurofunctional / neurophysiological predictors of neurological (motor) deficiency, most informative in patients at stages of the syndromes of depressed consciousness (unconscious state) are indicated. Based on the findings and conclusions of a comprehensive survey of the studied cases and their comparison with the control group that was made by patients with acute cerebral blood flow disturbance, key highly informative diagnostic indices were identified. On that basis the integral prognostic index of consciousness restoration was calculated, which reflected the probability of reaching the next highest stage of post-coma consciousness syndromes starting with the vegetative status. The expected results thus formed, at the end of the period of observation of the main sample population, were statistically compared with those actually achieved, which formed the basis for the criteria for assessing the effectiveness of the performed restorative treatment and rehabilitation.
Particular attention is paid to the structure, key clinical tasks, design of the implementation of individual rehabilitation programs, as well as the volume and daily distribution of the total load, taking into account the specific stage of consciousness restoration on which this or that patient was. Basic rehabilitation methods are described, primarily those based on computerized (robotic) technologies of kinesitherapy (mechanotherapy), neurophysiological treatment, including multimodal stimulation of the brain. The review of used methods (means) of ergotherapy, neuropsychological, logopedic correction is given. The problems of early rehabilitation, the principles, the differentiated approach and the consistency of involving methods and techniques in individual rehabilitation programs in specific clinical cases are investigated, and the relationships between the various types of filling of individual programs and the dynamics of opportunities in patients with the same level of consciousness are revealed for the first time. There are convincing arguments about the need to accelerate the restoration of the gravitational gradient in the early stages of the depressed consciousness syndrome, and then its expansion and complication of the gravitational (verticalization) activity against the background of the total systemic daily activation of the patient, no less than 8–9 hours. Moreover, it is noted that ignoring or artificially diminishing the capabilities of patients at each stage of post-coma consciousness, unproved exaggeration of risks, the generation of clinical myths, especially in the unconscious stages, which caused the minimization of the filling of the IPR and the creation of pseudo restrictions in the daily schedule of sessions or procedures, thereby reducing the vital activation of the patient, certainly led to a critical lag in the pace of recovery, or even destroyed all the existing prospects to achieve high stages of post-coma consciousness. The given data testify that the principle of differentiated selection of rehabilitation methods, as well as the principle of cyclic continuity, when access to each higher stage of consciousness recovery repeated the cycle of medical intervention actions but of a higher magnitude, turned out to be key in the interaction of all components of the developed complex system of medical (physical) rehabilitation of patients with long-lasting post-coma disorders of consciousness after severe traumatic brain injury.
