Tony Young, ABI Rehabilitation, Auckland, NZ
Tony is a registered physiotherapist with a PGDip in Neuro rehabilitation and a PGDip in Health management and business studies. He is a certified Brain Injury Specialist (BIAA) and CARF programme surveyor with over 25 years experience in Brian injury rehabilitation.
Giving Emerging Consciousness Adults a Fighting Chance
Young, T, ABI Rehabilitation, NZ
Introduction: Historically, adults with very severe brain injuries in NZ did not have a clear pathway for rehabilitation. Clinical measures were not routinely done with rehabilitation and potential benefits not fully understood.
- Establish and implement clinical outcome measures for people in emerging consciousness state (ECS)
- Development and implement ECS programme
- Demonstrate value of ECS
- Analyse data over a 5-year period (2008 – 2012) prior to established ECS programme
- Implement processes to improve clinical practice
- Review ECS data over past five years to analysis effectiveness of programme
Results: Rather than taking a ‘wait and see’ approach, data from initial analysis demonstrated that there was benefit in regularly using multiple clinical outcome measures to enhance clinical decision making for those in an ECS. This aligns with international best practice (Wilford, 2019). On average, there was a reduction in rehabilitation time for those having regular measures completed.
Data has informed development of a clear ECS clinical pathway and programme that has been established with its own funding stream. The ECS programme is based on international best practice and has associated information developed for families (Giacino, 2018).
Over the past five years (2016-2020) ABI has served 51 people through the ECS programme. 42 people emerged from a minimally conscious state. Of these, 67% were discharged home.
Conclusion: There is continued work required in this field of rehabilitation. Implementing these changes have positioned NZ in a stronger position to assess and deliver rehabilitation to those presenting in an ECS.
Giacino, J. K.-R. Comprehensive systematic review update summary: Disorders of consciousness. Archives of Physical Medicine and Rehabilitation, 99, 1710-1719. (2018)
Wilford, S. H. How do we build a picture of a patient in prolonged disorder of consciousness? Neuropsychological Rehabilitation. (2019)