Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA
Between 30 to 40% of the cases after an acquired brain injury present disorders of consciousness. The clinical progression of the patients can be heterogeneous, varying from coma, in which patients are unable to respond to environmental stimuli, to vegetative states, in which reflex motor responses persist, or to minimally conscious states, in which subjects are aware of themselves or the environment. Disorders of consciousness are particularly vulnerable to neglect basing on the wrong idea that “nothing can be done”. The delay in the provision of clinical intervention is essential as it implies wasting a unique temporal therapeutic window in terms of brain plasticity. Therapeutic approaches used to date are based on pharmacologic interventions or on constant multimodal stimulation to promote the initiation of behavior with limited success. This project means a radically innovative rehabilitation paradigm based on the early interaction through conscious responses, including brain activity and eye movements (commonly, the first responses that appear). The project proposes a multimodal stimulation approach including multisensory stimulation, electric peripheral nerve stimulation, and transcranial direct current stimulation. Passive intervention has provided positive but limited results. Interaction is the key to this new paradigm.