Severe craniosynostosis often causes extensive damage to the cerebral cortex due to hypoxia, or diffuse axonal disruption and blockage of the brainstem upstream activation system due to mid-axis injury, resulting in prolonged coma or unconsciousness. The patient is unconscious to peripheral events, but subcortical and brainstem functions are still present. When the patient is still in a coma after 2 weeks of onset, it is considered a prolonged coma.
In severe craniocerebral injury, cerebral edema appears early, is severe, and lasts for a long time. Under 0.25 Mpa HBO treatment, cerebral vasoconstriction, cerebral blood flow decreases while oxygen content increases, and the arterial partial pressure of oxygen is more than 14 times that of inhaled air under normal pressure [2]. At the same time, the vertebral artery system is dilated and the blood flow is increased by 18%, which improves the blood supply to the brainstem and effectively stimulates the excitability of the brainstem reticular up-activation system and promotes the awakening of comatose patients.
Rehabilitation treatment
(I) Rehabilitation goals To return the patient to normal living and working environment as far as possible.
(B) Principles of developing rehabilitation plan
The dysfunction caused by craniocerebral injury is diverse and varies greatly from patient to patient, so the treatment plan should vary from person to person. The rehabilitation of craniocerebral injury is long-term. Most physical impairments have stabilized within 1 year after injury, but cognitive, behavioral, and psychosocial problems often persist for a long time.
Therefore, goals for long-term rehabilitation should be set. If there are also behavioral, emotional, and cognitive disorders, they must be addressed first, otherwise the patient may resist, resist, or treat rehabilitation negatively, or many retraining methods may not be effective due to poor attention and memory. Cognitive rehabilitation is long-term, and patients’ families must be taught practical methods that can be used for long-term training at home.
(C) Treatment of common functional disorders
1. Treatment in the acute stage Necessary medication and surgical treatment, strengthening nutrition; passive activities to prevent joint stiffness; prevention of pressure sores and deep vein thrombosis; correction of abnormal posture using reflex inhibition mode.
2. Rehabilitation of cognitive disorders Computers have been widely used for cognitive rehabilitation in foreign countries, but they are not yet popular in China. The following are some simple and practical rehabilitation methods that can be carried out either in the hospital or after the patient goes home.
(1) Training of attention and concentration
① Guessing game (shell game): take two transparent glasses and a pinball, let the patient watch the operator snap a glass over the pinball and point out the glass with the pinball, repeat several times. After the game is correct, switch to the two opaque glasses and operate as above. After several repetitions and success, switch to more cups or more balls of different colors, snap them on and ask the patient to point out the cups with various colors of bouncing balls, move the cups and then ask again.
②deletion task: write several capital letters of Hanyu Pinyin such as KBLRBPYO on a white sheet of paper (numbers and figures can also be used) and let the patient use a pencil to delete the letters specified by the operator, such as B. Then rewrite the order of the letters and specify the letters to be deleted, and repeat several times. Increase the number of lines and difficulty of the letters after success.
③Time sense: Ask the patient to start the stopwatch as ordered by the operator and stop it at 10 seconds, then gradually extend the time to 1 minute, when the error is less than 1~2 seconds, change to not letting the patient look at the watch, and let him mentally calculate to stop at 10 seconds after starting, then extend the time to stop at 2 minutes, and the error should not exceed 1.5 seconds per 10 seconds. After meeting the requirements change to talking with the patient while letting him perform the above training so that he can try to control himself not to be distracted by talking.
④Operational therapy: knitting, woodworking, puzzle practice, etc.
(2) Memory training
①Visual memory: first place 3~5 picture cards with everyday objects in front of the patient, tell the patient to look at each card for 5 seconds, then put the card away and have the patient write down the names of the items seen with a pen, repeat several times, and increase the number of cards after success.
②Make up a story method: Make up the content to be memorized into a short story according to your own habits and hobbies, which helps to remember.
③Operational therapy: woodworking, clay work, inlay, arrow throwing, etc.
The following methods should be used in daily life.
① Establish a constant daily activity routine for the patient to repeat and practice constantly;
②Patiently and quietly ask questions and give orders to the patient;
③Practice from simple to complex, decompose the whole exercise into small parts, train one part at a time, and then gradually combine them after success;
④Use multiple sensory inputs such as visual, auditory, tactile, olfactory, and motor to coordinate the training;
⑤ Each training should be short, and rewards should be given in a timely and frequent manner when the memory is correct;
⑥Let the patient divide the focus and remember the most necessary things first, not to remember some irrelevant trivial things.
(3) Training of thinking
Thinking includes a variety of processes such as reasoning, analysis, synthesis, comparison, abstraction, and generalization, which are often expressed in human problem solving.
The following are some training methods for reasoning and problem solving skills.
① Point out the news in the newspaper: Take a local newspaper and first ask the patient about the information on the front page of the newspaper such as the headline, date, name of the newspaper, etc. If the answer is correct, then ask him to point out the columns in the newspaper such as sports, business, classified ads, etc. After the answer is correct, then train him to point out the columns in the newspaper. After the answer is correct, he is then trained to look for special news, for example, he can be asked how the scores of two teams’ games are? How is the movie opening in a movie theater? After the answer is correct, train him to look for news that requires him to make a decision.
②Arrange the numbers: Give the patient three number cards and ask him to arrange the periods from smallest to largest, then give him one card at a time and ask him to insert the numbers according to the size of the period between the three arranged cards. After they are correct, give him a few more number cards and ask him what they have in common, such as those with odd or even numbers, those that can be multiples of each other, etc.?
③Classification: Let the patient classify and match the names of several items according to the purpose of the items, etc.
④Operational therapy: picture synthesis, woodworking, etc. The training is varied, and also not all the so steps in a certain training are completed in one day. The training can be continued at home after discharge without special supplies, so the patient’s family members should also be trained so that they can master the training methods.
(4) Improvement of the environment
If cognitive dysfunction remains after a patient is discharged from the hospital or returns to work, environmental modification may be the most effective rehabilitation strategy. For attention training, keep the patient in a quiet environment, such as turning off the radio and television, to reduce noise interference. The best approach to memory impairment is to use assistive devices that can compensate for their memory. For example, patients can be taught to rely on wall calendars, alarm clocks and timers to organize their work schedules. Post a work list in the workplace. Keep commonly used tools where they can be most easily seen and reached.
3. Rehabilitation of behavioral disorders
For episodic loss of control and frontal lobe aggression, treat with medication and positive punishment method behavioral therapy. For negative behavioral disorders, behavioral therapy such as negative punishment method, molding method, and token method are used. Occupational therapy can also be performed to eliminate aggressive feelings.