Adelphi Centre for the Rehabilitation of Post-Comatose Patients with Severe Brain Injuries

Project location: Italy, Rome
Project start date: December 2010 - Project end date: April 2011
Project number: 2010-70
Beneficiary: Roboris Foundation ONLUS

In the final phase of the project ( June- October 2012) the work and activities undertaken were concentrated on finalising building work and fine tuning the Centre's appliances and equipment, as well as the creation of the Centre's website.

The following is a breakdown of the work and activities undertaken:

- purchase of medical equipment and accessories

- finalization of the computerised management system handling patient medical records. The intervention on the patient with Acquired Brain Injury (ABI) requires the putting in place of an individual program which takes into consideration the overall condition of the patient in distress. It is also fundamental to constantly monitor the quality of the services proved by the Centre in order to determine the level of success achieved.

- restructuring work on a small area of the building to adapt the area into a second storeroom and into a room where patients' incontinence pads can be changed.

- positioning of road signs facilitating access to the Centre and the placing of nameplates at the entrance to the Centre and of plate at the hall with the giver names

- installation of an employee time and attendance clocking-in system, using ID photo cards

- installation of a system to control the CL and PH of the water in the medical basin

- installation of a permanent projector, an amplification system and a large screen in the meeting room. Blackout curtains also fitted to the windows.

- the creation and publication of the Centre' website

- application of a highly specialised opaque film covering to the ground floor windows. This to ensure patient and staff privacy when using certain areas i.e. the medical pool, changing rooms, surgery, occupational therapy room, etc.

On completion of the above work and activities, the Centre became fully operational and started to admit patients from April 1st 2012. The daily intake of patients is 25 of whom 18 are full time. All patients arrive at 9.00 am. The full-time patients leave at 4.00 pm. while the part-time patients leave at 1.00 pm. There are 30 clinical staff employed at the Centre (doctors, psychologists, speech therapists, therapists, etc), of whom some are employed on a part-time basis.

At long last, the rehabilitation of patients could get underway. The patients involved are those who, after a period of hospitalization during the acute phase of the come and emergence from it , are characterised as having little or no autonomy caused by the persistence of psycho-physical disabilities of varying severity and duration.

In Italy, as in other industrialised nations, traumas are caused, for the most part, by road and workplace accidents. As a result the category of the population most affected is working-age adults.

Traumatic brain injury is the leading cause of death and disability in children and adults from the ages of 1 to 44, reaching a peak between the ages of 15 and 35. Cerebrovascular disease also significantly affects working-age adults and not only the elderly.

Thanks to the medical advances and the increasingly efficient organization of emergency services and care, a growing number of patients, who in the past would have died after a few days, now survive and emerge from their coma.

A new category of patients is thus created: an increasing number of post-comatose patients with severe Acquired Brain Injury (ABI), characterized by a residual physical, intellectual, behavioural, social and emotional deficit, are not catered for in the prevailing medical environment.

The first intervention on a patient with ABI is to develop an individual rehabilitation programme which addresses the overall physical and mental condition of the patient. This entails taking into account and intervening on a patient's damaged physical functions, psychological and behavioural problems, and the difficulties encountered in the areas of social interactions, relationships and workplace integration.

Moreover, initial experience with patients has shown the need to intensify cognitive rehabilitation. In fact the deductive reasoning of patients and consequently their whole cognitive sphere is greatly impaired, presenting differing degrees of severity. The global cognitive functions most hit are memory, attention and the executive functions, especially the procedural memory; patients can also present behavioural problems such as inertia, stereotypy, disinhibition aggressiveness, depending on the location of the damage in the brain. As a result, in most cases the clinical state of a patient is aggravated by a psychopathological problem thereby further negatively affecting his/her overall state of health. It is therefore essential to implement cognitive training on a continual basis. It must be measurable, reproducible and comparable for homogenous classes of patients and provide a baseline reference to measure the stabilization and/or the improvement of the cognitive functions. Cognitive training is also important to contain deterioration and to activate social value orientations such as team playing, competing with others, etc.

Another fundamental aspect of a patient to take into consideration is focal brain damage. This prevents or reduces a patient's ability to speak intelligibly and therefore affects his/her ability to communicate, as is the case of patients with aphasia, dysarthria or during locked-in syndrome.

All the above is aggravated by a patient's inability to move his/her hand or arm effectively, when paralysis is present, during spasticity or in the presence of involuntary movements, etc. In all these cases, the use of a symbol communicator, voice synthesizer or a Writer device is indispensable.

In rare cases, when the damage affects the visual occipital areas of the brain, patients need devices to help them communicate and interact with their surroundings. These can be special shields for computer keyboards, a Braille alphabetic communicator, voice synthesizer, etc.

During the seven months the Centre has been operational, important therapeutic results have been achieved. Many patients no longer need their wheelchairs, others have begun to talk, etc.

The Adelphi Centre has now become not only fully operational but also a model of reference and excellence in the rehabilitation of patients who have emerged from a coma with Severe Brain Injuries.