Tolle Patrizia, Reimer Marlene
Faculty of Nursing, University of Calgary, Calgary, Alberta T2N 1N4.
Axone. 2003 Dec;25(2):20-6.
The rehabilitative care of persons suffering long-lasting effects of brain injury is a significant challenge for nurses as they are the health professionals who usually spend the most time with them. Historically in Germany, the term "apallic syndrome" has been commonly used for what Plum and Posner (1980) termed the persistent vegetative state. When persons are diagnosed as being in a persistent vegetative state, that is awake but not aware, for more than six months, they seldom receive active therapy except what nurses or families may provide. Stimulation programs have been advocated for these persons, but there is still no reliable evidence as to their effectiveness, and the conceptual basis of the two main types of programs has been poorly understood. The multisensory stimulation approach, such as the Coma Recovery Program or Coma Arousal Therapy, is based on behaviourism with the belief that intensive stimulation provided to all senses will enhance synaptic reinnervation and stimulate the reticular activating system to increase brain tone. In contrast, the sensory regulation approach is based on information processing and mediation of reaction to sensory information with emphasis on enhancing selective attention by regulating the environment rather than providing high degrees of stimulation. What both approaches have in common is the belief that the person in a persistent vegetative state may, at some level, be able to perceive and begin to process information and that external stimulation may enhance that process. Nurses interacting with persons in persistent vegetative state are encouraged to think about how they can regulate sensory input to enhance meaning and facilitate information processing for these persons.
对脑损伤长期影响患者的康复护理，对护士来说是一项重大挑战，因为护士是通常与这些患者相处时间最长的健康专业人员。在德国历史上，“无动性缄默症”一词通常用于指代普卢姆和波斯纳（1980年）所称的持续性植物状态。当患者被诊断为处于持续性植物状态，即清醒但无意识超过六个月时，除了护士或家属可能提供的护理外，他们很少接受积极治疗。已经有人主张为这些患者开展刺激项目，但关于其有效性仍没有可靠证据，而且这两种主要项目类型的概念基础也未得到充分理解。多感官刺激方法，如昏迷恢复项目或昏迷唤醒疗法，基于行为主义，认为对所有感官进行强化刺激将增强突触再支配，并刺激网状激活系统以提高脑张力。相比之下，感官调节方法基于信息处理以及对感官信息反应的调节，强调通过调节环境而非提供高强度刺激来增强选择性注意。这两种方法的共同之处在于，都认为处于持续性植物状态的患者在某种程度上可能能够感知并开始处理信息，并且外部刺激可能会增强这一过程。鼓励与持续性植物状态患者互动的护士思考如何调节感官输入，以增强这些患者的信息意义并促进其信息处理。
