Zakrepina A V, Sidneva Yu G, Bratkova M V, Valiullina S A
Clinical and Research Institute of Emergency Pediatric Surgery and Trauma of the Department of Healthcare of Moscow, Moscow, Russia; Institute of Correctional Pedagogics of the Russian Academy of Education of the Russian Academy of Education, Moscow, Russia.
Clinical and Research Institute of Emergency Pediatric Surgery and Trauma of the Department of Healthcare of Moscow, Moscow, Russia; N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of Russia, Moscow, Russia.
Vopr Kurortol Fizioter Lech Fiz Kult. 2020;97(1):51-59. doi: 10.17116/kurort20209701151.
Children who have suffered brain damage form a large group of patients in need of rehabilitation. For rehabilitation, patients require not only surgical, neurosurgical, traumatological, pharmacological and other medical support, but also the creation of special conditions for psychiatric care, psychological and pedagogical correction of their psychophysical potential. Neurological, motor and mental consequences of severe injuries of the nervous system in children lead to a high degree of disability with a subsequent restriction of their life, where social maladaptation and a violation of the quality of life are the primary problems. An integrated approach with differentiated qualified help will increase the effectiveness of rehabilitation programs and help the children adapt when they return to their normal environment.
To identify the characteristics of mental activity during the recovery of the level of consciousness in children after acute severe brain damage at an early stage of rehabilitation.
We examined 210 children under the age of 18 years with severe brain damage (traumatic brain injury, hypoxia, hydrocephalus) who were admitted for treatment and rehabilitation. Clinical-psychopathological, pedagogical methods were used for examination as well as diagnostic scales, questionnaires.
The main differentiating signs were divided into three groups, depending on the mental activity of the child, the level of consciousness: Group 1 - 37 (18%) patients with mental activity with physical, cognitive and social abilities with the minimal '+' consciousness (a-/hyperkinetic mutism with emotional reactions, understanding of speech); 2-nd group - 67 (32%) patients with dominant manifestations of physical and cognitive abilities with the minimal '-' consciousness (a-/hyperkinetic mutism without emotional manifestations and understanding of speech); 3rd group - 106 (50%) children with a weak manifestation of mental activity (physical abilities) in a vegetative status/exit from a vegetative status.
Three variants of mental activity in children after acute severe brain injuries were distinguished - from minimal involuntary reactions or their absence during the vegetative status/exit from the vegetative status to arbitrary actions according to the instructions of an adult with a minimum '+' consciousness. Understanding the dynamics of the recovery of children's mental activity after neurotrauma may make it possible to have a differentiated approach to psychiatric, psychological and pedagogical rehabilitation in order to correct the recovery of mental functions in pediatric patients, and to prevent the developmental disorders as the child grows.
脑损伤儿童是需要康复治疗的一大类患者群体。对于康复治疗，患者不仅需要外科、神经外科、创伤科、药物治疗及其他医疗支持，还需要为精神护理创造特殊条件，对其心理生理潜能进行心理和教育矫正。儿童神经系统严重损伤的神经、运动和精神后果会导致高度残疾，进而限制其生活，其中社会适应不良和生活质量受损是主要问题。采用综合方法并提供有针对性的专业帮助将提高康复计划的有效性，并帮助儿童在回归正常环境时更好地适应。
确定急性重度脑损伤儿童在康复早期意识水平恢复过程中的心理活动特征。
我们对210名18岁以下因重度脑损伤（创伤性脑损伤、缺氧、脑积水）入院接受治疗和康复的儿童进行了检查。采用临床心理病理学、教育学方法以及诊断量表、问卷进行检查。
根据儿童的心理活动、意识水平，主要鉴别体征分为三组：第一组——37名（18%）患者，其心理活动具有身体、认知和社交能力，意识水平为最低限度的“+”（a-/多动性缄默伴有情感反应、能理解言语）；第二组——67名（32%）患者，身体和认知能力的主要表现为最低限度的“-”意识（a-/多动性缄默无情感表现且不能理解言语）；第三组——106名（50%）儿童，在植物状态/脱离植物状态时心理活动（身体能力）表现较弱。
急性重度脑损伤后儿童的心理活动有三种变体——从植物状态/脱离植物状态时的最低限度非自主反应或无反应，到具有最低限度“+”意识的根据成人指令的随意动作。了解神经创伤后儿童心理活动恢复的动态变化，可能有助于对精神、心理和教育康复采取有针对性的方法，以纠正儿科患者心理功能的恢复，并预防儿童成长过程中的发育障碍。
