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GRUPO CASAVERDE

 

Anoxic-Ischemic Brain Damage

This is a clinical syndrome caused by a disruption in blood flow to the brain, leading to global cerebral ischemia and cutting off the oxygen supply to the brain. Global cerebral ischemia is a situation in which the blood supply to the brain falls to below the minimum required for it to function correctly. The entire brain is affected at the same time and tissue damage is not restricted to any particular area.  Ischemia (lack of blood supply) leads to cerebral anoxia which means that there is a complete lack of oxygen supply to the brain. In some cases, anoxia is not caused by a failure in the blood supply to the brain, such as in carbon dioxide or carbon monoxide poisoning.

The brain is very sensitive to lack of oxygen, so even short periods of anoxia lead to brain cell death and permanent damage. Early treatment is therefore crucial to prevent further damage occurring. If the brain is starved of oxygen for only a few minutes, severe permanent damage may occur, which manifests itself as:

  • Diffuse cerebral anoxia
  • Persistent vegetative state
  • Focal motor or sensory deficit
  • Lack of coordination
  • Focal deficit, visual agnosia, visual impairment, Bálint's syndrome, etc.
  • Brain death

Overall survival rates are low and, although 80% of patients survive after 10 days following the episode, by 12 months survival rates drop to 25%, and only 20% of this figure are in good neurological condition. Life expectancy after 9 years is only 8.7%. 

The most frequent cause of death is cardiac arrest, usually caused by spontaneous arrhythmia or as a result of coronary ischemia.  Only 10% of patients who suffer cardiac arrest in the community are discharged from hospital in a conscious state. Again, the patient's end state ranges from a vegetative state and minimum response situation, through to loss of movement, cognitive deficit (memory, awareness, learning), limited ability to communicate (aphasia, dysarthria), emotional problems, behavioural problems. Because the parts of the brain that deal with memory are particularly sensitive, lack of oxygen frequently causes memory deficits in patients recovering from cardiac arrest. 

Dealing with these symptoms requires a coordinated approach by physiotherapists, occupational therapists, speech therapists and neuropsychologists, all of which can be provided at the CASAVERDE NEUROLOGICAL REHABILITATION CENTRE.

Rehabilitation treatment

The treatment programme is based on neuro-rehabilitation techniques adapted to suit each patient's individual circumstances and aimed at enabling them to recover as fully as possible.  The rehabilitation team meets regularly to set shared objectives and exchange useful information, ensuring excellent quality treatment. Below is a general description of the activities carried out by each of the medical specialities involved in the rehabilitation of people with neurological injuries: 

Medical Assessment: The Neurology Consultant and the Rehabilitation Consultant carry out an initial assessment and analysis of the reports compiled by the physiotherapy, occupational therapy, speech therapy and neuropsychology units. 

This initial assessment is regularly reviewed and the treatment programmes implemented by the various units are continued or changed depending on the patient's progress.

Physiotherapy Unit

Initial assessment:

  • Assessing the range of movement in the affected joint
  • Muscle balance
  • Modified Ashworth Scale (MAS) for assessing spasticity
  • Tinetti Assessment Tool
  • Berg Balance Scale (BBS)
  • Sensitivity assessment

Planning and implementing treatment:

  • Preventing damage associated with the neurological injury
  • Treating deterioration in muscle tone 
  • Improving posture control
  • Improving balance
  • Treating problems with walking
  • Pain treatment
  • Aquatic physiotherapy
  • Giving relatives advice on the proper way to handle the patient

Monitoring and progress:

  • Progress is assessed regularly to review treatment objectives. When the highest possible degree of mobility has been recovered, doctors will recommend the patient is discharged.

Occupational Therapy Unit

Initial assessment:

  • Chessington Occupational Therapy Neurological Assessment Battery (COTNAB)
  • Loewenstein Occupational Therapy Cognitive Assessment (LOTCA)
  •  Motor Assessment Scale (MAS)
  • Sensitivity assessment
  • FIM + FAM (Functional Independence Measure + Functional Assessment Scale)
  • The Barthel Index

Planning and implementing treatment:

  • Treatment for impaired skills following the neurological injury
  • Improving functionality of affected upper limbs
  • Increasing independence in everyday activities and tasks
  • Adapting the patient's environment
  • Recommending technical aids
  • Advice for families
  • Vocational guidance / Rejoining the workplace

Monitoring and progress:

  • Progress is assessed regularly to review treatment objectives. When the highest possible degree of functionality has been recovered, doctors will suggest the patient is discharged.

Speech Therapy Unit

Initial assessment:

  • The Boston Diagnostic Aphasia Examination (BDAE)
  • The Token Test
  • Testing for Dysarthria
  • Short Aphasia screening test
  • Screening for swallowing disorders without bolus
  • Screening for swallowing disorders using the volume-viscosity method of clinical examination 

Planning and implementing treatment:

  • Language retraining
  • Speech retraining
  • Retraining the swallowing reflex
  • Voice therapy
  • Mouth and facial stimulation
  • AAC: Augmentative and/or Alternative Communication

Monitoring and progress:

  • Progress is assessed regularly to review treatment objectives. When the highest possible degree of recovery has been attained, doctors will suggest the patient is discharged.

Neuropsychology Unit

Initial assessment:

  • Clock drawing test
  • Tracing test
  • Hamilton Rating Scale for Depression
  • Hamilton Rating Scale for Depression
  • Integrated neuropsychology screening programme The Barcelona test
  • Wechsler Adult Intelligence Scale WAIS-III
  • Rey Complex Figure Test (RCFT)
  • Complutense Verbal Learning Test for Spain (TAVEC)
  • Benton Visual Retention Test
  • Stroop Colour-Word Test
  • Wisconsin Card Sorting Test (WCST)
  • Rivermead Behavioural Memory Test (RBMT) 

Planning and implementing treatment:

  • Neurological rehabilitation
  • Behaviour modification
  • Emotional treatment
  • Advice for families 

Monitoring and progress:

  • Progress is assessed regularly to review treatment objectives. When the highest possible degree of recovery has been attained, doctors will recommend the patient is discharged.

Criteria for Admission

Patients with acquired brain damage following:

  • Head injury
  • Acute cerebral haemorrhage
  • Cerebral ischemic anoxia
  • Benign brain tumours
  • Meningitis and acute encephalitis
  • Aged over 15
  • With recent injuries
  • Showing NO behaviour disorders or aggressive behaviour that may out other residents at risk and/or disturb normal relationships at the centre
  • Showing no signs of infectious or contagious disease
  • Clinically stable

Why come to the Neurological Rehabilitation Unit

  • Because following brain injury, it is vital to receive specialist rehabilitation treatment as early as possible to have the best chance of making a full recovery.
  • Because we believe that every person is unique and we are confident that they can make progress, however slight.
  • Because we have a team of highly qualified professionals who have huge experience in treating these types of injury.
  • Because we have the very latest technical equipment for treating neurological problems: transcranial magnetic stimulator (TMS), ICS balance platform and the AUPA Robot for upper limb rehabilitation, which we designed.
  • Because we train our staff to ensure that care is based on a professional and human approach, catering for the needs of patients and their families.
  • Because even when the patient cannot recover all their lost faculties, we can still work on giving them greater independence by using compensatory strategies.
  • Because we not only treat the patient, we also take into account their family and home life so we can show them how to handle the patient correctly once they are at home. We also provide support and psychological help to enable everyone to adapt to their new situation.
  • Because we give patients and their families information about how to access social assistance and other services they may need.
  • Because all our facilities are specially designed for patient rehabilitation in adapted surroundings where patients and their families can feel at home, rather than in a stereotypical hospital environment. We offer extensive gardens, light and airy facilities, a pleasant temperature all year round, a welcoming atmosphere, countryside location, and much more.

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