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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 3  |  Issue : 1  |  Page : 9-11

Effect of early rehabilitation nursing intervention on the recovery of cognitive function in patients with craniocerebral trauma


1 The First Department of Cerebral Surgery, Affiliated TCM Hospital of Xinjiang Medical University, Urumqi, China
2 Emergency Center, Affiliated TCM Hospital of Xinjiang Medical University, Urumqi, China
3 The Second Department of Oncology, Affiliated TCM Hospital of Xinjiang Medical University, Urumqi, China
4 The Second Department of Encephalopathy, Affiliated TCM Hospital of Xinjiang Medical University, Urumqi, China
5 Department of Nursing, Affiliated TCM Hospital of Xinjiang Medical University, Urumqi, China
6 Department of Nursing, The Second Section of the Cadre Ward, Affiliated TCM Hospital of Xinjiang Medical University, Urumqi, China

Date of Submission17-Jun-2019
Date of Acceptance19-Sep-2019
Date of Web Publication13-Dec-2019

Correspondence Address:
Dr. Z H Qin
The First Department of Cerebral Surgery, Affiliated TCM Hospital of Xinjiang Medical University, Urumqi
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MTSM.MTSM_20_19

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  Abstract 


Objectives: The objective is to apply the early rehabilitation nursing to the clinical nursing of patients with craniocerebral trauma and analyze the recovery of cognitive function. Methods: A total of 38 cases of craniocerebral trauma patients admitted to our hospital were selected as the research object, and they were randomly divided into an observation group and control group. Nineteen cases in the control group were treated with routine nursing, and 19 cases in the observation group adopted the early rehabilitation nursing. The recovery of cognitive function and nursing satisfaction were observed and recorded in the two groups. Results: Compared with the control group, the effect of cognitive function recovery in patients with craniocerebral trauma was more significant. There was a significant difference in cognitive function recovery between the two groups (P < 0.05). The patients' satisfaction in the control group was significantly lower than that in the observation group, and the difference between the two groups was statistically significant (P < 0.05). Conclusions: Applying early rehabilitation nursing to the clinical nursing of patients with craniocerebral trauma can accelerate the recovery of cognitive function.

Keywords: Clinical nursing, cognitive function, craniocerebral trauma, rehabilitation nursing


How to cite this article:
Qin Z H, Zhang J J, Wang R, Li H P, Gao Y, Tan X H, Sun Y Q. Effect of early rehabilitation nursing intervention on the recovery of cognitive function in patients with craniocerebral trauma. Matrix Sci Med 2019;3:9-11

How to cite this URL:
Qin Z H, Zhang J J, Wang R, Li H P, Gao Y, Tan X H, Sun Y Q. Effect of early rehabilitation nursing intervention on the recovery of cognitive function in patients with craniocerebral trauma. Matrix Sci Med [serial online] 2019 [cited 2020 Jul 8];3:9-11. Available from: http://www.matrixscimed.org/text.asp?2019/3/1/9/272985




  Introduction Top


With the rapid development of traffic, construction, and natural disasters in our country, the number of accidents absolutely increases, and the incidence rate of (traumatic brain continues to increase.[1] In recent years, with the rapid development of emergency rescue technology and intensive care technology, the death rate of severe traumatic brain injury (TBI) decreased significantly. However, most of the survivors left behind different degrees of consciousness disorder, cognitive dysfunction, behavioral disorder, speech disorder, movement disorder, and so on, which seriously affected the patients' ability of daily living.[2] Make its quality of life fall, bring a huge burden to family and society. Therefore, how to wake up coma patients after tube and improve cognitive impairment is a hot and difficult point in the field of nerve rehabilitation at home and abroad. It is very important economic and social value for patients to return to their homes and society. Coma is an extremely serious disorder of consciousness, which is mainly caused by the decrease in the degree of awakening. The disorder of consciousness refers to a state in which people are tolerant of obstacles in the mental activities of their perception of the environment. It can be divided into two parts: the decline of awakening degree and the change of consciousness and behavior. Coma patients completely lost consciousness; all kinds of strong stimulation cannot make them awake, no purposeful autonomous activities, and cannot open their eyes spontaneously. As for the treatment of coma patients after TBI, it is particularly important to promote the treatment of waking up.[3]

Overview

The domestic and foreign measures mainly include the following points: maintenance of patients' vital signs and stability of the internal environment and other routine drug treatment: neurotropic drugs, such as rat nerve growth factor; arousal drugs, such as levodopa and dopaminergic preparations (such as amantadine), are partially effective. Surgical treatment: about 44% of coma patients after brain trauma develop hydrocephalus. Routine shunt surgery for hydrocephalus patients with a definite diagnosis can improve the consciousness of patients by acupuncture in Traditional Chinese Medicine (TCM), massage with Chinese medicine, treatment with TCM, and the treatment of hyperbaric oxygen chamber with a certain curative effect: it can effectively improve the anoxia in brain tissue. Speed up the repair of damaged nerves, promote regeneration and functional reorganization, 6 central nervous electrical stimulation: including cervical spinal cord epidural stimulation (cervical spinal cord stimulation, [CSCS]) and deep brain microelectrode implantation electrical stimulation (deep brain stimulation [DBS], chapter 1 introduction to DBS): two basic experimental and clinical methods. All the experimental studies have achieved curative effects. The total effective rate was about 20%–40%, but these two methods were traumatic, expensive, and complicated in operation, so they were not suitable for extensive clinical use of peripheral nerve stimulation. At present, there is mainly vague and median nerve electrical stimulation. The median nerve stimulation is widely used in clinic because of its noninvasive, economical, and safe. The mechanism of its action is also the hot spot and focus of domestic and foreign research in recent years.


  Methods Top


The annual incidence of injury TBI in China is 100–200/100,000, and the incidence of TBI increases by 4.67%/year. Experts also predict that brain injury will become the third-largest disease burden in the whole globe in 2020. As high as, 14% of the TBI patients were in a long-term coma or persistent vegetative state after rescue, and the duration of coma was positively correlated with the coma mortality rate of brain trauma. Therefore, it is of great economic and social significance to promote the recovery of brain injury coma patients, to restore their functions, and to reduce the rate of disability and mortality. At present, the commonly used methods of comatose treatment are as follows: (1) maintenance of patient's vital signs and stable internal environment; (2) reduction of intracranial pressure; (3) surgical treatment; (4) use of neurotropic drugs and arousal drugs; (5) Chinese medicine and acupuncture, massage; (6) language, vocal music and light stimulation; (7) hyperbaric oxygen therapy; and (8) stem cell transplantation (84). Although the treatment of drugs, hyperbaric oxygen, sensory stimulation, and stem cell transplantation has certain clinical effects, because of its own effectiveness, side effects, and the limitations and deficiencies of the treatment associated with immune rejection and tumor formation risk, limiting the clinical availability of these treatments cannot effectively solve the clinical coma of patients with arousal [Figure 1].
Figure 1: Brain functional partition

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In recent years, with the rapid development of stimulation therapy, this technique has made some new progress in the clinical application and basic research of coma stimulation. Stimulation is a method of preventing and treating diseases using various electric currents or electromagnetic fields.[4] After electrical stimulation, a series of changes occur in organisms, including morphology, expression of cytokines, electrophysiological changes, and so on. At present, the clinical methods include cervical spinal cord epidural stimulation, CSCS, transcranial magnetic stimulation (TMS), transcranial direct current stimulation, (transcranial direct current stimulation and ds), median nerve stimulation, which include: cervical spinal cord epidural stimulation, TMS, (TMS, toms), transcranial direct current stimulation. It found that t ds and r toms can improve their electroencephalogram (EEG) activity.[5] To improve the score of the coma recovery scale in patients with minimal consciousness after brain injury. However, there was insufficient evidence of the effect of r toms in patients with consciousness disorder, and the mechanism of coma in promoting wakefulness was not clear. There was no significant difference between r toms and control group in the effect of, t ds on the wake-up of patients with consciousness disorders, and there was no significant difference between r toms and the control group.[6] The mechanism of t ds in the treatment of coma arousal has not been reported. SC was first applied to pain. With the further study, the treatment has been paid more attention in many fields. The literature at home and abroad showed that c sacs had the effect of promoting wakefulness and the cerebral blood flow increased significantly after treatment and up-regulated the level of excitatory neurotransmitters in the brain of patients with severe consciousness disorder. Zhu Jin et al. through animal experiments, it is found that the ascending cerebral blood flow effect of sacs may be connected [Figure 2].
Figure 2: Brain injury functional zone

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  Results Top


In clinical practice, unilateral neglect is easily confused, and patients with unilateral neglect may be accompanied by hemianopia at the same time, which should be distinguished. First of all, the nature of the two is completely different [Figure 3]. Hemianopia is caused by damage to the bundle and armature of the eye. Patients usually understand the existence of the disorder and actively turn around to compensate for it. However, the unilateral space neglects the patient can not realize the existence of the obstacle and does not take the initiative to change the head compensatory action; in the visual field examination, the unilateral neglect patient's visual field can be normal or has the defect, but the patient is fixed the sightline of sight, It is impossible to see a single field of vision. Unilateral space neglect has long been regarded as a “collection of multiple symptoms” that is highly anatomically controversial. Numerous studies based on the localization of local brain anatomy and the injury has reported that a large number of cortical regions and subcortical structures are associated with unilateral neglect. However, the available anatomical evidence does not explain the clinical symptoms perfectly. With the development of neuroimaging techniques, there is increasing evidence that ubiquitous sensor network (USN) is caused by network damage mediated by directional attention, including frontal lobe, parietal lobe, thalamus, basal ganglia, superior calculus, and cingulate cortex. In addition, some studies have shown that the injury of parahippocampal gyros, angular gyros, right parietal, and temporal joint region can also lead to unilateral spatial neglect, but the clinical manifestations of USN are different in different parts of the brain, corvette, and others report. The dorsal frontal and parietal pathways (such as the medial parietal sulcus and the frontal lobe eye movement region) and the ventral pathway (such as temporal-parietal cortex and ventral frontal cortex) are the neuroanatomical networks. Functional sect combined with structural computed tomography to study brain localization of USN, In addition to frontal lobe parietal lobe and cortex of anterior cingulate gyros temporal-parietal occipital region (top) was also associated with the occurrence of USN.
Figure 3: Time varying Rated load amperage (RLA)

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  Conclusions Top


The main subjects of this study were brain trauma, a common disease in rehabilitation medicine. The clinical effects of two methods of rehabilitation medicine (median nerve stimulation, TMS) were observed, and EEG, single-electron emission computed tomography, and B-ultrasound were used. Various techniques such as resting f mire were used to explore the possible mechanism of the therapeutic effect of this method, and the research contents were rich, the tools and equipment's used for index evaluation were accurate and high-end, and all of them were randomized controlled trials of high quality. It is of great significance. To investigate the clinical effect of median nerve electrical stimulation on brain injury coma patients, and to explore the possible mechanism of the effect using electroencephalogram and single-photon emission computed tomography. It can provide the treatment basis and reference for the patients with clinical brain injury, and it can also provide the theoretical basis for the application of median nerve electrical stimulation in the patients with brain injury. It has important clinical research value.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hampel R, Ziems S, Zingler CH, Gabert A. Pituitary gland function following craniocerebral trauma III [deg] in younger patients. Endocrine Abstracts 2011;26:217.  Back to cited text no. 1
    
2.
Xu G, Hu B, Chen G, Yu X, Luo J, Lv J, et al. Analysis of blood trace elements and biochemical indexes levels in severe craniocerebral trauma adults with Glasgow coma scale and injury severity score. Biol Trace Elem Res 2015;164:192-7.  Back to cited text no. 2
    
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Zongsheng Z, Peiwu HE. Analysis of acute intraoperative encephalocele in patients with severe craniocerebral trauma. Clin Med 2010;10:637-8.  Back to cited text no. 3
    
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Nishijima DK, Offerman SR, Ballard DW, Vinson DR, Chettipally UK, Rauchwerger AS, et al. Risk of traumatic intracranial hemorrhage in patients with head injury and preinjury warfarin or clopidogrel use. Acad Emerg Med 2013;20:140-5.  Back to cited text no. 4
    
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Seidl RO, Nusser-Müller-Busch R, Hollweg W, Westhofen M, Ernst A. Pilot study of a neurophysiological dysphagia therapy for neurological patients. Clin Rehabil 2007;21:686-97.  Back to cited text no. 5
    
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Byun CS, Park IH, Oh JH, Bae KS, Lee KH, Lee E, et al. Epidemiology of trauma patients and analysis of 268 mortality cases: Trends of a single center in Korea. Yonsei Med J 2015;56:220-6.  Back to cited text no. 6
    


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