Physiotherapy in patients with consciousness impairment

Abstract

Initial management of comatose patients aims at maintaining vital functions to assess the etiology of coma and administer any specific treatments if required. Management is multidisciplinary. Caregivers play an important role to prevent and treat intensive care unit (ICU)-acquired complications including skin, bone and joint, muscle, lung, thromboembolic and vascular complications. Prolonged immobilization-related complications may rapidly occur in the comatose patients, requiring a rehabilitation program in the first days of ICU stay. The physiotherapist should be aware of the different etiologies of coma as well as their specific features during the acute phase, especially in case of intracranial hypertension since education of caregivers regarding patient’s specific positioning is mandatory. Additionally, the physiotherapist should adapt treatments to each comatose patient’s specificities, be able to assess consciousness level and develop all the different techniques contributing to the patient’s awakening. Early rehabilitation is mandatory to improve the physical and functional outcome of ICU patients as well as their final quality of life.