A patient in Persistent Vegetative State and his Rehabilitation

Authors: M. Lippert-Grüner 1,2;  Y. Angerová 2;  M. Hralová 3;  O. Švestková 2
Authors‘ workplace: Universität zu Köln, Kolín nad Rýnem, Německo 1;  Klinika rehabilitačního lékařství 1. LF UK a VFN v Praze 2;  Fyziologický ústav 1. LF UK v Praze 3
Published in: Cesk Slov Neurol N 2011; 74/107(3): 279-284
Category: Review Article


The aim of this article is to introduce the possibility of rehabilitation for vegetative patients, something that is far from common in the Czech Republic. We maintain that it is very important to draw attention to the matter, particularly today, when the comprehensive system of care for patients with cerebrovascular disease is at its very beginning. The vegetative state (term used in Anglophone countries), or “apalic syndrome” (translation of the term used in German-speaking contries) refers to subacute or chronic failure of brain cortex functions leading to a dissociation between awareness and optical vigilance (capacity for visual pursuit), assuming that the activating system of the formatiae reticularis is functioning. Some patients remain vigilant despite vegetative functions but communication with them is impossible.

In spite of a great deal of diagnostic and therapeutic progress, the prognosis for those in whom a vegetative state lasts longer that four weeks remains doubtful. For the majority of patients, complete remission not achieveable. In certain cases, however, remission over a period of years is still possible. Having established an improvement in vigilance and inceptive capacity for perception, the primary aims of rehabilitation in the early stages of remission are to extend vigilance and facilitate its enhancement. However, patients have very limited endurance and therefore rehabilitation should be individually targeted, preferably taking place in an optimally-adapted environment, especially without intrusive impacts. During the following stages of remission it is possible gradually to enhance the complexity of individual rehabilitation, still with the aim of alleviating the functional deficiency based on the actual abilities of the patient at any given point.

Key words:
vegetative state – apalic syndrome – rehabilitation – remission


1. Matis GK, Birbilis TA. Poor relation between Glasgow coma scale and survival after head injury. Med Sci Monit 2009; 15(2): 62–65.

2. Sörbo AK, Blomqvist M, Emanuelsson IM, Rydenhag B. Psychosocial adjustment and life satisfaction until 5 years after severe brain damage. Int J of Rehab Res 2009; 32(2): 1–22.

3. Jeon IC, Kim OL, Kim MS, Kim SH, Chang CH, Bai DS. The effect of premorbid demographic factors on the recovery of neurocognitive function in traumatic brain injury patients. J Korean Neurosurg Soc 2008; 44(5): 295–302.

4. Green RE, Colella B, Hebert DA, Bayley M, Kang HS, Till C et al. Prediction of return to productivity after severe traumatic brain injury: investigations of optimal neuropsychological tests and timing of assessment. Arch Phys Med Rehabil 2008; 89 (Suppl 12): S51–S60.

5. Niedzwecki CM, Marwitz JH, Ketchum JM, Cifu DX, Dillard CM, Monasterio EA. Traumatic brain injury: a comparison of inpatient functional outcomes between children and adults. J Head Trauma Rehabil 2008; 23(4): 209–219.

6. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. Lancet 1974; 2(7872): 81–84.

7. Katz DI, Alexander MP. Traumatic brain injury: Predicting course of recovery and outcome for patients admitted to rehabilitation. Arch Neurol 1994; 51(7): 661–670.

8. Chua KS, Kong KH. Rehabilitation outcome following traumatic brain injury – the Singapore experience. Int J of Rehab Res 1999; 22(3): 189–197.

9. Lancioni GE, Olivetti Belardinelli M, Oliva D, Signorino M, De Tommaso M, Megna G et al. Successful extension of assessment and rehabilitation intervention for an adolescent with postcoma multiple disabilities through a learning setup. Eur J Phys Rehab Med 2008; 44(4): 449–53.

10. Wilson FC, Harpur J, McConnell N. Vegetative and minimally conscious state(s) survey: attitudes of clinical neuropsychologists and speech and language therapists. Disabil Rehabil 2007; 29(22): 1751–1756.

11. Grossmann P, Hagel K. Post-traumatic apallic syndrome following head injury. Part 2: treatment. Disabil Rehabil 1996; 18(2): 57–68.

12. Talbot LR, Whitaler HA. Brain Injured persons in an altered state of consciousness: measures and intervention strategies. Brain Inj 1994; 8(8): 689–699.

13. Mitchell S, Bradlez VA, Welch JL. Coma arrousal procedure: a therapeutic intervention in the treatment of head injury. Brain Inj 1990; 4(3): 273–279.

14. Lippert-Grüner M, Terhaag D. Multimodal early onset stimulation [MEOS] in rehabilitation after brain injury. Brain Inj 2000; 14(6): 585–594.

15. Mazaux JM, Richer E. Rehabilitation after traumatic brain injury in adults. Disabil Rehabil 1998; 20(12): 435–447.

16. Schönle PW. Neurologische Frührehabilitation erste epidemiologische und medizinische Untersuchungsergebnisse. In: von Wild K (ed). Spektrum der Neurorehabilitation. München: W Zuckschwerdt Verlag 1993: 125–130.

17. Pierce JP, Lyle DM, Quine S, Evans NJ, Morris J, Fearnside MR. The effectiveness of coma arousal intervention. Brain Inj 1990; 4(2): 191–197.

18. Wood RL, Winkowski TB, Miller JL, Tierney L, Goldman L. Evaluating sensory regulation as a method to improve awareness in patients with altered states of consciousness: a pilot study. Brain Inj 1992; 6(5): 411–418.

19. Hall M, MacDonald S, Young GC. The effectiveness of directed multisensory stimulation versus non-directed stimulation in comatose CHI patients: pilot study of a single subject design. Brain Inj 1992; 6(5): 435–445.

20. Pfurtscheller G, Schwory G, Gravenstein N. Clinical relevance of long latency SEPs and VEPs during coma and emergence from coma. Electro­encephalogr Clin Neurophysiol 1985; 62(2): 88–98.

21. Lippertová-Grünerová M. Neurorehabilitace. Praha: Galén 2005.

22. Jennet B, Bond M. Assessment of outcome after severe brain damage – a practical scale. Lancet 1975; 2: 480–484.

23. Lippertová-Grünerová M . Trauma mozku a jeho rehabilitace. Praha: Galén 2009.

24. Andrews K, Murphy L, Munday R, Littlewoo C. Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. BMJ 1996; 313 (7048): 13–16.

25. Zieger A. Frührehabilitation komatöser Patienten auf der neurochirurgischen Intensivstation Zentralbl Neurochir 1992; 53: 92–113.

26. Gerstenbrand F. Das traumatische Apallische Syndrom. Wien, New York: Springer 1967.

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