Multidisciplinary attentive treatment for patients with chronic disorders of consciousness following severe traumatic brain injury in the NASVA of Japan

ABSTRACT

Primary Objective: The aim of this study was to demonstrate the clinical outcomes of long-term multidisciplinary attentive treatment (MAT) in patients with chronic disorders of consciousness (DOC) due to severe traumatic brain injury (TBI) following automotive accidents.

Research Design: Five hundred and ten patients (mean age: 40.4 years) were enrolled in this retrospective study.

Methods and Procedures: Patients were provided MAT for one to several years in the eight medical facilities of the National Agency for Automotive Safety and Victims’ Aid (NASVA) in Japan. Clinical status for consciousness, communication, and activities of daily living were evaluated using the NASVA grading system.

Outcomes and results: Following MAT, NASVA scores at discharge were significantly improved compared to those at admission in every patient subgroup including sex, age, NASVA score, and association with/without hypoxic encephalopathy at admission. Younger age, shorter interval between injury and admission, and better neurocognitive function at admission were found to be significant and independent factors for a good prognosis.

Conclusions: MAT can partially improve the cognitive and physical abilities of patients with chronic DOC. From the perspective of not only restoring a patient’s daily life, but also reducing the caregiver’s burden, this type of treatment program warrants more public attention.

KEYWORDS:

• Chronic DOC
• severe TBI
• NASVA
• NASVA score
• multidisciplinary attentive treatment (MAT)

Acknowledgments

The authors sincerely thank the medical staff of the Department of Neurosurgery, Kohnan Hospital, Tohoku Ryogo Center (Dr. Satoru Fujiwara, Dr. Nobukazu Nakasato, Dr. Yasuhiko Matsumori, Dr. Shintarou Seki, Ms. Tomoko Satoh, Ms. Kaoru Saitoh, Ms. Nobui Kawakuma, Ms. Takemi Hayasaka, Ms. Hiroko Oimatsu, Ms. Yoko Hayakawa, Ms. Yukiko Kurimura, Ms. Mineko Shoji and Mr. Hiroaki Abe), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims’ Aid (Ms. Tomomi Kishibe and Ms. Yumiko Akihiro), Chubu Medical Center for Prolonged Traumatic Dysfunction, Kizawa Memorial Hospital (Dr. Yoshitaka Asano, Dr. Yuka Ikegame, Dr. Tomohiko Kawasaki, Dr. Hiroaki Takei, Dr. Jun Matsumoto-Miyazaki, Ms. Kaori Toyama, Ms. Yukari Kanematsu, Ms. Yuka Okumura and Mr. Masaru Makibayashi), NASVA Okayama Medical Center (Dr. Chiho Honda, Dr. Ichirou Kamata, Dr. Daisuke Katayama, Dr. Kunio Fujita, Ms. Emiko Kataoka, Ms. Ritsuko Misaki, Ms. Shinako Mizumoto and Mr. Kazunari Honda), Department of Neurosurgery, Nakamura Memorial Hospital (Dr. Shuhei Takahashi, Ms. Keiko Kakumaru, Ms. Chiaki Kuga, Ms. Mayumi Kimura, Ms. Masami Haga and Mr. Motoyuki Nakai), and Department of Neurosurgery, St. Mary’s Hospital (Dr. Susumu Nakashima, Dr. Setsuko Nakagawa, Ms. Kimiko Yamada, Ms. Shigeko Nakashima, Ms. Yumiko Higuchi, Ms. Miki Hashimoto, Ms. Kuniko Higuchi, Ms. Yumi Inoue and Mr. Kiyonori Izumi) for providing treatment and nursing care support for patients and Mr. Ken Shimizu for support in the statistical analyses of the clinical data.

Author Disclosure Statement

No competing financial interests exist.