Wednesday, November 12, 2008

Vegetables waking up

But here’s at least one mordantly amusing and true story told to me by a psychologist at Putney’s Royal Hospital for Neuro-disability. “Young man with motorbike head injury in a coma. His mum, a keen evangelical, comes every day with friends to sing Onward, Christian Soldiers by his bedside. She’s hoping to stimulate his brain into action. It works: he comes round, but he can’t speak. So they fit him up with one of those Stephen Hawking-type laptops, and the first words he speaks are: “For God’s sake, Mum, shut it!” That’s about as funny as it gets on a brain-injury ward, but there’s a serious take-home message. Even minimally aware patients can retain emotions, personality, a capacity to suffer – and, as the young biker showed, attitude.

The biggest, most tragic clinical myth about brain injury today is that PVS can be reliably diagnosed by bedside observation alone. It has in fact been known for at least a decade, ever since a key survey of brain-injured patients, that misdiagnosis of the condition runs at more than 40%, a statistic originally calculated by Professor Keith Andrews, former head of the Putney hospital, and confirmed by recent surveys in Europe and North America. This means that valuable rehabilitation strategies are routinely neglected, and misdiagnosed patients end up on unsuitable wards or in care homes where their needs are neither understood nor met.


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