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What is Apallic Syndrom?
Apallic Syndrome describes a state of "waking coma" which is the result of severe brain damage. The literal meaning of apallic is "without pallium or cortex". The condition is sometimes referred to as "coma vigil". The patient lies in bed, seemingly awake, but does not respond to external stimuli. The eyes are open and the patient appears to be staring into space. It is impossible to make eye contact with them. This may be accompanied by neurological failures such as paralysis. The patient also goes through daily periods when he or she is obviously asleep.
What causes Apallic Syndrom?
The cause of Apallic Syndrome is always some form of severe brain damage, such as that connected with craniocerebal injury, stroke, inflammatory diseases of the brain (meningitis, encephalitis) or a period of oxygen deprivation in patients who have been resuscitated. It is thought that the cerebral cortex becomes disconnected from the rest of the brain, and in particular from the brainstem. The functions of the vegetative nervous system which are controlled by the brainstem (breathing, cardio-vascular regulation and the rhythm of waking and sleep) remain fully or partially intact, as do chewing, swallowing and non-specific pain reflexes. However, due to the damage to the cerebral cortex, no purposeful muscle movement seems to be possible. Sensory perception and the processing of sensory stimuli (cognitive ability) is also almost or fully absent. If the patient cannot eat or drink due to problems with swallowing, they will need to be fed via a tube into their stomach. Artificial respiration with a breathing tube may also be necessary, at least in the early stages of the condition.
What are the typical symptoms of Apallic Syndrom?
- Dependence on life-preserving treatment
- Open eyes
- Lack of reaction to external stimuli
- Loss of the powers of speech and communication
- Paralysis
- Incontinence
- Problems swallowing
- Occasional vegetative and emotional reactions
Patients emerging from a "waking coma" are said to go through six stages:
- Apallic phase (vegetative state as described above)
- Psychomotoric phase (patient can turn their head, begins to be able to eat, can perceive acoustic stimuli, can fix their gaze on a specific point and can emit loud cries)
- Grasping phase (patient laughs, sulks, can follow sounds, reaches out for objects)
- Klüver Bucy phase (patient can understand speech, distinguish between people and things, begins to move independently)
- Korsakov phase (patient becomes conscious of their situation, first attempts at rational behaviour, begins to speak, mood swings)
- Integration phase (increasing independence, start of reintegration into society)
What treatment exists for Apallic Syndrome?
The rehabilitation of apallic patients involves enabling them to relearn lost skills and abilities. The severity and complexity of the syndrome means that this is often a very time consuming and drawn-out process. Long periods of time can go by in which the patient makes little visible progress, and the carers and family of the patient run the risk of becoming despondent and resigned. However, good results are possible, especially with children, as their brains are best able to "reorganize" and restructure themselves. The first phase of unconsciousness is the most dangerous time as the patient is likely to be suffering from life-threatening breathing, cardiac or circulatory problems. He or she thus needs to be constantly monitored. Later on the patient is at risk from infections (urinary tract) and the complications connected with being bedridden for a long period (bed sores, thrombosis, bloating), against which preventative measures need to be taken.
Depending on the stage of the illness, the following therapies are used with varying degrees of intensity:
- Occupational therapy
- Basal stimulation to the body and face
- Passive physiotherapy
- Exercises to facilitate swallowing
- Orientation exercises
- Physiotherapy:
- individually
- in a group (depending on state of health)
- Exercises to improve metabolism
- Breathing exercises
- Pelvic floor exercises
- Swimming pool therapy
- Help with walking
- Physical therapy
- Hot air
- Red light
- Massage
- Stimulating currents
- Inhalation
- Oxygen therapy
- Exercise baths
- Speech therapy
- Music therapy
What provisions are made for day-to-day life?
This depends on the stage of the condition the patient is currently going through. The carers of apallic patients need to be well trained in medical rehabilitation, exercise therapy, physiology and psychology in order to be able to provide effective care, and due to the length of the processes involved also need to display a lot of empathy and strong powers of persuasion vis-à-vis the patient and their family. The families of apallic patients are often offered a private room in which they can spend the night with the patient over long periods of time if so desired. |
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