Memory Loss and Joint Calcification: Rehabilitation Challenges After Trauma

Amnesia vs. Tendon Calcification?

Last year, my mother was burned in a fire and misdiagnosed by a well-known hospital in Kaohsiung, which led to her being in a coma and on the brink of death.
She was then transferred to another hospital for observation.
She remained in the intensive care unit (ICU) in a coma for six months.
After being discharged from the ICU, her memory had deteriorated; she has lost all memories of the two years prior and only remembers her childhood.
Her limbs cannot function normally as they used to, and she requires rehabilitation.
It has been over a year since her discharge, and her family has been seeking medical help everywhere.
Her condition has improved somewhat, but the problem is that her wrists cannot fully extend or bend and are in a stiff state.
X-rays indicate calcification, and the doctors are at a loss, stating that surgery may not guarantee improvement.
Therefore, we hope the doctors can provide us with valuable advice to help my mother regain her memory and improve her mobility.
Thank you for your kindness.
^^

Hikaru, 20~29 year old female. Ask Date: 2005/08/12

Dr. Xu Zhenrong reply Rehabilitation

Dear Hikaru,
In general, the duration and depth of coma are related to subsequent recovery, making the level and duration of coma critical indicators for assessing the severity of brain injury.
Typically, patients with severe and prolonged coma have poorer prognoses.

Regarding post-injury amnesia: Generally, if the duration of amnesia exceeds twenty-four hours, it can be classified as severe brain injury; if the duration is between one hour and twenty-four hours, it is considered moderate brain injury; and if the duration is less than one hour, it is classified as mild brain injury.
If recovery has not occurred more than a year after the brain injury, it is less likely to improve and may lead to cognitive decline.
It is recommended that you take your mother to a major hospital's neurology department for a detailed examination.
For burn issues, in the field of physical therapy, we utilize the following treatment methods:
☆ To prevent joint contractures:
1.
Positioning and assistive devices
2.
Stretching exercises
3.
Joint mobilization techniques
4.
Soft tissue mobilization
5.
Educating patients and families on self-directed range of motion exercises
☆ For the management of burn scars:
1.
Soft tissue mobilization
2.
Deep tissue massage
3.
Modalities such as hydrotherapy to soften scars and increase joint mobility.
Since your mother has experienced a coma, she may have some sequelae similar to brain injury, with the most significant impact being the decline in physical function.
Exercise therapy is the best approach and can be tailored to your mother's condition, including activities such as turning exercises, hip lifting exercises, cycling training, and walking training, all of which promote cardiovascular activity and prevent deterioration.
If there are any other concerns, I suggest you visit a nearby hospital's rehabilitation department for further evaluation and treatment.
We are more than happy to provide you with professional medical services!
Sincerely,
Dr.
Hsu Chen-Jung
Director, Rehabilitation Department, Taipei City Hospital

Reply Date: 2005/08/12

More Info

Memory loss and joint calcification following trauma present significant rehabilitation challenges, particularly in cases involving severe injuries such as burns and prolonged unconsciousness. Your mother's situation, as described, involves complex medical issues that require a multifaceted approach to rehabilitation.

Firstly, the memory loss your mother is experiencing can be attributed to the prolonged state of unconsciousness and the potential brain injury she sustained during her hospitalization. Memory loss after a traumatic event, especially one involving a coma, is not uncommon. The duration of unconsciousness is often correlated with the severity of cognitive impairment post-recovery. In your mother's case, the fact that she was in a coma for six months suggests that she may have experienced significant brain trauma, which can lead to difficulties in forming new memories and recalling recent events.

The brain's recovery process can be quite variable. Cognitive rehabilitation strategies may include cognitive exercises, memory aids, and engaging in activities that stimulate cognitive function. It is essential to work with a neuropsychologist or a rehabilitation specialist who can tailor a cognitive rehabilitation program to her specific needs. Techniques such as using memory journals, visual aids, and structured routines can help improve her memory retention and recall.

Regarding the joint calcification and stiffness in her hands, this condition, often referred to as heterotopic ossification, can occur after severe trauma, particularly when there is prolonged immobility. The calcification can lead to joint stiffness, making it difficult for her to regain full range of motion. Rehabilitation for this issue typically involves physical therapy focused on gentle stretching and strengthening exercises. Techniques such as passive range-of-motion exercises, heat therapy, and ultrasound therapy may also be beneficial. In some cases, occupational therapy can help her learn adaptive techniques to perform daily activities despite the limitations in her joints.

If surgical intervention is being considered, it is crucial to weigh the potential benefits against the risks. Surgery may not always guarantee improvement and could lead to further complications. Therefore, a thorough discussion with her healthcare team about the potential outcomes and alternative treatments is essential.

In addition to physical and cognitive rehabilitation, emotional support is vital. Patients recovering from severe trauma often experience emotional and psychological challenges, including anxiety and depression. Engaging a mental health professional can provide your mother with the necessary support to navigate these emotional hurdles.

It is also important to involve family members in the rehabilitation process. Educating them about her condition and how they can assist in her recovery can create a supportive environment that fosters her progress. Family members can help reinforce memory exercises, encourage physical activity, and provide emotional support.

In summary, your mother's recovery journey will require a comprehensive rehabilitation plan that addresses both cognitive and physical challenges. Collaborating with a multidisciplinary team, including neurologists, rehabilitation specialists, physical and occupational therapists, and mental health professionals, will be crucial in optimizing her recovery. While the road ahead may be challenging, with the right support and interventions, there is potential for improvement in both her memory and physical function.

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