Curare il corpo

Dalla coscienza al corpo e ritorno

riflessione propedeuticain una TI Neuro

Francesco Procaccio

Terapia Intensiva Neuro

Azienda Ospedaliera-Universitaria di Verona

Curiamo il corpo ma cerchiamo la coscienza

Copyright restrictions may apply.

Zeman, A. Brain 2001 124:1263-1289; doi:10.1093/brain/124.7.1263

Shallice's information-processing model of consciousness

S Laureys, Lancet 2004

Awareness Arousal

What is CONSCIOUSNESS ?

Brain Function

Consciousness depends on the way the brain functions.

Consciousness is much reduced during slow wave sleep or seizures

even though levels of neural activity is higher than in

wakefulness. G Tononi, 2005

Psychiatry University of Wisconsin

• Cum scire = condividereinteragire, relazione, comunicazione

2. Consapevolezza =

Sentirsi se stesso e non un altro.

Inaccessibile all’osservazione esterna, soggettivo indimostrabile.

Non coscienza= totale incapacità di comunicare

Reborn

We have always been told there is no recovery from persistent vegetative

state - doctors can only make a sufferer's last days as painless as

possible. But is that really the truth? Across three continents, severely

brain-damaged patients are awake and talking after taking ... a sleeping

pill.

Tuesday September 12, 2006

SeverityPrognosi

s

Biochemical prognosis consciousness

Functional insight of cosciousness

Loss of arousal regulation

Widespread loss of cerebral connectivity

Large-scale networks preservation

Science, 2006

She retainedThe ability tounderstand

spoken commands and to respond through

her brain activityrather than speech

or movement

Coscienza nascosta

Facilitare la comunicazione

Prevenire trattare il dolore, l’ipertono, la privazione sensoriale,

offrire il contatto umano

Il corpo comunica

Comunicazone primitiva ?

Essenziale?

Uscire dagli schemi

Aperti rispetto alla risposta attesa, incoraggiare, prendere per mano,

“Inventarsi un’altra semeiotica”Empatica ? Minimi segnali?, valorizzando le impressioni,

Sviluppando intuizione…

La fanciulla innamorata

rossore, respiro , tachicardia, sospiro, sguardo,

atteggiamento,fuga …

Terapisti della Riabilitazione

in T.I.

Fisioterapia Respiratoria e NeurologicaRiabilitazione precoce

Reparto di T.I. Dipartimento di Neurochirurgia

Verona

Reparto di T.I. Dipartimento di Neurochirurgia

Verona

Infermieri Fisioterapisti

Medici

L’approccioempatico

The problem of consciousness in NICU

• Open approach to ICU extraordinary clinical peculiarities (clinical information vs neurophysiology and functional imaging).

• Intellectual challenge across disciplines

• Common objective language and data

Multidisciplinary approach to consciousness impairement

Continuity of cultural knowledge from first-aid to rehabilitation and clinical feedback

Heath professionals treating disorders of consciousness

should be aware both of its scientific complexity

and of its broad cultural background, which influences

the public understanding of these conditions.

Alfred Zeman, 2006