Riassunto
Per Grave Cerebrolesione Acquisita (GCA) si intende un danno cerebrale, dovuto a trauma cranio-encefalico o ad altre cause (anossia cerebrale, emorragia ecc.), tale da determinare una condizione di coma, più o meno protratto (di durata superiore alle 24 ore) con Glascow coma scale iniziale uguale o minore di 8, associato a menomazioni sensitivo-motorie, cognitive o comportamentali, che comportano una disabilità severa [1]. Secondo Cohadon [2] la coscienza è “la consapevolezza di sé, degli altri, dell’ambiente che ci circonda, quindi essere’ presenti’ per sé e per gli altri, rispondere agli stimoli”. La coscienza è riferita sia alla qualità soggettiva dell’esperienza (e in quanto tale non direttamente accessibile all’osservazione) sia alla consapevolezza di sé e dell’ambiente, quindi valutabile dal comportamento da essa determinato. Necessita di due componenti: lo stato di veglia e il contenuto. Lo stato di veglia è identificato dall’apertura degli occhi e può essere presente in assenza di qualsiasi contenuto. Il contenuto è identificato con i processi superiori: intelligenza, linguaggio, memoria, affettività ecc., e richiede lo stato di veglia per poter essere operativo. I pazienti in seguito a GCA presentano spesso alterazione dello stato di coscienza: per alcuni il recupero procede molto lentamente, altri invece dopo un miglioramento iniziale sembrano stabilizzati, e soprattutto per questi ultimi si rende necessario stabilire criteri che consentano di definire se vi siano ancora margini di miglioramento. A fronte di numerose evidenze di recupero tardivo superiore a un anno [3], non è possibile stabilire dei confini temporali precisi oltre i quali un paziente è da ritenersi in una condizione di non ulteriore evolutività.
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Inzaghi, M.G., Sozzi, M., Lombardi, F., Conforti, J. (2012). I postumi della grave cerebrolesione: stato vegetativo e stato di minima coscienza. In: Vallar, G., Cantagallo, A., Cappa, S.F., Zoccolotti, P. (eds) La riabilitazione neuropsicologica. Springer, Milano. https://doi.org/10.1007/978-88-470-2349-9_10
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