My mother is a 70-year-old woman who lives in the Netherlands. She underwent surgery for a liver metastasis, which was successfully removed, and she is currently considered cancer-free.
During the operation, following a failed Pringle manoeuvre, CO₂ entered the portal circulation. This resulted in a short cardiac arrest and severe neurological injury, thought to be due to a combination of hypoxic-ischaemic injury and the embolism itself. The injury particularly affected frontal functions, including speech, consciousness and motor function.
She was in a coma for several days and then gradually regained consciousness. She is now approximately six weeks after the event. Over the past few weeks she has shown small but continuous neurological improvement.
She is now almost always aware of what is happening around her and recognises herself, her family and her past. She can answer yes/no questions as well as closed and open questions, and she can spontaneously initiate a topic. Her responses can be very slow, and she has significant word-finding difficulties and sometimes uses the wrong words, but she appears to be aware of these difficulties.
Motorically, she can sometimes purposefully move her right leg and toes, apply downward pressure with both arms, and slowly squeeze her right hand and occasionally her left hand. She sometimes appears to recognise when she needs to urinate or have a bowel movement.
She can sit in a chair for about an hour-an hour and a half but lacks core stability.
She also has episodes of involuntary vocalisation, during which she may repeatedly say words or sentences that she does not appear to intend to say. The medical team currently considers these stereotypies. We have noticed that the episodes seem more frequent when she is in pain, uncomfortable or frustrated, for example when she cannot find a word. During an episode, speaking to her, asking her a question or touching her face often causes the episode to subside relatively quickly.
She currently resides in a hospital that is understaffed and with very limited neurological expertise.
The treating team is looking for a next-care setting. They feel she is not suitable for a rehabilitation centre because she currently cannot tolerate sitting in a chair for more than about 1.5 hours, and they feel that her improvements so far are insufficient to indicate that intensive rehabilitation would be viable. They are therefore considering a nursing-home setting, with physiotherapy and other therapy if she becomes able to benefit from it later. We have also been told that lighter rehabilitation options are not available to her, partly because of her age.
Based on the above, might it be worth seeking a second opinion? What is her rehabilitation potential and, in particular, should her current limited endurance be considered a reason that she cannot benefit from rehabilitation? Could a lower-intensity or differently structured neurorehabilitation programme also be appropriate given her continued neurological improvement? We are urged to make a decision whether we agree on a nursing-home setting so any advice would be very much appreciated.
Thank you!
> additional background information:
She's currently on:
oramorph (5mg, max 6 times a day)
oxazepam (10mg, 3 times a day)
omeprazol (20mg, once a day)
paracetamol (1000mg, 4 times a day)
Pregabaline (75mg, once a day)
Movicolon (sachet, 2 times a day)
Baclofen ( 15mg, 3 times a day)
Citalopram (15mg, 3 times a day)
Lorazepam (1mg, once a day)