Commentary on oh h. and seo w. (2003) sensory stimulation programme to improve recovery in comatose patients. journal of clinical nursing 12, 394-404

The rational management of patients recovering from posttraumatic coma has been plagued by a paucity of hard data addressing the role of different physical interventions. In this paper, Oh and Seo present some useful and thorough research in a clinical area that is critically under-researched. As technology, knowledge and understanding advances, the number of patients surviving severe brain injury is increasing. Although the majority make a good recovery, a minority remain in coma, the minimally conscious state or the vegetative state. It has been estimated that as many as six to eight in 100 000 people each year sustain a moderate or severe head injury, with long-term consequences. Unfortunately, this is not reflected in the provision of health care or research effort in this field. These patients are often ignored by modern health care. While billions of research pounds and dollars have been spent on the investigation of (mainly ineffective) acute neuroprotective interventions, little research effort has been directed at dealing with the clinical reality of patients who are left severely disabled following brain injury. There should no longer be any doubt that early rehabilitation is essential to the effective care and long-term recovery of patients who have sustained a brain injury. As a result, the interface of clinical responsibility between acute care and rehabilitation has become increasingly blurred, with acute care teams taking greater responsibility for early rehabilitation (Von Wild, 2001). It is no longer appropriate to initiate rehabilitation only after acute care has come to an end, not only for self-evident logistic and clinical reasons, but also because the biology of acute inflammation following brain injury imperceptibly merges into processes involved in repair Correspondence: Leslie Gelling, Research Officer, School of Community Health and Social Studies, Anglia Polytechnic University, East Road, Cambridge, CB1 1PT, UK, E-mail: leslie.gelling@ntlworld.com