(Rivista Internazionale - December 1997: The Awakening Unit of the St. John the Baptist Hospital - 3/6)

View of the entrance to the Awakening Unit. A highly specialised department for assisting patients with serious craniocerebral trauma in the post-acute intensive stare. In Italy there are practically no other centres of this kind, so that a large number of requests are unsatisfied. This department mainly accepts young patients who are awakening from coma, defined as the "vegetative state". The main feature of the clinical picture is the absence of consciousness of the self and external environment, meaning complete dependence, both for physiological needs and on the sensorimotor plane, with a massive perceptive, intellectual and emotional isolation. The evident initial physical trauma is accompanied by the less evident but no less serious, psychic trauma.

Hospital rooms in the awakening unit. Each large room has five beds and a work corner for the nursing staff. This arrangement means that all the patients' various vital parameters can be closely monitored and behavioural variables constantly observed.

To date, 63 patients have been treated, with an average age of 22, of which over a third have been able to take up their education and/or work and normal relationships again and the rest, albeit with varying disabilities, have been able to reinsert themselves in society.
If they had not had specific assistance, many of these young people would undoubtedly have encountered serious complications and perhaps even died.
Besides the "awakening phase" the hospital ensures continuity of treatment for the sequelae or residual symptoms in other departments to minimise the disability as far as possible. Moreover, it does not only accept patients from the special unit but also hundreds of people with brain injuries in various clinical stages from other hospitals.
The quality of the health care, supported by the various qualified specialist services in a spirit of great dedication and humanity, enables patients not only to profit from the appropriate treatment, but to come to terms with their own drama in a sensitive and qualified environment, tailor-made to their needs.

The special, electric hospital beds make it easy for nurses and attendants to turn and tilt the patient In addition, they have the particular feature of standing up vertically, so that the patient is in the erect position. This is of fundamental importance for patients in coma or with serious alterations to their state of consciousness. They also give the possibility of providing specific proprioceptive and sensory inputs, fundamental for reconstructing a spatial concept and for stimulating the tonus preparatory to standing up.

No less important and incisive is the support offered for family problems, an inherent part of the patients' situation.
The difficulties involved have prompted the creation of a specific body for supporting families of people with brain injuries: the "Awakening" Association.
The aim of this association is to give all those involved in such dramatic experiences a valid social and practical support in all the different stages of the evolution of the craniocerebral trauma. At the same time, the association has shouldered the task of pinpointing the deficiencies and neglected problems involved in a brain injury. It then refers them to the relevant bodies with requests for improvements to reduce their incidence and to encourage the creation of suitable units to guarantee a proper therapy. Equally, there is the need to stimulate research and exchanges with all the other world centres belonging to the same system, and an Internet site has been set up with the following address: http://wwwgeocities.com/HotSprings/6779.
The functionality and originality of the operational model has been enthusiastically acknowledged by all those who have come into direct contact with it or heard about it for personal, professional or scientific reasons. The undoubted significance under a health and social aspect of the initiative undertaken by the Sovereign Military Order of Malta once again emphasises its focus on filling in the welfare "gaps", as well as the intuition which over the centuries has prompted it to espouse seriously neglected problems.

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