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minimally consciousness state

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https://www.readbyqxmd.com/read/28633545/late-recovery-of-awareness-in-prolonged-disorders-of-consciousness-a-cross-sectional-cohort-study
#1
Kudret Yelden, Sophie Duport, Leon M James, Agnieszka Kempny, Simon F Farmer, Alex P Leff, E Diane Playford
PURPOSE: To detect any improvement of awareness in prolonged disorders of consciousness in the long term. METHODS: A total of 34 patients with prolonged disorders of consciousness (27 vegetative state and seven minimally conscious state; 16 males; aged 21-73) were included in the study. All patients were initially diagnosed with vegetative/minimally conscious state on admission to our specialist neurological rehabilitation unit. Re-assessment was performed 2-16 years later using Coma Recovery Scale-Revised...
June 21, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/28621620/deep-brain-stimulation-for-the-early-treatment-of-the-minimally-conscious-state-and-vegetative-state-experience-in-14-patients
#2
Darko Chudy, Vedran Deletis, Fadi Almahariq, Petar Marčinković, Jasenka Škrlin, Veronika Paradžik
OBJECTIVE An effective treatment of patients in a minimally conscious state (MCS) or vegetative state (VS) caused by hypoxic encephalopathy or traumatic brain injury (TBI) is not yet available. Deep brain stimulation (DBS) of the thalamic reticular nuclei has been attempted as a therapeutic procedure mainly in patients with TBI. The purpose of this study was to investigate the therapeutic use of DBS for patients in VS or MCS. METHODS Fourteen of 49 patients in VS or MCS qualified for inclusion in this study and underwent DBS...
June 16, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28615196/withdrawing-clinically-assisted-nutrition-and-hydration-canh-in-patients-with-prolonged-disorders-of-consciousness-is-there-still-a-role-for-the-courts
#3
Veronica English, Julian C Sheather
Currently, in England and Wales, Court of Protection's Practice Directive 9E (PD9E) requires all cases of proposed withdrawal or withholding of life-sustaining treatment in relation to adults in a permanent vegetative state (PVS) or minimally conscious state be referred to the Court. This paper looks at the origins of PD9E and contrasts the routine requirement to refer cases to court with the complex clinical terrain that comprises those suffering from prolonged disorders of consciousness. We look at the role of the court in decision making in these contexts and we ask what role the courts are called on to play in these decisions...
June 14, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28594194/conducting-preference-assessments-for-youth-with-disorders-of-consciousness-during-rehabilitation
#4
Adrianna Amari, Stacy J Suskauer, Valerie Paasch, Lauren K Grodin, Beth S Slomine
PURPOSE: Care and rehabilitation for individuals with disorders of consciousness (DOC) can be challenging; the use of observational data collection, individualized treatment programs, and incorporation of preferred, personally meaningful and salient items may be helpful in addressing such challenges during assessment and intervention. In this article, we extend the predominantly adult literature on use of salient items to promote differential responding by describing our methodology to identify preferred items across sensory domains for application during inpatient rehabilitation with children with DOC...
June 8, 2017: Rehabilitation Psychology
https://www.readbyqxmd.com/read/28569534/family-caregivers-opinions-about-interaction-with-the-environment-in-consciousness-disorders
#5
Pasquale Moretta, Luigi Trojano, Orsola Masotta, Viviana Cardinale, Vincenzo Loreto, Anna Estraneo
OBJECTIVES: To assess family caregivers' opinions about level of interaction with the environment in their relatives with disorders of consciousness (DOCs) and to explore psychological features of caregivers whose opinions diverge from clinicians' diagnosis. METHOD: Forty-five family caregivers of 38 DOC inpatients without communication abilities answered 2 questions assessing their opinion about level of interaction with the environment in their relatives. Self-report questionnaires were used to evaluate caregivers' depression, anxiety, psychophysiological disturbances, prolonged grief disorder, coping strategies, quality of perceived needs and social support...
May 2017: Rehabilitation Psychology
https://www.readbyqxmd.com/read/28554611/a-mathematical-model-of-embodied-consciousness
#6
David Rudrauf, Daniel Bennequin, Isabela Granic, Gregory Landini, Karl Friston, Kenneth Williford
We introduce a mathematical model of embodied consciousness, the Projective Consciousness Model (PCM), which is based on the hypothesis that the spatial field of consciousness (FoC) is structured by a projective geometry and under the control of a process of active inference. The FoC in the PCM combines multisensory evidence with prior beliefs in memory, and frames them by selecting points of view and perspectives according to preferences. The choice of projective frames governs how expectations are transformed by consciousness...
May 26, 2017: Journal of Theoretical Biology
https://www.readbyqxmd.com/read/28553427/functional-evaluation-of-awareness-in-vegetative-and-minimally-conscious-state
#7
Silvia Marino, Lilla Bonanno, Rosella Ciurleo, Annalisa Baglieri, Rosa Morabito, Silvia Guerrera, Carmela Rifici, Antonio Giorgio, Placido Bramanti, Nicola De Stefano
OBJECTIVE: The aim of this study was to assess differences in brain activation in a large sample of Vegetative State (VS) and Minimally Conscious State (MCS) patients, using functional magnetic resonance imaging (fMRI). METHODS: We studied 50 patients four to seven months after brain injury. By using international clinical criteria and validated behavioural scales such as the Glasgow Coma Scale and the Clinical Unawareness Assessment Scale, the patients were grouped into VS (n=23) and MCS (n=27)...
2017: Open Neuroimaging Journal
https://www.readbyqxmd.com/read/28534673/effects-of-preference-and-sensory-modality-on-behavioural-reaction-in-patients-with-disorders-of-consciousness
#8
L Heine, B Tillmann, M Hauet, A Juliat, A Dubois, S Laureys, M Kandel, J Plailly, J Luauté, F Perrin
BACKGROUND: Reliable evaluation of patients with unresponsive wakefulness syndrome (UWS) or in a minimally conscious state (MCS) remains a major challenge. It has been suggested that the expression of residual cerebral function could be improved by allowing patients to listen to their favourite music. However, the potential effect of music on behavioural responsiveness, as well as the effect of preferred stimuli in other sensory modalities (e.g. olfaction), remain poorly understood. OBJECTIVE: The aim of our study was to investigate the effect of sensory modality (auditory versus olfactory) and preference (preferred versus neutral) of the test stimuli on patients' subsequent performance on the Coma Recovery Scale-Revised (CRS-R)...
May 23, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/28534652/a-review-of-the-evidence-of-zolpidem-efficacy-in-neurological-disability-after-brain-damage-due-to-stroke-trauma-and-hypoxia-a-justification-of-further-clinical-trials
#9
J A Sutton, R P Clauss
During 15 years, 23 clinical reports and 6 studies have demonstrated associations between sub-sedative doses of zolpidem and recoveries from brain damage due to strokes, trauma and hypoxia. Clinical findings include unexpected awakenings from vegetative states and regressions of stroke symptoms after dosing that disappear during elimination and reappear on repeat dosing. Initially single-photon emission computed tomography scans showed improved perfusion within, around and distant from infarctions. Then positron emission tomography scans and electroencephalography detected renewed metabolic and neuronal activity...
May 23, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/28515709/effects-of-10-hz-repetitive-transcranial-magnetic-stimulation-of-the-left-dorsolateral-prefrontal-cortex-in-disorders-of-consciousness
#10
Xiaoyu Xia, Yang Bai, Yangzhong Zhou, Yi Yang, Ruxiang Xu, Xiaorong Gao, Xiaoli Li, Jianghong He
BACKGROUND: While repetitive transcranial magnetic stimulation (rTMS) has been applied in treatment of patients with disorders of consciousness (DOC), a standardized stimulation protocol has not been proposed, and its therapeutic effects are inconsistently documented. OBJECTIVES: To assess the efficacy of rTMS in improving consciousness in patients with persistent minimally conscious state (MCS) or unresponsive wakefulness syndrome (UWS), previously known as vegetative state (VS)...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28511826/use-of-hypnosis-meditation-and-biofeedback-in-dermatology
#11
Philip D Shenefelt
Hypnosis utilizes trance to access otherwise inaccessible repressed or unconscious memories and features of the psyche and control of physiology not attainable in the ordinary conscious waking state. Medical uses of hypnosis in dermatology include reducing discomfort from itching or skin pain, altering ingrained dysfunctional habits such as scratching, promoting healing of skin disorders, searching for psychosomatic aspects of skin disorders and alleviating them, and reframing cognitive and emotional dysfunctional patterns related to skin disorders...
May 2017: Clinics in Dermatology
https://www.readbyqxmd.com/read/28484929/functional-mri-for-assessment-of-the-default-mode-network-in-acute-brain-injury
#12
Daniel Kondziella, Patrick M Fisher, Vibeke Andrée Larsen, John Hauerberg, Martin Fabricius, Kirsten Møller, Gitte Moos Knudsen
BACKGROUND: Assessment of the default mode network (DMN) using resting-state functional magnetic resonance imaging (fMRI) may improve assessment of the level of consciousness in chronic brain injury, and therefore, fMRI may also have prognostic value in acute brain injury. However, fMRI is much more challenging in critically ill patients because of cardiovascular vulnerability, intravenous sedation, and artificial ventilation. METHODS: Using resting-state fMRI, we investigated the DMN in a convenience sample of patients with acute brain injury admitted to the intensive care unit...
May 8, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28438464/association-of-medial-prefrontal-cortex-connectivity-with-consciousness-level-and-its-outcome-in-patients-with-acquired-brain-injury
#13
Xiaoyan Liu, Jingqi Li, Jian Gao, Zhen Zhou, Fanxia Meng, Gang Pan, Benyan Luo
Medial prefrontal cortex (mPFC) is usually known for participating in virtually all self related processing. However, few have investigated the role of mPFC in modulating conscious awareness. This study aimed to depict the relationship between the mPFC connectivity and the severity and outcome of the disorders of consciousness (DOC) among patients with acquired brain injury. Thirty-four patients with DOC (17 in a minimally conscious state and 17 in an unresponsive wakefulness syndrome/vegetative state) and 11 healthy controls were recruited, underwent clinical assessment and resting-state functional MRI scan, and were further followed up to evaluate recovery outcome using the Glasgow Outcome Scale...
April 21, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28431117/seeking-certainty-judicial-approaches-to-the-non-treatment-of-minimally-conscious-patients
#14
Richard Huxtable, Giles Birchley
A modest, but growing, body of case law is developing around the (non-)treatment of patients in the minimally conscious state. We sought to explore the approaches that the courts take to these decisions. Using the results of a qualitative analysis, we identify five key features of the rulings to date. First, the judges appear keen to frame the cases in such a way that these are rightly matters for judicial determination. Secondly, the judges appraise the types and forms of expertise that enter the courtroom, seeming to prefer the 'objective' and 'scientific', and particularly the views of the doctors...
April 18, 2017: Medical Law Review
https://www.readbyqxmd.com/read/28424921/evolution-of-psychological-condition-in-caregivers-of-patients-with-disorders-of-consciousness-a-longitudinal-study
#15
Francesco Corallo, Lilla Bonanno, Viviana Lo Buono, Simona De Salvo, Cettina Allone, Rosanna Palmeri, Elena La Gattuta, Carmela Rifici, Antonella Alagna, Antonino Todaro, Placido Bramanti, Silvia Marino
The aim of this study is to evaluate mood disorders and needs in caregivers of disorders of consciousness (DOC) patients during the admission to Neurorehabilitation Unit. A total of 80 caregivers was enrolled and divided in two groups (caregivers of vegetative state-VS patients and caregivers of minimally conscious state-MCS patients). Paired sample t tests were carried out to test differences between baseline observation (T0) and after 6 months (T1). Caregivers of VS patients showed an improvement between T0 and T1 especially, in vitality, mean health, Beck Depression Inventory (BDI-II), Spielberger State-Trait Anxiety Inventory-Y (STAI-Y), Prolonged Grief Disorder (PG 12) and Caregiver Needs Assessment (CNA)...
April 19, 2017: Neurological Sciences
https://www.readbyqxmd.com/read/28424270/significance-of-circadian-rhythms-in-severely-brain-injured-patients-a-clue-to-consciousness
#16
Christine Blume, Julia Lechinger, Nayantara Santhi, Renata Del Giudice, Maria-Teresa Gnjezda, Gerald Pichler, Monika Scarpatetti, Johann Donis, Gabriele Michitsch, Manuel Schabus
OBJECTIVE: To investigate the relationship between the presence of a circadian body temperature rhythm and behaviorally assessed consciousness levels in patients with disorders of consciousness (DOC; i.e., vegetative state/unresponsive wakefulness syndrome or minimally conscious state). METHODS: In a cross-sectional study, we investigated the presence of circadian temperature rhythms across 6 to 7 days using external skin temperature sensors in 18 patients with DOC...
May 16, 2017: Neurology
https://www.readbyqxmd.com/read/28420294/smart-recognising-the-value-of-existing-practice-and-introducing-recent-developments-leaving-no-stone-unturned-in-the-assessment-and-treatment-of-the-pdoc-patient
#17
H Gill-Thwaites, K E Elliott, R Munday
Over the last 25 years there have been a number of papers highlighting the issues of high rates of misdiagnosis in prolonged disorders of consciousness (PDOC) (Andrews, K., Murphy, L., Munday, R., & Littlewood, C. (1996). Misdiagnosis of the vegetative state: Retrospective study in a rehabilitation unit. BMJ, 313(7048), 13-16; Childs, N. L., Mercer, W. N., & Childs, H. W. (1993). Accuracy of diagnosis of persistent vegetative state. Neurology, 43(8), 1465-1467). Surprisingly, these rates still remain at the same level despite defined criteria for diagnosis (Schnakers, C...
April 18, 2017: Neuropsychological Rehabilitation
https://www.readbyqxmd.com/read/28399792/understanding-the-decision-making-environment-for-people-in-minimally-conscious-state
#18
Kudret Yelden, Sarah Sargent, Jo Samanta
Patients in minimally conscious state (MCS) show minimal, fluctuating but definitive signs of awareness of themselves and their environments. They may exhibit behaviours ranging from the ability to track objects or people with their eyes, to the making of simple choices which requires the ability to recognise objects and follow simple commands. While patients with MCS have higher chances of further recovery than people in vegetative states, this is not guaranteed and their prognosis is fundamentally uncertain...
April 11, 2017: Neuropsychological Rehabilitation
https://www.readbyqxmd.com/read/28399715/prevalence-of-coma-recovery-scale-revised-signs-of-consciousness-in-patients-in-minimally-conscious-state
#19
Sarah Wannez, Olivia Gosseries, Deborah Azzolini, Charlotte Martial, Helena Cassol, Charlène Aubinet, Jitka Annen, Géraldine Martens, Olivier Bodart, Lizette Heine, Vanessa Charland-Verville, Aurore Thibaut, Camille Chatelle, Audrey Vanhaudenhuyse, Athena Demertzi, Caroline Schnakers, Anne-Françoise Donneau, Steven Laureys
Different behavioural signs of consciousness can distinguish patients with an unresponsive wakefulness syndrome from patients in minimally conscious state (MCS). The Coma Recovery Scale-Revised (CRS-R) is the most sensitive scale to differentiate the different altered states of consciousness and eleven items detect the MCS. The aim of this study is to document the prevalence of these items. We analysed behavioural assessments of 282 patients diagnosed in MCS based on the CRS-R. Results showed that some items are particularly frequent among patients in MCS, namely fixation, visual pursuit, and reproducible movement to command, which were observed in more than 50% of patients...
April 11, 2017: Neuropsychological Rehabilitation
https://www.readbyqxmd.com/read/28393761/enhancing-clinical-communication-assessments-using-an-audiovisual-bci-for-patients-with-disorders-of-consciousness
#20
Fei Wang, Yanbin He, Jun Qu, Qiuyou Xie, Qing Lin, Xiaoxiao Ni, Yan Chen, Steven Laureys, Ronghao Yu, Yuanqing Li
OBJECTIVE: The JFK Coma Recovery Scale-Revised (JFK CRS-R), a behavioral observation scale, is widely used in the clinical diagnosis/assessment of patients with disorders of consciousness (DOC). However, the JFK CRS-R is associated with a high rate of misdiagnosis (approximately 40%) because DOC patients cannot provide sufficient behavioral responses. A brain-computer interface (BCI) that detects command/intention-specific changes in electroencephalography (EEG) signals without the need for behavioral expression may provide an alternative method...
April 10, 2017: Journal of Neural Engineering
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