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Schnetzer L, Steinbacher J, Bauer G, Kunz AB, Bergmann J, Kronbichler M, Trinka E, McCoy M. The vascular locked-in and locked-in-plus syndrome: A retrospective case series. Ther Adv Neurol Disord 2023; 16:17562864231207272. [PMID: 38021476 PMCID: PMC10655646 DOI: 10.1177/17562864231207272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
The locked-in syndrome (LiS) is defined as the loss of most voluntary muscle movements with preserved cognitive abilities due to a ventral pontine lesion. However, some patients may also have severe impairment of consciousness [locked-in plus syndrome (LiPS)]. Here we aimed to explore structural differences between LiS and LiPS patients of vascular aetiology, focusing on lesion patterns and locations to better delineate the clinical spectrum of LiS and LiPS. In this retrospective case series study, we report nine patients (two women), ages 29-74 years (median 50) with LiS and LiPS who were diagnosed between 2007 and 2021. Clinical parameters, MRI findings including the lesioned structures, and a shape feature calculation are presented for every patient. The lesioned structures were determined by a senior neuroradiologist. Two of nine patients had fully retained consciousness (LiS) and seven showed various degrees of impaired consciousness (LiPS). Lesions of LiS patients are round and confined to the pons, whereas lesions of LiPS patients are more elongated and reach neighbouring areas such as the mesencephalon, thalamus or ascending reticular activating system. Lesions involving the mesencephalon and the thalamus are strong indicators of LiPS, whereas for lesions restricted to the pons, the dorsal extension and the associated damage to the ascending reticular activating system are crucial to differentiate LiS from LiPS. Recognizing LiPS using clinical and radiological findings is important as these patients may need different therapies and care and, most importantly, should not be mistaken as unresponsive wakefulness syndrome.
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Affiliation(s)
- Laura Schnetzer
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Paracelsus Medical University, Ignaz-Harrer-Straße 79, Salzburg A-5020, Austria
- Neuroscience Institute, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience Salzburg, Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institute of Neurorehabilitation and Space Neurology, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Centre, Paracelsus Medical University, Salzburg, Austria
| | - Jürgen Steinbacher
- Department of Neuroradiology, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Gerhard Bauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander Baden Kunz
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience Salzburg, Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institute of Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Jürgen Bergmann
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience Salzburg, Paracelsus Medical University, Salzburg, Austria
- Neuroscience Institute, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Martin Kronbichler
- Neuroscience Institute, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Psychology, Centre for Cognitive Neuroscience Salzburg, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience Salzburg, Paracelsus Medical University, Salzburg, Austria
- Neuroscience Institute, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience Salzburg, Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institute of Neurorehabilitation and Space Neurology, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Centre, Paracelsus Medical University, Salzburg, Austria
| | - Mark McCoy
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience Salzburg, Paracelsus Medical University, Salzburg, Austria
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Moro V, Beccherle M, Scandola M, Aglioti SM. Massive body-brain disconnection consequent to spinal cord injuries drives profound changes in higher-order cognitive and emotional functions: A PRISMA scoping review. Neurosci Biobehav Rev 2023; 154:105395. [PMID: 37734697 DOI: 10.1016/j.neubiorev.2023.105395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 09/23/2023]
Abstract
Spinal cord injury (SCI) leads to a massive disconnection between the brain and the body parts below the lesion level representing a unique opportunity to explore how the body influences a person's mental life. We performed a systematic scoping review of 59 studies on higher-order cognitive and emotional changes after SCI. The results suggest that fluid abilities (e.g. attention, executive functions) and emotional regulation (e.g. emotional reactivity and discrimination) are impaired in people with SCI, with progressive deterioration over time. Although not systematically explored, the factors that are directly (e.g. the severity and level of the lesion) and indirectly associated (e.g. blood pressure, sleeping disorders, medication) with the damage may play a role in these deficits. The inconsistency which was found in the results may derive from the various methods used and the heterogeneity of samples (i.e. the lesion completeness, the time interval since lesion onset). Future studies which are specifically controlled for methods, clinical and socio-cultural dimensions are needed to better understand the role of the body in cognition.
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Affiliation(s)
- Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy.
| | - Maddalena Beccherle
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy; Department of Psychology, Sapienza University of Rome and cln2s@sapienza Istituto Italiano di Tecnologia, Italy.
| | - Michele Scandola
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy
| | - Salvatore Maria Aglioti
- Department of Psychology, Sapienza University of Rome and cln2s@sapienza Istituto Italiano di Tecnologia, Italy; Fondazione Santa Lucia IRCCS, Roma, Italy
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Nilsen HW, Martinsen ACT, Johansen I, Kirkevold M, Sunnerhagen KS, Becker F. Demographic, Medical, and Clinical Characteristics of a Population-Based Sample of Patients With Long-lasting Locked-In Syndrome. Neurology 2023; 101:e1025-e1035. [PMID: 37442623 PMCID: PMC10491452 DOI: 10.1212/wnl.0000000000207577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/10/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with classic locked-in syndrome (LIS), typically caused by ventral pontine stroke, present with quadriplegia, mutism, intact consciousness, and communication skills limited to vertical gazing and/or blinking. Clinical presentations and definitions of LIS differ, especially regarding incomplete LIS. In our study, we explored the functional diversity of LIS, its outcomes, and the complexity of its course along with variations in the location of lesions and their potential significance for outcomes. METHODS A national cohort of patients with vascular LIS who remained in the LIS state for at least 6 weeks according to a functional definition of LIS was studied. Demographic, medical, and follow-up data, collected between 2012 and 2022, were obtained from the quality register of the Norwegian National Unit for Rehabilitation of Locked-In Syndrome. Outcomes in verbal communication, motor function, and dependency were evaluated according to criteria for being in or not in the LIS state. The modified Rankin scale and LIS motor recovery scale were applied. Descriptive analysis was performed. The relationship between lesion location and functional outcome was investigated. RESULTS The sample included 51 patients (median age: 55.7 years, 36 male individuals), 43 of whom had follow-up data. Ischemic stroke was the most common etiology (n = 35). Twenty-three patients had emerged from the LIS state, mostly within 2 years after onset. All but 1 patient achieved some motor improvement, whereas only 3 achieved full motor recovery, and 88% had a persistently high level of dependence. The 3-year survival rate was 87%. Five patients had an isolated pontine lesion, whereas 80% showed various lesions outside the brain stem. Patients who emerged from the LIS state had a significantly lower prevalence of lesions outside the brain stem than patients who remained in the LIS state did. DISCUSSION Investigating an unselected population-based sample of patients with vascular LIS offers important insights into the functional diversity of LIS. Although most patients remained severely disabled, even small improvements in function can substantially increase the potential for activity and participation. Additional lesions outside the brain stem seem to be common in long-lasting LIS and might be prognostic for remaining in the LIS state.
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Affiliation(s)
- Helle Walseth Nilsen
- From the Sunnaas Rehabilitation Hospital (H.W.N., A.C.T.M., F.B.), Nesoddtangen; Institute of Clinical Medicine (H.W.N., F.B.), University of Oslo; Department of Radiology (A.C.T.M.), Oslo Metropolitan University; Institute of Health and Society (I.J.), University of Oslo; Department of Nursing and Health Promotion (M.K.), Oslo Metropolitan University, Norway; Department of Clinical Neuroscience (K.S.S.), University of Gothenburg; and Neurocare (K.S.S.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anne Catrine T Martinsen
- From the Sunnaas Rehabilitation Hospital (H.W.N., A.C.T.M., F.B.), Nesoddtangen; Institute of Clinical Medicine (H.W.N., F.B.), University of Oslo; Department of Radiology (A.C.T.M.), Oslo Metropolitan University; Institute of Health and Society (I.J.), University of Oslo; Department of Nursing and Health Promotion (M.K.), Oslo Metropolitan University, Norway; Department of Clinical Neuroscience (K.S.S.), University of Gothenburg; and Neurocare (K.S.S.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inger Johansen
- From the Sunnaas Rehabilitation Hospital (H.W.N., A.C.T.M., F.B.), Nesoddtangen; Institute of Clinical Medicine (H.W.N., F.B.), University of Oslo; Department of Radiology (A.C.T.M.), Oslo Metropolitan University; Institute of Health and Society (I.J.), University of Oslo; Department of Nursing and Health Promotion (M.K.), Oslo Metropolitan University, Norway; Department of Clinical Neuroscience (K.S.S.), University of Gothenburg; and Neurocare (K.S.S.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marit Kirkevold
- From the Sunnaas Rehabilitation Hospital (H.W.N., A.C.T.M., F.B.), Nesoddtangen; Institute of Clinical Medicine (H.W.N., F.B.), University of Oslo; Department of Radiology (A.C.T.M.), Oslo Metropolitan University; Institute of Health and Society (I.J.), University of Oslo; Department of Nursing and Health Promotion (M.K.), Oslo Metropolitan University, Norway; Department of Clinical Neuroscience (K.S.S.), University of Gothenburg; and Neurocare (K.S.S.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina Stibrant Sunnerhagen
- From the Sunnaas Rehabilitation Hospital (H.W.N., A.C.T.M., F.B.), Nesoddtangen; Institute of Clinical Medicine (H.W.N., F.B.), University of Oslo; Department of Radiology (A.C.T.M.), Oslo Metropolitan University; Institute of Health and Society (I.J.), University of Oslo; Department of Nursing and Health Promotion (M.K.), Oslo Metropolitan University, Norway; Department of Clinical Neuroscience (K.S.S.), University of Gothenburg; and Neurocare (K.S.S.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Frank Becker
- From the Sunnaas Rehabilitation Hospital (H.W.N., A.C.T.M., F.B.), Nesoddtangen; Institute of Clinical Medicine (H.W.N., F.B.), University of Oslo; Department of Radiology (A.C.T.M.), Oslo Metropolitan University; Institute of Health and Society (I.J.), University of Oslo; Department of Nursing and Health Promotion (M.K.), Oslo Metropolitan University, Norway; Department of Clinical Neuroscience (K.S.S.), University of Gothenburg; and Neurocare (K.S.S.), Sahlgrenska University Hospital, Gothenburg, Sweden.
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Yahya MW, Sani AF, Kurniawan D. Locked-in syndrome caused by extracranial and intracranial takayasu arteritis: A rare case report and radiological findings. Radiol Case Rep 2023; 18:2987-2991. [PMID: 37441449 PMCID: PMC10333113 DOI: 10.1016/j.radcr.2023.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 07/15/2023] Open
Abstract
Locked-in syndrome (LiS) is a condition of motor paralysis involving all the voluntary muscles of 4 extremities with retained consciousness and alertness. Meanwhile, Takayasu arteritis (TA) is a systemic inflammatory disease affecting large arteries, including the aorta and the branches. This disease often affects the extracranial arteries but rarely occurs in the intracranial arteries. An 18-year-old male presented with a sudden onset of decreased consciousness and bilateral weakness. The patient exhibited normal horizontal and vertical eye movements but presented with impairment of the trigeminal nerve, peripheral-type facial palsy, absence of gag reflex and tongue movement, and neck weakness. Physiological reflexes were increased bilaterally, while pathological reflexes were present on both sides. Autonomic function was impaired, and communication was impossible due to paralysis. Additionally, the patient displayed varying blood pressure readings between the right and left arms. The antinuclear antibody (ANA) and antismooth muscle (ASMA) antibody tests yielded negative results, while the electroencephalogram (EEG) showed normal readings. The cerebral angiogram indicated multiple internal and external stenoses, with total stenosis evident in the basilar artery. The patient was diagnosed with multiple extracranial and intracranial stenoses due to TA. Total stenosis of the basilar artery resulted in brainstem infarction, which led to the development of LiS. Meanwhile, the disturbance of the motor tracts in the ventral brainstem was the underlying cause of the LiS. This case report demonstrated a variety of atypical presentations of TA. The involvement of multiple extracranial and intracranial arterial was attributed to LiS.
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Schnetzer L, McCoy M, Bergmann J, Kunz A, Leis S, Trinka E. Locked-in syndrome revisited. Ther Adv Neurol Disord 2023; 16:17562864231160873. [PMID: 37006459 PMCID: PMC10064471 DOI: 10.1177/17562864231160873] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/14/2023] [Indexed: 03/31/2023] Open
Abstract
The locked-in syndrome (LiS) is characterized by quadriplegia with preserved vertical eye and eyelid movements and retained cognitive abilities. Subcategorization, aetiologies and the anatomical foundation of LiS are discussed. The damage of different structures in the pons, mesencephalon and thalamus are attributed to symptoms of classical, complete and incomplete LiS and the locked-in plus syndrome, which is characterized by additional impairments of consciousness, making the clinical distinction to other chronic disorders of consciousness at times difficult. Other differential diagnoses are cognitive motor dissociation (CMD) and akinetic mutism. Treatment options are reviewed and an early, interdisciplinary and aggressive approach, including the provision of psychological support and coping strategies is favoured. The establishment of communication is a main goal of rehabilitation. Finally, the quality of life of LiS patients and ethical implications are considered. While patients with LiS report a high quality of life and well-being, medical professionals and caregivers have largely pessimistic perceptions. The negative view on life with LiS must be overthought and the autonomy and dignity of LiS patients prioritized. Knowledge has to be disseminated, diagnostics accelerated and technical support system development promoted. More well-designed research but also more awareness of the needs of LiS patients and their perception as individual persons is needed to enable a life with LiS that is worth living.
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Affiliation(s)
| | - Mark McCoy
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Jürgen Bergmann
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Alexander Kunz
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institute of Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Stefan Leis
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
- MRI Research Unit, Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institute of Neurorehabilitation and Space Neurology, Salzburg, Austria
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6
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What the study of spinal cord injured patients can tell us about the significance of the body in cognition. Psychon Bull Rev 2022; 29:2052-2069. [PMID: 35697914 DOI: 10.3758/s13423-022-02129-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 11/08/2022]
Abstract
Although in the last three decades philosophers, psychologists and neuroscientists have produced numerous studies on human cognition, the debate concerning its nature is still heated and current views on the subject are somewhat antithetical. On the one hand, there are those who adhere to a view implying 'disembodiment' which suggests that cognition is based entirely on symbolic processes. On the other hand, a family of theories referred to as the Embodied Cognition Theories (ECT) postulate that creating and maintaining cognition is linked with varying degrees of inherence to somatosensory and motor representations. Spinal cord injury induces a massive body-brain disconnection with the loss of sensory and motor bodily functions below the lesion level but without directly affecting the brain. Thus, SCI may represent an optimal model for testing the role of the body in cognition. In this review, we describe post-lesional cognitive modifications in relation to body, space and action representations and various instances of ECT. We discuss the interaction between body-grounded and symbolic processes in adulthood with relevant modifications after body-brain disconnection.
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Fitzpatrick-DeSalme E, Long A, Patel F, Whyte J. Behavioral Assessment of Patients With Disorders of Consciousness. J Clin Neurophysiol 2022; 39:4-11. [PMID: 34474426 DOI: 10.1097/wnp.0000000000000666] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY Brain injury resulting in coma may evolve into a prolonged disorder of consciousness, including the vegetative and minimally conscious states. Early detection of emerging consciousness has positive prognostic significance, and improvement in consciousness at any point may indicate the potential for meaningful communication and environmental control. Despite the importance of accurate assessment of consciousness, research indicates that as many as 40% of patients with a disorder of consciousness may be assessed incorrectly. Assessment of consciousness is challenging for many reasons, including the fact that consciousness cannot be measured directly but must be inferred from patterns of behavioral activity, that many patients have confounding deficits and treatments that may mask consciousness, and that patient performance may be highly variable over time. In this manuscript, we discuss strategies for optimizing patient status during assessment and review a number of structured assessment approaches that can be used. The available assessment techniques vary in their length and cost, and the expertise required to use them. Which of these approaches is most applicable to a given acute or subacute setting will vary with the volume of patients with a disorder of consciousness and the available resources. Importantly, lack of consciousness in the acute setting should not be used to justify the withdrawal of care or denial of rehabilitation services.
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Affiliation(s)
| | - Angela Long
- MossRehab, Albert Einstein Healthcare Network, Elkins Park, Pennsylvania, U.S.A.; and
| | - Ferzeen Patel
- MossRehab, Albert Einstein Healthcare Network, Elkins Park, Pennsylvania, U.S.A.; and
| | - John Whyte
- MossRehab, Albert Einstein Healthcare Network, Elkins Park, Pennsylvania, U.S.A.; and
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, U.S.A
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8
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Kujawa K, Zurek G, Kwiatkowska A, Olejniczak R, Żurek A. Assessment of Language Functions in Patients With Disorders of Consciousness Using an Alternative Communication Tool. Front Neurol 2021; 12:684362. [PMID: 34354661 PMCID: PMC8329337 DOI: 10.3389/fneur.2021.684362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
This study aimed to describe the percentage of tasks involving language functions that were completed by patients diagnosed with disorders of consciousness, as observed during neurorehabilitation conducted for different periods of time using an alternative communication tool. The project involved six participants, who were observed for 1 month, 6 months, and 1 year. The patients were asked to solve tasks involving language functions with the use of an eye-controlled device. The language functions were evaluated on the basis of the average number of tasks performed by the patients, which was 70.45% for the whole subject group. It is not entirely clear what determined the changes in language functions during the research. It is crucial that patients performed the presented tasks even though their state of consciousness, as confirmed through medical documentation (unresponsive wakefulness syndrome), did not suggest the possibility of establishing any contact with them.
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Affiliation(s)
- Katarzyna Kujawa
- Department of Biostructure University School of Physical Education in Wroclaw, Wroclaw, Poland
- Neurorehabilitation Clinic, Wroclaw, Poland
| | - Grzegorz Zurek
- Department of Biostructure University School of Physical Education in Wroclaw, Wroclaw, Poland
| | | | | | - Alina Żurek
- Institute of Psychology, University of Wroclaw, Wroclaw, Poland
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Malhi SK, Welch-West P, Koo AM, Fogarty J, Lazosky A. Thinking without speaking: Neuropsychological testing with individuals who have communication impairments. Neuropsychol Rehabil 2021; 32:1605-1619. [PMID: 33977850 DOI: 10.1080/09602011.2021.1921813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Cognitive ability may be masked by communication impairments. This study aimed to assess cognitive functioning using binary choice (i.e., yes/no) neuropsychological tests in patients with communication impairments. Four participants underwent neuropsychological testing. Two participants were in the minimally conscious state (MCS), one participant had locked-in syndrome and was an alternative communication user, and one participant was an augmentative communication user. There was better performance in all cognitive domains for the augmentative and alternative communication (AAC) users (who performed like the non-communication impaired normative data) compared to the MCS participants. However, using established yes/no communication methods, MCS participants performed above chance on a measure of memory and performance on measures of auditory comprehension was variable. Auditory comprehension appeared to be more influenced by working memory demands for the MCS participants than for the AAC users. For emotional functioning, the AAC users endorsed lower mood compared to the MCS participants. The results support the need to assess cognition, communication, as well as capacity in individuals with communication impairments with the consultation of a neuropsychologist and a speech-language pathologist.
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Affiliation(s)
- Simritpal Kaur Malhi
- London Health Sciences Centre, London, ON, Canada.,St. Joseph's Health Care London, London, ON, Canada
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10
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Rouleau N, Murugan NJ, Kaplan DL. Toward Studying Cognition in a Dish. Trends Cogn Sci 2021; 25:294-304. [PMID: 33546973 PMCID: PMC7946736 DOI: 10.1016/j.tics.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/31/2022]
Abstract
Bioengineered neural tissues help advance our understanding of neurodevelopment, regeneration, and neural disease; however, it remains unclear whether they can replicate higher-order functions including cognition. Building upon technical achievements in the fields of biomaterials, tissue engineering, and cell biology, investigators have generated an assortment of artificial brain structures and cocultured circuits. Though they have displayed basic electrochemical signaling, their capacities to generate minimal patterns of information processing suggestive of high-order cognitive analogues have not yet been explored. Here, we review the current state of neural tissue engineering and consider the possibility of a study of cognition in vitro. We adopt a practical definition of minimal cognition, anticipate problems of measurement, and discuss solutions toward a study of cognition in a dish.
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Affiliation(s)
- Nicolas Rouleau
- Department of Psychology, Algoma University, 1520 Queen Street East, Sault Ste. Marie, Ontario, Canada, P6A 2G4; Department of Biomedical Engineering, Tufts University, Science and Technology Center, 4 Colby Street, Medford, MA 02155, USA
| | - Nirosha J Murugan
- Department of Biology, Algoma University, 1520 Queen Street East, Sault Ste. Marie, Ontario, Canada, P6A 2G4
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Science and Technology Center, 4 Colby Street, Medford, MA 02155, USA.
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11
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Khalili-Ardali M, Wu S, Tonin A, Birbaumer N, Chaudhary U. Neurophysiological aspects of the completely locked-in syndrome in patients with advanced amyotrophic lateral sclerosis. Clin Neurophysiol 2021; 132:1064-1076. [PMID: 33743301 DOI: 10.1016/j.clinph.2021.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) patients in completely locked-in syndrome (CLIS) are incapable of expressing themselves, and their state of consciousness and awareness is difficult to evaluate. Due to the complete paralysis included paralysis of eye muscles, any assessment of the perceptual and psychophysiological state can only be implemented in passive experimental paradigms with neurophysiological recordings. METHODS Four patients in CLIS were investigated in several experiments including resting state, visual stimulation (eyes open vs eyes closed), auditory stimulation (modified local-global paradigm), somatosensory stimulation (electrical stimulation of the median nerve), and during sleep. RESULTS All patients showed altered neurophysiological metrics, but a unique and common pattern could not be found between patients. However, slowing of the electroencephalography (EEG) and attenuation or absence of alpha wave activity was common in all patients. In two of the four patients, a slow dominant frequency emerged at 4 Hz with synchronized EEG at all channels. In the other two patients slowing of EEG appears less synchronized. EEGs between eyes open and eyes closed were significantly different in all patients. The dominant slow frequency during the day changes during slow-wave sleep (supposedly sleep stage 3) to even slower frequencies below 2 Hz. Somatosensory evoked potentials (SEPs) were absent or significantly altered in comparison to healthy subjects, similarly for auditory evoked potentials (AEPs). CONCLUSIONS The heterogeneity of the results underscores the fact that no single neurophysiological index is available to assess psychophysiological states in unresponsive ALS patients in CLIS. This caveat may also be valid for the assessment of cognitive processes; a functioning BCI can be the solution. SIGNIFICANCE Most of the studies of the neurophysiology of ALS patients focused on the early stage of the disease, and there are very few studies on the late stage when patients are completely paralyzed with no means of communication (i.e., CLIS). This study provides quantitative metrics of different neurophysiological aspects of these patients.
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Affiliation(s)
- Majid Khalili-Ardali
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany
| | - Shizhe Wu
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany
| | - Alessandro Tonin
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany; Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
| | - Niels Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany.
| | - Ujwal Chaudhary
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany
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12
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Farr E, Altonji K, Harvey RL. Locked-In Syndrome: Practical Rehabilitation Management. PM R 2021; 13:1418-1428. [PMID: 33465298 DOI: 10.1002/pmrj.12555] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 11/07/2022]
Abstract
Locked-in syndrome is a rare and devastating condition that results in tetraplegia, lower cranial nerve paralysis, and anarthria with preserved cognition, vertical gaze, and upper eyelid movements. Although acute management is much like that of any severe stroke, rehabilitation and recovery of these patients have not been previously described. Challenges relevant to this population include blood pressure management and orthostasis, timing and appropriateness of reinstating oral feeding, ventilatory support, decannulation after tracheostomy, bowel and bladder management, vestibular dysfunction, and eye care. Targeted rehabilitation of head, neck, and trunk stability to improve function, and proper fit in an appropriate wheelchair are essential to assist with mobility. Rehabilitation interventions should include a focus on distal motor control and upright tolerance training followed by balance and mobility exercises. In addition, special considerations must be given to developing early methods of communication through use of augmentative systems to call for help and express needs. These systems along with additional technology provide the basis to promote connectivity to family and friends through the use of social media and the internet. Establishment of communication, mobility, and connectivity is essential in promoting independence, autonomy, and improving quality of life. Overall, with specialized rehabilitative care and access to the proper equipment, long-term outcomes and quality of life in these patients can be favorable.
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Affiliation(s)
- Ellen Farr
- Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kathryn Altonji
- Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard L Harvey
- Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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13
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Carrière M, Larroque SK, Martial C, Bahri MA, Aubinet C, Perrin F, Laureys S, Heine L. An Echo of Consciousness: Brain Function During Preferred Music. Brain Connect 2020; 10:385-395. [DOI: 10.1089/brain.2020.0744] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Manon Carrière
- Coma Science Group, GIGA-Consciousness, University of Liège, University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Stephen Karl Larroque
- Coma Science Group, GIGA-Consciousness, University of Liège, University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Mohamed Ali Bahri
- GIGA-Cyclotron Research Center In Vivo Imaging, University of Liège, Liège, Belgium
| | - Charlène Aubinet
- Coma Science Group, GIGA-Consciousness, University of Liège, University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Fabien Perrin
- Lyon Neuroscience Research Center, Auditory Cognition and Psychoacoustics Team, Inserm U1028—CNRS UMR522, University of Lyon1, Lyon, France
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Lizette Heine
- Lyon Neuroscience Research Center, Auditory Cognition and Psychoacoustics Team, Inserm U1028—CNRS UMR522, University of Lyon1, Lyon, France
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14
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Nagels-Coune L, Benitez-Andonegui A, Reuter N, Lührs M, Goebel R, De Weerd P, Riecke L, Sorger B. Brain-Based Binary Communication Using Spatiotemporal Features of fNIRS Responses. Front Hum Neurosci 2020; 14:113. [PMID: 32351371 PMCID: PMC7174771 DOI: 10.3389/fnhum.2020.00113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/12/2020] [Indexed: 12/14/2022] Open
Abstract
“Locked-in” patients lose their ability to communicate naturally due to motor system dysfunction. Brain-computer interfacing offers a solution for their inability to communicate by enabling motor-independent communication. Straightforward and convenient in-session communication is essential in clinical environments. The present study introduces a functional near-infrared spectroscopy (fNIRS)-based binary communication paradigm that requires limited preparation time and merely nine optodes. Eighteen healthy participants performed two mental imagery tasks, mental drawing and spatial navigation, to answer yes/no questions during one of two auditorily cued time windows. Each of the six questions was answered five times, resulting in five trials per answer. This communication paradigm thus combines both spatial (two different mental imagery tasks, here mental drawing for “yes” and spatial navigation for “no”) and temporal (distinct time windows for encoding a “yes” and “no” answer) fNIRS signal features for information encoding. Participants’ answers were decoded in simulated real-time using general linear model analysis. Joint analysis of all five encoding trials resulted in an average accuracy of 66.67 and 58.33% using the oxygenated (HbO) and deoxygenated (HbR) hemoglobin signal respectively. For half of the participants, an accuracy of 83.33% or higher was reached using either the HbO signal or the HbR signal. For four participants, effective communication with 100% accuracy was achieved using either the HbO or HbR signal. An explorative analysis investigated the differentiability of the two mental tasks based solely on spatial fNIRS signal features. Using multivariate pattern analysis (MVPA) group single-trial accuracies of 58.33% (using 20 training trials per task) and 60.56% (using 40 training trials per task) could be obtained. Combining the five trials per run using a majority voting approach heightened these MVPA accuracies to 62.04 and 75%. Additionally, an fNIRS suitability questionnaire capturing participants’ physical features was administered to explore its predictive value for evaluating general data quality. Obtained questionnaire scores correlated significantly (r = -0.499) with the signal-to-noise of the raw light intensities. While more work is needed to further increase decoding accuracy, this study shows the potential of answer encoding using spatiotemporal fNIRS signal features or spatial fNIRS signal features only.
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Affiliation(s)
- Laurien Nagels-Coune
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center, Maastricht, Netherlands.,University Psychiatric Centre Sint-Kamillus, Bierbeek, Belgium
| | - Amaia Benitez-Andonegui
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center, Maastricht, Netherlands
| | - Niels Reuter
- Institute of Systems Neuroscience, Heinrich-Heine University, Düsseldorf, Germany.,Institute of Neuroscience and Medicine (INM-7), Research Centre Jülich, Jülich, Germany
| | | | - Rainer Goebel
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center, Maastricht, Netherlands.,Brain Innovation B.V., Maastricht, Netherlands
| | - Peter De Weerd
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center, Maastricht, Netherlands.,Maastricht Centre for Systems Biology (MaCSBio), Maastricht University, Maastricht, Netherlands
| | - Lars Riecke
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center, Maastricht, Netherlands
| | - Bettina Sorger
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center, Maastricht, Netherlands
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15
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Satow T, Komuro T, Yamaguchi T, Tanabe N, Mima T. Transcranial direct current stimulation for a patient with locked-in syndrome. Brain Stimul 2020; 13:375-377. [DOI: 10.1016/j.brs.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022] Open
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16
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Annen J, Laureys S, Gosseries O. Brain-computer interfaces for consciousness assessment and communication in severely brain-injured patients. BRAIN-COMPUTER INTERFACES 2020; 168:137-152. [DOI: 10.1016/b978-0-444-63934-9.00011-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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17
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Sonkar SK, Kumar S, Singh NK, Tandon R. Hyperhomocysteinemia induced locked-in syndrome in a young adult due to folic acid deficiency. Nutr Neurosci 2019; 24:781-783. [DOI: 10.1080/1028415x.2019.1681064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Satish Kumar
- Department of Medicine, King George’s Medical University, Lucknow, India
| | - Neeraj Kumar Singh
- Department of Medicine, King George’s Medical University, Lucknow, India
| | - Ruchika Tandon
- Department of Medicine, King George’s Medical University, Lucknow, India
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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18
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Zasler ND, Aloisi M, Contrada M, Formisano R. Disorders of consciousness terminology: history, evolution and future directions. Brain Inj 2019; 33:1684-1689. [DOI: 10.1080/02699052.2019.1656821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Nathan D. Zasler
- Concussion Care Centre of Virginia, LTD; Tree of Life Services, Inc., Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
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19
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Khalili Ardali M, Rana A, Purmohammad M, Birbaumer N, Chaudhary U. Semantic and BCI-performance in completely paralyzed patients: Possibility of language attrition in completely locked in syndrome. BRAIN AND LANGUAGE 2019; 194:93-97. [PMID: 31151035 DOI: 10.1016/j.bandl.2019.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/14/2019] [Accepted: 05/23/2019] [Indexed: 06/09/2023]
Abstract
Patients with completely locked-in syndrome (CLIS) are incapable of any voluntary muscle movement and do not have any means of communication. Recently functional near infrared spectroscopy (fNIRS) based brain computer interface (BCI) has been successfully used to enable communication with these patients. The developed fNIRS-BCI system relies on the intactness of language comprehension in these patients in all dimensions of language. Interwoven language and motor cortex in brain, and lack of muscular activity in long run, can cause language attrition due to complete immobility in CLIS patients. In this study we have investigated effects of semantic content of sentences presented to a CLIS patient on the performance of the BCI system during a YES/NO paradigm. Comparison of communication success rate in BCI classification between different semantic categories indicate that semantic content of sentences presented to a CLIS patient can affect the BCI performance. Affected concepts are mostly associated with executive words. These findings can be beneficial towards development of more reliable communication device for patients in CLIS. In addition, these results may assist in elucidating the cognitive changes in completely paralyzed patients with the passage of time since the onset of total immovability.
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Affiliation(s)
- Majid Khalili Ardali
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tubingen, Tubingen, Germany; Department of Cognitive Linguistics, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Aygul Rana
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tubingen, Tubingen, Germany
| | - Mehdi Purmohammad
- Department of Cognitive Linguistics, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Niels Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tubingen, Tubingen, Germany; Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
| | - Ujwal Chaudhary
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tubingen, Tubingen, Germany; Wyss Center for Bio and Neuroengineering, Geneva, Switzerland.
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20
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Diagnosis of May-Thurner Syndrome in a Case of Acute Pulmonary Embolism with Multiple Risk Factors: A Case Report and Review of Literature. JOURNAL OF CLINICAL REVIEW & CASE REPORTS 2019; 4. [DOI: 10.33140/jcrc.04.03.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: May-Thurner Syndrome (MTS) is aniliac vein compression syndrome which results in a thrombosis of the common left iliac vein. The main cause of this compression is the overlying right common iliac artery. Method: In this article we describe the case of a 35-year-old woman with bilateral lobar pulmonary embolism (PE) together with an investigation of the risk factors leading to PE. The final diagnosis was a MTS with asymptomatic left internal vein thrombosis, further complicated by a PE. Results: Precipitating factors were polycystic ovarian syndrome, combined oral contraceptives and a possible protein S deficiency.Treatment encompassed anticoagulation during the first year of treatment. Re-evaluation together with further retesting of protein S and imaging will determine the need for an endovascular approach to the iliac vein compression. In this article we discuss the diagnostic approach to patients with PE with an asymptomatic deep venous thrombosis. Conclusions: This article seeks to draw attention to MTS as an incompletely studied syndrome which is potentially frequent in female patients with PE and interacts with other factors to increase the risk of a thrombosis. MTS should be considered in the differential diagnosis of a patient with PE in addition to patients presenting with a proximal deep venous thrombosis.
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21
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Berlucchi G. Wandering thoughts about consciousness, the brain, and the commentary system of Larry Weiskrantz. Neuropsychologia 2019; 128:266-269. [DOI: 10.1016/j.neuropsychologia.2017.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/06/2017] [Accepted: 10/08/2017] [Indexed: 11/15/2022]
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23
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Functional diversity of brain networks supports consciousness and verbal intelligence. Sci Rep 2018; 8:13259. [PMID: 30185912 PMCID: PMC6125486 DOI: 10.1038/s41598-018-31525-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/15/2018] [Indexed: 11/08/2022] Open
Abstract
How are the myriad stimuli arriving at our senses transformed into conscious thought? To address this question, in a series of studies, we asked whether a common mechanism underlies loss of information processing in unconscious states across different conditions, which could shed light on the brain mechanisms of conscious cognition. With a novel approach, we brought together for the first time, data from the same paradigm-a highly engaging auditory-only narrative-in three independent domains: anesthesia-induced unconsciousness, unconsciousness after brain injury, and individual differences in intellectual abilities during conscious cognition. During external stimulation in the unconscious state, the functional differentiation between the auditory and fronto-parietal systems decreased significantly relatively to the conscious state. Conversely, we found that stronger functional differentiation between these systems in response to external stimulation predicted higher intellectual abilities during conscious cognition, in particular higher verbal acuity scores in independent cognitive testing battery. These convergent findings suggest that the responsivity of sensory and higher-order brain systems to external stimulation, especially through the diversification of their functional responses is an essential feature of conscious cognition and verbal intelligence.
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Vanhaudenhuyse A, Charland-Verville V, Thibaut A, Chatelle C, Tshibanda JFL, Maudoux A, Faymonville ME, Laureys S, Gosseries O. Conscious While Being Considered in an Unresponsive Wakefulness Syndrome for 20 Years. Front Neurol 2018; 9:671. [PMID: 30233480 PMCID: PMC6127614 DOI: 10.3389/fneur.2018.00671] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/26/2018] [Indexed: 11/13/2022] Open
Abstract
Despite recent advances in our understanding of consciousness disorders, accurate diagnosis of severely brain-damaged patients is still a major clinical challenge. We here present the case of a patient who was considered in an unresponsive wakefulness syndrome/vegetative state for 20 years. Repeated standardized behavioral examinations combined to neuroimaging assessments allowed us to show that this patient was in fact fully conscious and was able to functionally communicate. We thus revised the diagnosis into an incomplete locked-in syndrome, notably because the main brain lesion was located in the brainstem. Clinical examinations of severe brain injured patients suffering from serious motor impairment should systematically include repeated standardized behavioral assessments and, when possible, neuroimaging evaluations encompassing magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography.
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Affiliation(s)
- Audrey Vanhaudenhuyse
- Department of Algology and Palliative Care, University Hospital of Liege, Liege, Belgium.,GIGA-Consciousness, Sensation & Perception Research Group, University of Liege, Liege, Belgium
| | - Vanessa Charland-Verville
- GIGA-Consciousness, Coma Science Group & Neurology Department, University Hospital of Liege, Liege, Belgium
| | - Aurore Thibaut
- GIGA-Consciousness, Coma Science Group & Neurology Department, University Hospital of Liege, Liege, Belgium.,Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Camille Chatelle
- GIGA-Consciousness, Coma Science Group & Neurology Department, University Hospital of Liege, Liege, Belgium.,Laboratory for NeuroImaging of Coma and Consciousness-Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jean-Flory L Tshibanda
- GIGA-Consciousness, Coma Science Group & Neurology Department, University Hospital of Liege, Liege, Belgium.,Department of Radiology, University Hospital of Liege and University of Liege, Liege, Belgium
| | - Audrey Maudoux
- GIGA-Consciousness, Sensation & Perception Research Group, University of Liege, Liege, Belgium.,Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liege, Liege, Belgium
| | - Marie-Elisabeth Faymonville
- Department of Algology and Palliative Care, University Hospital of Liege, Liege, Belgium.,GIGA-Consciousness, Sensation & Perception Research Group, University of Liege, Liege, Belgium
| | - Steven Laureys
- GIGA-Consciousness, Coma Science Group & Neurology Department, University Hospital of Liege, Liege, Belgium
| | - Olivia Gosseries
- GIGA-Consciousness, Coma Science Group & Neurology Department, University Hospital of Liege, Liege, Belgium
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Pitt KM, Brumberg JS. Guidelines for Feature Matching Assessment of Brain-Computer Interfaces for Augmentative and Alternative Communication. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:950-964. [PMID: 29860376 PMCID: PMC6195025 DOI: 10.1044/2018_ajslp-17-0135] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/01/2017] [Accepted: 02/27/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Brain-computer interfaces (BCIs) can provide access to augmentative and alternative communication (AAC) devices using neurological activity alone without voluntary movements. As with traditional AAC access methods, BCI performance may be influenced by the cognitive-sensory-motor and motor imagery profiles of those who use these devices. Therefore, we propose a person-centered, feature matching framework consistent with clinical AAC best practices to ensure selection of the most appropriate BCI technology to meet individuals' communication needs. METHOD The proposed feature matching procedure is based on the current state of the art in BCI technology and published reports on cognitive, sensory, motor, and motor imagery factors important for successful operation of BCI devices. RESULTS Considerations for successful selection of BCI for accessing AAC are summarized based on interpretation from a multidisciplinary team with experience in AAC, BCI, neuromotor disorders, and cognitive assessment. The set of features that support each BCI option are discussed in a hypothetical case format to model possible transition of BCI research from the laboratory into clinical AAC applications. CONCLUSIONS This procedure is an initial step toward consideration of feature matching assessment for the full range of BCI devices. Future investigations are needed to fully examine how person-centered factors influence BCI performance across devices.
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Affiliation(s)
- Kevin M. Pitt
- Department of Speech-Language-Hearing: Sciences & Disorders, The University of Kansas, Lawrence
| | - Jonathan S. Brumberg
- Department of Speech-Language-Hearing: Sciences & Disorders, Neuroscience Graduate Program, The University of Kansas, Lawrence
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26
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Heilinger A, Ortner R, La Bella V, Lugo ZR, Chatelle C, Laureys S, Spataro R, Guger C. Performance Differences Using a Vibro-Tactile P300 BCI in LIS-Patients Diagnosed With Stroke and ALS. Front Neurosci 2018; 12:514. [PMID: 30108476 PMCID: PMC6080415 DOI: 10.3389/fnins.2018.00514] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/10/2018] [Indexed: 12/12/2022] Open
Abstract
Patients with locked-in syndrome (LIS) are typically unable to move or communicate and can be misdiagnosed as patients with disorders of consciousness (DOC). Behavioral assessment scales are limited in their ability to detect signs of consciousness in this population. Recent research has shown that brain-computer interface (BCI) technology could supplement behavioral scales and allows to establish communication with these severely disabled patients. In this study, we compared the vibro-tactile P300 based BCI performance in two groups of patients with LIS of different etiologies: stroke (n = 6) and amyotrophic lateral sclerosis (ALS) (n = 9). Two vibro-tactile paradigms were administered to the patients to assess conscious function and command following. The first paradigm is called vibrotactile evoked potentials (EPs) with two tactors (VT2), where two stimulators were placed on the patient’s left and right wrist, respectively. The patients were asked to count the rare stimuli presented to one wrist to elicit a P300 complex to target stimuli only. In the second paradigm, namely vibrotactile EPs with three tactors (VT3), two stimulators were placed on the wrists as done in VT2, and one additional stimulator was placed on his/her back. The task was to count the rare stimuli presented to one wrist, to elicit the event-related potentials (ERPs). The VT3 paradigm could also be used for communication. For this purpose, the patient had to count the stimuli presented to the left hand to answer “yes” and to count the stimuli presented to the right hand to answer “no.” All patients except one performed above chance level in at least one run in the VT2 paradigm. In the VT3 paradigm, all 6 stroke patients and 8/9 ALS patients showed at least one run above chance. Overall, patients achieved higher accuracies in VT2 than VT3. LIS patients due to ALS exhibited higher accuracies that LIS patients due to stroke, in both the VT2 and VT3 paradigms. These initial data suggest that controlling this type of BCI requires specific cognitive abilities that may be impaired in certain sub-groups of severely motor-impaired patients. Future studies on a larger cohort of patients are needed to better identify and understand the underlying cortical mechanisms of these differences.
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Affiliation(s)
| | - Rupert Ortner
- g.tec medical engineering Spain SL, Barcelona, Spain
| | - Vincenzo La Bella
- ALS Clinical Research Center, BioNeC, University of Palermo, Palermo, Italy
| | - Zulay R Lugo
- GIGA Consciousness, Coma Science Group, University of Liège, Liège, Belgium.,French Association of Locked-in Syndrome (ALIS), Paris, France.,Research Department, Hospital Universitari Institut Pere Mata, Reus, Spain
| | - Camille Chatelle
- GIGA Consciousness, Coma Science Group, University of Liège, Liège, Belgium
| | - Steven Laureys
- GIGA Consciousness, Coma Science Group, University of Liège, Liège, Belgium
| | - Rossella Spataro
- ALS Clinical Research Center, BioNeC, University of Palermo, Palermo, Italy.,Centro Neurolesi Bonino Pulejo (IRCCS), Palermo, Italy
| | - Christoph Guger
- g.tec medical engineering GmbH, Schiedlberg, Austria.,Guger Technologies OG, Graz, Austria
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27
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Nizzi MC, Blandin V, Demertzi A. Attitudes towards Personhood in the Locked-in Syndrome: from Third- to First- Person Perspective and to Interpersonal Significance. NEUROETHICS-NETH 2018. [DOI: 10.1007/s12152-018-9375-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lugo Z, Pellas F, Blandin V, Laureys S, Gosseries O. Assessment of needs, psychological impact and quality of life in families of patients with locked-in syndrome. Brain Inj 2017; 31:1590-1596. [PMID: 28837360 DOI: 10.1080/02699052.2017.1347277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Family needs of patients with acquired brain injuries have been studied for about three decades. In this study, we assessed the needs, the quality of life and the psychological state of relatives of patients with locked-in syndrome (LIS). DESIGN A survey was carried out using the family needs' questionnaire (FNQ). SUBJECTS AND METHODS Thirty relatives of patients with LIS fully completed the FNQ. RESULTS The most important need reported by families corresponded to the need for medical information. The highest percentage of satisfaction (66%) was also observed for this need. Among the needs for information, specifically, the most important for LIS' relatives was to know that the patient's needs and wishes were respected by the professional staff, which were fulfilled in 93% of the sample. The need for emotional support was the least important and had the lowest percentage of satisfaction (55%). The number of met/unmet needs correlated with the quality of life of the families. Most of the relatives reported anxiety feelings and depressive thoughts. CONCLUSIONS Receiving accurate medical information is the most important need for family of patients with LIS and their quality of life is correlated with the fulfilment of their needs.
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Affiliation(s)
- Zulay Lugo
- a GIGA-consciousness, GIGA-consciousness, Coma Science Group , University and University Hospital of Liège , Liège , Belgium.,b French Association for Locked-In Syndrome (ALIS) , Paris , France
| | - Fréderic Pellas
- b French Association for Locked-In Syndrome (ALIS) , Paris , France.,c Coma Arousal Unit, PMR Department , Nîmes University Hospital , Nîmes , France
| | | | - Steven Laureys
- a GIGA-consciousness, GIGA-consciousness, Coma Science Group , University and University Hospital of Liège , Liège , Belgium
| | - Olivia Gosseries
- a GIGA-consciousness, GIGA-consciousness, Coma Science Group , University and University Hospital of Liège , Liège , Belgium.,b French Association for Locked-In Syndrome (ALIS) , Paris , France
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30
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Lugo ZR, Quitadamo LR, Bianchi L, Pellas F, Veser S, Lesenfants D, Real RGL, Herbert C, Guger C, Kotchoubey B, Mattia D, Kübler A, Laureys S, Noirhomme Q. Cognitive Processing in Non-Communicative Patients: What Can Event-Related Potentials Tell Us? Front Hum Neurosci 2016; 10:569. [PMID: 27895567 PMCID: PMC5107572 DOI: 10.3389/fnhum.2016.00569] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/26/2016] [Indexed: 12/03/2022] Open
Abstract
Event-related potentials (ERP) have been proposed to improve the differential diagnosis of non-responsive patients. We investigated the potential of the P300 as a reliable marker of conscious processing in patients with locked-in syndrome (LIS). Eleven chronic LIS patients and 10 healthy subjects (HS) listened to a complex-tone auditory oddball paradigm, first in a passive condition (listen to the sounds) and then in an active condition (counting the deviant tones). Seven out of nine HS displayed a P300 waveform in the passive condition and all in the active condition. HS showed statistically significant changes in peak and area amplitude between conditions. Three out of seven LIS patients showed the P3 waveform in the passive condition and five of seven in the active condition. No changes in peak amplitude and only a significant difference at one electrode in area amplitude were observed in this group between conditions. We conclude that, in spite of keeping full consciousness and intact or nearly intact cortical functions, compared to HS, LIS patients present less reliable results when testing with ERP, specifically in the passive condition. We thus strongly recommend applying ERP paradigms in an active condition when evaluating consciousness in non-responsive patients.
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Affiliation(s)
- Zulay R Lugo
- Coma Science Group, University and University Hospital of Liège, GIGALiège, Belgium; Institute of Psychology, University of WürzburgWürzburg, Germany; French Association of Locked-in Syndrome (ALIS)Paris, France
| | - Lucia R Quitadamo
- Neuroelectrical Imaging and BCI Laboratory, Fondazione Santa Lucia, IRCCSRome, Italy; School of Life and Health Sciences, Aston Brain Centre, Aston UniversityBirmingham, UK
| | - Luigi Bianchi
- Department of Civil Engineering and Computer Science, University of Rome Tor Vergata Rome, Italy
| | - Fréderic Pellas
- French Association of Locked-in Syndrome (ALIS)Paris, France; Coma Arousal Unit - PMR Department, Nîmes University HospitalNîmes, France
| | - Sandra Veser
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen Tübingen, Germany
| | - Damien Lesenfants
- Coma Science Group, University and University Hospital of Liège, GIGA Liège, Belgium
| | - Ruben G L Real
- Institute of Psychology, University of Würzburg Würzburg, Germany
| | - Cornelia Herbert
- Institute of Psychology, University of WürzburgWürzburg, Germany; Department of Psychiatry, University of TübingenTübingen, Germany; Department of Biomedical Resonance, University of TübingenTübingen, Germany
| | - Christoph Guger
- G.Tec Medical Engineering GmbH/Guger Technologies OG Graz, Austria
| | - Boris Kotchoubey
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen Tübingen, Germany
| | - Donatella Mattia
- Neuroelectrical Imaging and BCI Laboratory, Fondazione Santa Lucia, IRCCS Rome, Italy
| | - Andrea Kübler
- Institute of Psychology, University of Würzburg Würzburg, Germany
| | - Steven Laureys
- Coma Science Group, University and University Hospital of Liège, GIGA Liège, Belgium
| | - Quentin Noirhomme
- Coma Science Group, University and University Hospital of Liège, GIGALiège, Belgium; Department of Cognitive Neuroscience, Maastricht UniversityMaastricht, Netherlands; Brain Innovation B.V.Maastricht, Netherlands
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Can self-relevant stimuli help assessing patients with disorders of consciousness? Conscious Cogn 2016; 44:51-60. [DOI: 10.1016/j.concog.2016.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 06/08/2016] [Accepted: 06/18/2016] [Indexed: 11/21/2022]
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Affiliation(s)
- Walter Glannon
- Department of Philosophy, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2 N 1N4, Canada
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Rousseau MC, Baumstarck K, Billette de Villemeur T, Auquier P. Evaluation of quality of life in individuals with severe chronic motor disability: A major challenge. Intractable Rare Dis Res 2016; 5:83-9. [PMID: 27195190 PMCID: PMC4869587 DOI: 10.5582/irdr.2016.01017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Diverse conditions causing a very heavy and chronic motor disability, such as an advanced amyotrophic lateral, advanced form of multiple sclerosis, high spinal cord injury or a locked-in syndrom, are now getting better medical care and benefit of life support technology with consequent prolonged survival. Quality of life (QoL) assessment is being considered increasingly important to globally apprehend their general well-being. However, the motor disability that affects them appears as a substantial limitation for the assessment of their QoL and consequently a major challenge for all the community that carries an interest for them. This review discussed several avenues to provide to patients and caregivers, clinicians and researchers, and health decision making authority: i) elements to determine the most appropriate QoL measure with regard to the interest of patient's point of view, the QoL instruments suitable for this category of patients and their acceptability, ii) some arguments of the clinical relevance and accuracy of QoL assessment: interpretations of the questionnaires, QoL determinants, particularity of QoL evaluation for individuals with cognitive impairment and the caregivers perceptions of patients QoL. In conclusion, evaluation of QoL in patients with severe chronic motor handicap is a challenge of major interest, with major ethical issues. It needs to use adapted QoL scales and longitudinal following because of adaptive phenomena to the degree of handicap.
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Affiliation(s)
- Marie-Christine Rousseau
- Hôpital San Salvadour (Assistance Publique Hôpitaux de Paris), Paris, France
- Address correspondence to: Dr. Marie-Christine Rousseau, Hôpital San Salvadour (Assistance Publique Hôpitaux de Paris), BP 30 080, 83 407 Hyères cedex, France. E-mail:
| | - Karine Baumstarck
- EA3279 Santé Publique: Maladies Chroniques et Qualité de Vie, Faculté de Médecine Timone Marseille, Paris, France
| | | | - Pascal Auquier
- EA3279 Santé Publique: Maladies Chroniques et Qualité de Vie, Faculté de Médecine Timone Marseille, Paris, France
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Traumatic atlanto-occipital dissociation presenting as locked-in syndrome. J Clin Neurosci 2015; 22:1985-7. [DOI: 10.1016/j.jocn.2015.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/20/2015] [Indexed: 11/20/2022]
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Rousseau MC, Baumstarck K, Alessandrini M, Blandin V, Billette de Villemeur T, Auquier P. Quality of life in patients with locked-in syndrome: Evolution over a 6-year period. Orphanet J Rare Dis 2015; 10:88. [PMID: 26187655 PMCID: PMC4506615 DOI: 10.1186/s13023-015-0304-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/09/2015] [Indexed: 12/13/2022] Open
Abstract
Background Improved knowledge of the quality of life (QoL) of locked-in syndrome (LIS) patients have implications for managing their care, and assists clinicians in choosing the most appropriate interventions. We performed a survey of a population of LIS patients to describe the course of the QoL of LIS patients over a 6-year period and to determine the potential predictive factors of QoL changes over time. Method This is a study performed over a 6-year period in patients with a LIS diagnosis. Questionnaires were sent in 2007 and 2013. The following data were recorded: i) sociodemographic data; ii) clinical data related to LIS, physical/handicap status, psychological status; iii) self-reported QoL: Anamnestic Comparative Self-Assessment (ACSA); iv) Integration in life: French Reintegration to Normal Living Index (RNLI). Results Among the 67 patients included in 2007, 39 (58 %) patients returned their questionnaire in 2013. The LIS etiology was stroke in 51 individuals. The QoL of the patients was relatively satisfactory compared to populations in other severe conditions. Twenty-one (70 %) individuals reported a stable/improved QoL between 2007 and 2013. The physical/handicap statuses in 2007 and 2013 were not related to the QoL 6 years later, with the exception of one communication parameter: the individuals who used yes-no code reported significantly lower QoL levels than those who did not in 2013. Discussion In opposition to a widespread opinion, LIS persons report a relatively satisfactory QoL level that stays stable over time, suggesting that life with LIS is worth living. Preservation of autonomy and communication may help them to live as normal life as possible.
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Affiliation(s)
- Marie-Christine Rousseau
- Fédération des Hôpitaux de Polyhandicap et Multihandicap Hôpital San Salvadour, Assistance Publique Hôpitaux de Paris, BP 30 080, 83 407, Hyères, Cedex, France. .,EA 3279 Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France.
| | - Karine Baumstarck
- EA 3279 Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France. .,Methodologic and Clinical Research Plateform, Assistance Publique Hôpitaux de Marseille, Marseille, France.
| | - Marine Alessandrini
- EA 3279 Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France.
| | | | - Thierry Billette de Villemeur
- Fédération des Hôpitaux de polyhandicap et Multihandicap Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France.
| | - Pascal Auquier
- EA 3279 Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France. .,Methodologic and Clinical Research Plateform, Assistance Publique Hôpitaux de Marseille, Marseille, France.
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Lugo ZR, Bruno MA, Gosseries O, Demertzi A, Heine L, Thonnard M, Blandin V, Pellas F, Laureys S. Beyond the gaze: Communicating in chronic locked-in syndrome. Brain Inj 2015; 29:1056-61. [DOI: 10.3109/02699052.2015.1004750] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kübler A, Holz EM, Sellers EW, Vaughan TM. Toward independent home use of brain-computer interfaces: a decision algorithm for selection of potential end-users. Arch Phys Med Rehabil 2015; 96:S27-32. [PMID: 25721544 DOI: 10.1016/j.apmr.2014.03.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 02/01/2014] [Accepted: 03/14/2014] [Indexed: 11/17/2022]
Abstract
Noninvasive brain-computer interfaces (BCIs) use scalp-recorded electrical activity from the brain to control an application. Over the past 20 years, research demonstrating that BCIs can provide communication and control to individuals with severe motor impairment has increased almost exponentially. Although considerable effort has been dedicated to offline analysis for improving signal detection and translation, far less effort has been made to conduct online studies with target populations. Thus, there remains a great need for both long-term and translational BCI studies that include individuals with disabilities in their own homes. Completing these studies is the only sure means to answer questions about BCI utility and reliability. Here we suggest an algorithm for candidate selection for electroencephalographic (EEG)-based BCI home studies. This algorithm takes into account BCI end-users and their environment and should assist in study design and substantially improve subject retention rates, thereby improving the overall efficacy of BCI home studies. It is the result of a workshop at the Fifth International BCI Meeting that allowed us to leverage the expertise of multiple research laboratories and people from multiple backgrounds in BCI research.
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Affiliation(s)
- Andrea Kübler
- Institute of Psychology, University of Würzburg, Würzburg, Germany.
| | - Elisa Mira Holz
- Institute of Psychology, University of Würzburg, Würzburg, Germany
| | - Eric W Sellers
- Brain-Computer Interface Laboratory, Department of Psychology, East Tennessee State University, Johnson City, TN
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Abstract
Acute loss of consciousness poses a fascinating scenario for theoretical and clinical research. This chapter introduces a simple yet powerful framework to investigate altered states of consciousness. We then explore the different disorders of consciousness that result from acute brain injury, and techniques used in the acute phase to predict clinical outcome in different patient populations in light of models of acute loss of consciousness. We further delve into post-traumatic amnesia as a model for predicting cognitive sequels following acute loss of consciousness. We approach the study of acute loss of consciousness from a theoretical and clinical perspective to conclude that clinicians in acute care centers must incorporate new measurements and techniques besides the classic coma scales in order to assess their patients with loss of consciousness.
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Owen AM. Using functional magnetic resonance imaging and electroencephalography to detect consciousness after severe brain injury. HANDBOOK OF CLINICAL NEUROLOGY 2015; 127:277-93. [PMID: 25702223 DOI: 10.1016/b978-0-444-52892-6.00018-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In recent years, rapid technological developments in the field of neuroimaging have provided new methods for revealing thoughts, actions, and intentions based solely on the pattern of activity that is observed in the brain. In specialized centres, these methods are now being employed routinely in the assessment of patients diagnosed with so-called "disorders of consciousness," mapping patterns of residual function and dysfunction and helping to reduce diagnostic errors between related conditions such as the vegetative and minimally conscious states. Both functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) have now been shown to be effective tools for detecting covert awareness in behaviorally nonresponsive patients when standard clinical approaches have been unable to provide that information. Indeed, in some patients, communication with the outside world via simple "yes" and "no" questions has been achieved, even in cases where no possibility for behavioral interaction exists. These studies have profound implications for clinical care, diagnosis, prognosis and medical-legal decision making relating to the prolongation, or otherwise, of life after severe brain injury. Moreover, the results suggest an urgent need for a re-evaluation of the existing diagnostic guidelines for behaviorally nonresponsive patients to include information derived from functional neuroimaging.
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Affiliation(s)
- Adrian M Owen
- Brain and Mind Institute, Department of Psychology, University of Western Ontario, London, Ontario, Canada.
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Wästlund E, Sponseller K, Pettersson O, Bared A. Evaluating gaze-driven power wheelchair with navigation support for persons with disabilities. ACTA ACUST UNITED AC 2015; 52:815-26. [DOI: 10.1682/jrrd.2014.10.0228] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 06/12/2015] [Indexed: 11/05/2022]
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Cognitive and Affective Disturbances Following Focal Brainstem Lesions: A Review and Report of Three Cases. THE CEREBELLUM 2014; 14:317-40. [DOI: 10.1007/s12311-014-0626-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gayraud F, Martinie B, Bentot E, Lepilliez A, Tell L, Cotton F, Rode G. Written production in a case of locked-in syndrome with bilateral corticopontic degeneration. Neuropsychol Rehabil 2014; 25:780-97. [PMID: 25347464 DOI: 10.1080/09602011.2014.975253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Patients in locked-in syndrome show normal or near normal mental abilities that contrast with the limited motor capacity that hinders voluntary communication. However, eye movements and blinking are usually preserved and can be used to establish a communication system. We report an exceptional case of locked-in syndrome. The aetiology was basilar thrombosis consecutive to a cervical manipulation. In addition, brain MRI performed 23 years later showed a ventral pontine stroke with bilateral corticopontic degeneration. In this study the patient was able to produce written output using a chin-controlled Morse system decoded by a computer. A detailed linguistic analysis of text written over 20 years by the patient was carried out. The data demonstrate that improvements in language performance can be observed even in patients with brain lesions in areas associated with high-level cognitive processes. The data show a decrease of typing, grammatical and lexical errors over time, use of less frequent words, and an increase of more complex linguistic structures. This paper adds to previous findings confirming the value of daily practice and rehabilitation to enhance quality of life in this group of patients.
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Affiliation(s)
- F Gayraud
- a Université de Lyon, Université Lumière , Lyon , France
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Bicego A, Lejoly K, Maudoux A, Lefebvre P, Laureys S, Schweizer V, Diserens K, Faymonville ME, Vanhaudenhuyse A. [Swallowing in disorders of consciousness]. Rev Neurol (Paris) 2014; 170:630-41. [PMID: 24952924 DOI: 10.1016/j.neurol.2014.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 03/31/2014] [Accepted: 04/11/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Interest in studying swallowing disorders in patients with altered consciousness has increased over the past decade. Swallowing deficit is frequently encountered in severe brain-injured patients. STATE OF ART Results of studies have highlighted different factors such as the delay between the injury and the treatment and the level of consciousness of these patients, as well as the presence or not of tracheotomy, which will determine the feasibility of resuming oral feeding. Nowadays, very few valid and sensitive scales can be used to assess swallowing deficit in patients with disorders of consciousness. The Facial Oral Tract Therapy (FOTT) scale is an inter-professional multidisciplinary approach offering a structured way to evaluate and treat patients with swallowing disorders. In contrast with other scales, patients do not have to follow verbal instructions for the FOTT. PERSPECTIVES This paper presents a review of existing literature on the assessment and management of swallowing disorders in patients with altered state of consciousness, and a description of the FOTT method. CONCLUSION The FOTT seems to be an interesting assessment and rehabilitation tool for patients with disorders of consciousness. However, clinical studies are needed to confirm the validity and sensitivity of this technique.
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Affiliation(s)
- A Bicego
- Coma Science Group, centre de recherches du cyclotron, université de Liège, allée du 6-Août, Sart Tilman B30, 4000 Liège, Belgique
| | - K Lejoly
- Coma Science Group, centre de recherches du cyclotron, université de Liège, allée du 6-Août, Sart Tilman B30, 4000 Liège, Belgique
| | - A Maudoux
- Coma Science Group, centre de recherches du cyclotron, université de Liège, allée du 6-Août, Sart Tilman B30, 4000 Liège, Belgique; Service d'oto-rhino-laryngologie, hôpital universitaire de Liège, université de Liège, 13, avenue de l'Hôpital, 4000 Liège, Belgique
| | - P Lefebvre
- Service d'oto-rhino-laryngologie, hôpital universitaire de Liège, université de Liège, 13, avenue de l'Hôpital, 4000 Liège, Belgique
| | - S Laureys
- Coma Science Group, centre de recherches du cyclotron, université de Liège, allée du 6-Août, Sart Tilman B30, 4000 Liège, Belgique; Service de neurologie, hôpital universitaire de Liège, université de Liège, 13, avenue de l'Hôpital, 4000 Liège, Belgique
| | - V Schweizer
- Unité de phoniatrie, service d'oto-rhino-laryngologie, hôpital universitaire de Lausanne, 31, avenue Beaumont, 1011 Lausanne, Suisse
| | - K Diserens
- Unité de neurorééducation aiguë, département des neurosciences cliniques, hôpital universitaire de Lausanne, 46, rue du Bugnon, 1011 Lausanne, Suisse
| | - M-E Faymonville
- Service d'algologie-soins palliatifs, hôpital universitaire de Liège, université de Liège, CHU Sart Tilman, B35, 4000 Liège, Belgique
| | - A Vanhaudenhuyse
- Service d'algologie-soins palliatifs, hôpital universitaire de Liège, université de Liège, CHU Sart Tilman, B35, 4000 Liège, Belgique.
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Demertzi A, Jox RJ, Racine E, Laureys S. A European survey on attitudes towards pain and end-of-life issues in locked-in syndrome. Brain Inj 2014; 28:1209-15. [PMID: 24911332 DOI: 10.3109/02699052.2014.920526] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Patients with locked-in syndrome often self-report a higher quality of life than generally expected. This study reports third-person attitudes towards several salient issues on locked-in syndrome. METHODS Close-ended survey among conference attendees from 33 European countries. Analysis included chi-square tests and logistic regressions. RESULTS From the 3332 respondents (33% physicians, 18% other clinicians, 49% other professions; 47% religious), 90% agreed that patients with locked-in syndrome can feel pain. The majority (75%) disagreed with treatment withdrawal, but 56% did not wish to be kept alive if they imagined themselves in this condition (p < 0.001). Religious and southern Europeans opposed to treatment withdrawal more often than non-religious (p < 0.001) and participants from the North (p = 0.001). When the locked-in syndrome was compared to disorders of consciousness, more respondents endorsed that being in a chronic locked-in syndrome was worse than being in a vegetative state or minimally conscious state for patients (59%) than they thought for families (40%, p < 0.001). CONCLUSIONS Personal characteristics mediate opinions about locked-in syndrome. The dissociation between personal preferences and general opinions underlie the difference in perspective in disability. Ethical responses to dilemmas involving patients with locked-in syndrome should consider the diverging ethical attitudes of stakeholders.
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Affiliation(s)
- Athena Demertzi
- Coma Science Group, Cyclotron Research Centre & Neurology Department , University and University Hospital of Liège, Liège , Belgium
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Assessing consciousness in coma and related states using transcranial magnetic stimulation combined with electroencephalography. ACTA ACUST UNITED AC 2014; 33:65-71. [PMID: 24393302 DOI: 10.1016/j.annfar.2013.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lugo ZR, Rodriguez J, Lechner A, Ortner R, Gantner IS, Laureys S, Noirhomme Q, Guger C. A vibrotactile p300-based brain-computer interface for consciousness detection and communication. Clin EEG Neurosci 2014; 45:14-21. [PMID: 24415400 DOI: 10.1177/1550059413505533] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brain-computer interface (BCI) has been used for many years for communication in severely disabled patients. BCI based on electrophysiological signals has enabled communication, using auditory or visual stimuli to elicit event-related potentials (ERPs). The aim of this study was to determine whether patients with locked-in syndrome (LIS) could elicit a P300 wave, using a vibrotactile oddball paradigm for establishing somatosensory BCI-based communication. Six chronic LIS patients performed 2 electroencephalography (EEG)-based vibrotactile P300 oddball tasks. After a simple mental counting task of the target stimuli, participants were instructed to answer 5 questions by counting the vibration on either the right wrist for "yes" or the left wrist for "no." All participants were able to elicit a P300 wave using the vibrotactile oddball paradigm BCI task. In the counting task, 4 patients got accuracies of 100% (average above chance). In the communication task, one patient achieved 100% accuracy (average above chance). We have shown the feasibility of eliciting a P300 response using vibrotactile stimulation in patients with LIS. The present study provides evidence that this approach can be used for EEG-based BCI communications in this patient group. This is the first study to prove the feasibility of a BCI based on somatosensory (vibratory) stimulation in a group of brain-injured patients. Furthermore, this approach could be used for the detection of consciousness in non-communicating patients due to severe brain injuries.
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Abstract
Recent developments in functional neuroimaging have provided a number of new tools for assessing patients who clinically appear to be in a vegetative state. These techniques have been able to reveal awareness and even allow rudimentary communication in some patients who remain entirely behaviourally non-responsive. The implications of these results extend well beyond the immediate clinical and scientific findings to influencing legal proceedings, raising new ethical questions about the withdrawal of nutrition and hydration and providing new options for patients and families in that decision-making process. The findings have also motivated significant public discourse about the role of neuroscience research in society.
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Combaz A, Chatelle C, Robben A, Vanhoof G, Goeleven A, Thijs V, Van Hulle MM, Laureys S. A comparison of two spelling Brain-Computer Interfaces based on visual P3 and SSVEP in Locked-In Syndrome. PLoS One 2013; 8:e73691. [PMID: 24086289 PMCID: PMC3783473 DOI: 10.1371/journal.pone.0073691] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 07/30/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We study the applicability of a visual P3-based and a Steady State Visually Evoked Potentials (SSVEP)-based Brain-Computer Interfaces (BCIs) for mental text spelling on a cohort of patients with incomplete Locked-In Syndrome (LIS). METHODS Seven patients performed repeated sessions with each BCI. We assessed BCI performance, mental workload and overall satisfaction for both systems. We also investigated the effect of the quality of life and level of motor impairment on the performance. RESULTS All seven patients were able to achieve an accuracy of 70% or more with the SSVEP-based BCI, compared to 3 patients with the P3-based BCI, showing a better performance with the SSVEP BCI than with the P3 BCI in the studied cohort. Moreover, the better performance of the SSVEP-based BCI was accompanied by a lower mental workload and a higher overall satisfaction. No relationship was found between BCI performance and level of motor impairment or quality of life. CONCLUSION Our results show a better usability of the SSVEP-based BCI than the P3-based one for the sessions performed by the tested population of locked-in patients with respect to all the criteria considered. The study shows the advantage of developing alternative BCIs with respect to the traditional matrix-based P3 speller using different designs and signal modalities such as SSVEPs to build a faster, more accurate, less mentally demanding and more satisfying BCI by testing both types of BCIs on a convenience sample of LIS patients.
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Affiliation(s)
- Adrien Combaz
- Computational Neuroscience Group, Laboratory for Neuro- and Psychophysiology, KU Leuven, Leuven, Belgium
| | - Camille Chatelle
- Coma Science Group, Cyclotron Research Centerp, University of Liège, Liège, Belgium
| | - Arne Robben
- Computational Neuroscience Group, Laboratory for Neuro- and Psychophysiology, KU Leuven, Leuven, Belgium
| | - Gertie Vanhoof
- Department of Speech Language Pathology, ENT Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ann Goeleven
- Department of Speech Language Pathology, ENT Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Thijs
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Vesalius Research Center, VIB, Leuven, Belgium
| | - Marc M. Van Hulle
- Computational Neuroscience Group, Laboratory for Neuro- and Psychophysiology, KU Leuven, Leuven, Belgium
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Centerp, University of Liège, Liège, Belgium
- Department of Neurology, Liège University Hospital, Liège, Belgium
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