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Schnakers C. Assessing consciousness and cognition in disorders of consciousness. NeuroRehabilitation 2024; 54:11-21. [PMID: 38251070 DOI: 10.3233/nre-230140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Detecting willful cognition in these patients is known to be challenging due to the patients' motor disabilities and high vigilance fluctuations but also due to the lack of expertise and use of adequate tools to assess these patients in specific settings. This review will discuss the main disorders of consciousness after severe brain injury, how to assess consciousness and cognition in these patients, as well as the challenges and tools available to overcome these challenges and reach an accurate diagnosis.
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Affiliation(s)
- Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, 255 E. Bonita Avenue, Pomona, CA 91769, USA. Tel.: +1 909 596 7733 (ext. 3038); E-mail:
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Ren S, Zhu J, Xie X, Liu X, Jiang H, Ying C, Hu J, Di H, Hu N. The visual stimulation in disorders of consciousness. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-8. [PMID: 38104423 DOI: 10.1080/23279095.2023.2292244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Severe brain damage usually leads to disorders of consciousness (DOC), which include coma, unresponsive wakefulness syndrome (UWS) and a minimally conscious state (MCS). Visual stimulation is widely used, especially in the diagnosis and treatment and treatment of DOC. Researchers have indicated that tests based on visual stimulation including visual pursuit, when used in conjunction with the Coma Recovery Scale-Revised, are able to differentiate between UWS from an MCS. Recently, targeting patients' circadian rhythms has been proposed to be a possible treatment target for DOC. Indeed, light therapy has been applied in some other fields, including treating seasonal affective disorder, sleep problems, and Parkinson's disease. However, at present, although visual stimulation and light therapy are frequently used in DOC, there is still no international unified standard. Therefore, we recommend the development of an international consensus in regard to the definitions, operational criteria and assessment procedures of visual stimulation and light therapy. This review combines visual stimulation, circadian rhythm recovery, and light therapy in DOC patients and presents the mechanisms and current advances in applications related to light therapy and visual stimulation in an attempt to provide additional ideas for future research and treatment of DOC.
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Affiliation(s)
- Siyan Ren
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Jiajie Zhu
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai, China
| | - Xiangyu Xie
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Ximeng Liu
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Hui Jiang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Chenxi Ying
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Jia Hu
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Haibo Di
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Nantu Hu
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
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Overbeek BUH, van Erp WS, Eilander HJ, Koopmans RTCM, Lavrijsen JCM. Prevalence of the Minimally Conscious State Among Institutionalized Patients in the Netherlands: A Nationwide Study. Neurology 2023; 101:e2005-e2013. [PMID: 37857492 PMCID: PMC10662977 DOI: 10.1212/wnl.0000000000207820] [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: 03/03/2023] [Accepted: 08/03/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The minimally conscious state (MCS) is a prolonged disorder of consciousness (pDoC) and one of the most severe outcomes of acquired brain injury. Prevalence data are scarce. The aim of this study was to establish the nationwide point prevalence of institutionalized patients in MCS in the Netherlands. METHODS This was a descriptive cross-sectional study in which all 86 Dutch hospitals, all 5 specialized pDoC rehabilitation facilities, and all 274 nursing homes were asked whether they were treating patients with a pDoC on the point prevalence date of September 15, 2021. Each patient's legal representative provided informed consent for their inclusion. Patient level of consciousness was verified using the Coma Recovery Scale-Revised (CRS-R) in a single assessment session performed in the facility of residence by an experienced physician. Data on patient demographics, etiology, level of consciousness, facility of residence, and clinical status were collected from a questionnaire by the treating physician. The prevalence of institutionalized patients in MCS of per 100,000 members of the Dutch population was calculated, based on actual census data. RESULTS Seventy patients were reported to have a pDoC, of whom 6 were excluded. The level of consciousness was verified for 49 patients while for 15, it could not be verified. Of the patients verified, 38 had a pDoC, of whom 32 were in MCS (mean age 44.8 years, 68.8% male). The prevalence of institutionalized patients in MCS is 0.2-0.3 per 100,000 Dutch inhabitants. Traumatic brain injury was present in 21 of 32 patients (65.6%). Specialized pDoC rehabilitation was received by 17 of 32 patients (53%), with the rest admitted to nursing homes. The most frequent signs of consciousness on the CRS-R were visual pursuit, reproducible movement to command, and automatic motor response. DISCUSSION This nationwide study revealed a low prevalence of institutionalized patients in MCS in the Netherlands. These findings are now being used to organize pDoC care in this country.
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Affiliation(s)
- Berno U H Overbeek
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands.
| | - Willemijn S van Erp
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands
| | - Henk J Eilander
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands
| | - Raymond T C M Koopmans
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands
| | - Jan C M Lavrijsen
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands
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Gill-Thwaites HL, Elliott KE, Morrissey AM. LOCCATE: A tool to identify the diagnostic spectrum profile of motor function and functional communication responses for the individual with a prolonged disorder of consciousness. Neuropsychol Rehabil 2023; 33:48-68. [PMID: 34668462 DOI: 10.1080/09602011.2021.1981949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Standardized neurobehavioural assessment tools (SNBATs) form a key aspect of diagnostic assessment for individuals with prolonged disorders of consciousness (PDOCs). Each SNBAT has different psychometric properties, operational definitions of behaviours, scoring systems and methods of administration. Selection and implementation of SNBATs varies within and between healthcare settings. Defining diagnostic and prognostic parameters requires collating multiple SNBAT results over time, which is problematic if several assessors and professions are involved. The Levels of Consciousness Calibration of Assessment Tools Evaluations (LOCCATE) is the first tool designed to calibrate the results of any recognized PDOC SNBAT. It also categorizes the diagnostic spectrum profile of both motor and communication responses into eight criteria of behaviours. Each criterion has up to three levels of reproducibility, ultimately producing a LOCCATE calibration score ranging from 1 to 27. A case study is presented to illustrate changes in LOCCATE scores over time, while an audit explores the tool's clinical utility. With current directives placing less emphasis on a PDOC diagnosis, there is now a greater need for a calibration tool such as LOCCATE to identify exactly what the individual can do and create an accurate trajectory as an evidence base to support clinical and best-interest decision-making.
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Affiliation(s)
- Helen L Gill-Thwaites
- Royal Hospital for Neuro-disability, London, UK.,Gill-Thwaites & Elliott Consultants, Hatfield, UK
| | | | - Anne-Marie Morrissey
- Discipline of Occupational Therapy, School of Allied Health, Health Research Institute, Ageing Research Centre, University of Limerick, Ireland
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Papadimitriou C, Weaver JA, Guernon A, Walsh E, Mallinson T, Pape TLB. "Fluctuation is the norm": Rehabilitation practitioner perspectives on ambiguity and uncertainty in their work with persons in disordered states of consciousness after traumatic brain injury. PLoS One 2022; 17:e0267194. [PMID: 35446897 PMCID: PMC9022828 DOI: 10.1371/journal.pone.0267194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 04/04/2022] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study is to describe the clinical lifeworld of rehabilitation practitioners who work with patients in disordered states of consciousness (DoC) after severe traumatic brain injury (TBI). We interviewed 21 practitioners using narrative interviewing methods from two specialty health systems that admit patients in DoC to inpatient rehabilitation. The overarching theme arising from the interview data is "Experiencing ambiguity and uncertainty in clinical reasoning about consciousness" when treating persons in DoC. We describe practitioners' practices of looking for consistency, making sense of ambiguous and hard to explain patient responses, and using trial and error or "tinkering" to care for patients. Due to scientific uncertainty about diagnosis and prognosis in DoC and ambiguity about interpretation of patient responses, working in the field of DoC disrupts the canonical meaning-making processes that practitioners have been trained in. Studying the lifeworld of rehabilitation practitioners through their story-making and story-telling uncovers taken-for-granted assumptions and normative structures that may exist in rehabilitation medical and scientific culture, including practitioner training. We are interested in understanding these canonical breaches in order to make visible how practitioners make meaning while treating patients.
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Affiliation(s)
- Christina Papadimitriou
- Departments of Interdisciplinary Health Sciences, and Sociology, Oakland University, Rochester, MI, United States of America
| | - Jennifer A. Weaver
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, United States of America
| | - Ann Guernon
- Speech-Language Pathology Department, Lewis University, Romeoville, IL, United States of America
| | - Elyse Walsh
- Research Service and Center for Innovation in Complex Chronic Healthcare, Edward Hines Jr. VA, Hines, IL, United States of America
| | - Trudy Mallinson
- Department of Clinical Research & Leadership, George Washington University, Washington, DC, United States of America
| | - Theresa L. Bender Pape
- Research Service and Center for Innovation in Complex Chronic Healthcare, Edward Hines Jr. VA, Hines, IL, United States of America
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States of America
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Overbeek BUH, Lavrijsen JCM, van Gaal S, Kondziella D, Eilander HJ, Koopmans RTCM. Towards consensus on visual pursuit and visual fixation in patients with disorders of consciousness. A Delphi study. J Neurol 2022; 269:3204-3215. [PMID: 35001197 DOI: 10.1007/s00415-021-10905-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this Delphi study was to reach consensus about definition, operationalization and assessment of visual pursuit (VP) and visual fixation (VF). METHODS In a three-round international Delphi study, clinical and research experts on disorders of consciousness indicated their level of agreement on 87 statements using a 5-point Likert scale. Consensus for agreement was defined by a median of 5, an interquartile range (IQR) ≤ 1, and ≥ 80% indicating moderate or strong agreement. RESULTS Forty-three experts from three continents participated, 32 completed all three rounds. For VP, the consensus statements with the highest levels of agreement were on the term 'pursuit of a visual stimulus', the description 'ability to follow visually in horizontal and/or vertical plane', a duration > 2 s, tracking in horizontal and vertical planes, and a frequency of more than 2 times per assessment. For VF, consensus statements with the highest levels of agreement were on the term 'sustained VF', the description 'sustained fixation in response to a salient stimulus', a duration of > 2 s and a frequency of 2 or more times per assessment. The assessment factors with the highest levels of agreement were personalized stimuli, the use of eye tracking technology, a patient dependent time of assessment, sufficient environmental light, upright posture, and the necessity to exclude ocular/oculomotor problems. CONCLUSION This first international Delphi study on VP and VF in patients with disorders of consciousness provides provisional operational definitions and an overview of the most relevant assessment factors.
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Affiliation(s)
- Berno U H Overbeek
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. .,Kalorama, Beek Ubbergen, The Netherlands. .,Azora, Terborg, The Netherlands.
| | - Jan C M Lavrijsen
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Simon van Gaal
- Faculty of Social and Behavioural Sciences, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henk J Eilander
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Center for Specialized Geriatric Care, Joachim en Anna, Nijmegen, The Netherlands
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Han C, Xu G, Zheng X, Tian P, Zhang K, Yan W, Jia Y, Chen X. Assessing the Effect of the Refresh Rate of a Device on Various Motion Stimulation Frequencies Based on Steady-State Motion Visual Evoked Potentials. Front Neurosci 2022; 15:757679. [PMID: 35069096 PMCID: PMC8777290 DOI: 10.3389/fnins.2021.757679] [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: 08/12/2021] [Accepted: 12/15/2021] [Indexed: 12/03/2022] Open
Abstract
The refresh rate is one of the important parameters of visual presentation devices, and assessing the effect of the refresh rate of a device on motion perception has always been an important direction in the field of visual research. This study examined the effect of the refresh rate of a device on the motion perception response at different stimulation frequencies and provided an objective visual electrophysiological assessment method for the correct selection of display parameters in a visual perception experiment. In this study, a flicker-free steady-state motion visual stimulation with continuous scanning frequency and different forms (sinusoidal or triangular) was presented on a low-latency LCD monitor at different refresh rates. Seventeen participants were asked to observe the visual stimulation without head movement or eye movement, and the effect of the refresh rate was assessed by analyzing the changes in the intensity of their visual evoked potentials. The results demonstrated that an increased refresh rate significantly improved the intensity of motion visual evoked potentials at stimulation frequency ranges of 7-28 Hz, and there was a significant interaction between the refresh rate and motion frequency. Furthermore, the increased refresh rate also had the potential to enhance the ability to perceive similar motion. Therefore, we recommended using a refresh rate of at least 120 Hz in motion visual perception experiments to ensure a better stimulation effect. If the motion frequency or velocity is high, a refresh rate of≥240 Hz is also recommended.
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Affiliation(s)
- Chengcheng Han
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Guanghua Xu
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
- State Key Laboratory for Manufacturing System Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Xiaowei Zheng
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Peiyuan Tian
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Kai Zhang
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Wenqiang Yan
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
- State Key Laboratory for Manufacturing System Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Yaguang Jia
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Xiaobi Chen
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
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Aubinet C, Cassol H, Bodart O, Sanz LRD, Wannez S, Martial C, Thibaut A, Martens G, Carrière M, Gosseries O, Laureys S, Chatelle C. Simplified evaluation of CONsciousness disorders (SECONDs) in individuals with severe brain injury: A validation study. Ann Phys Rehabil Med 2021; 64:101432. [PMID: 32992025 DOI: 10.1016/j.rehab.2020.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/27/2020] [Accepted: 09/09/2020] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Coma Recovery Scale-Revised (CRS-R) is the gold standard to assess severely brain-injured patients with prolonged disorders of consciousness (DoC). However, the amount of time needed to complete this examination may limit its use in clinical settings. OBJECTIVE We aimed to validate a new faster tool to assess consciousness in individuals with DoC. METHODS This prospective validation study introduces the Simplified Evaluation of CONsciousness Disorders (SECONDs), a tool composed of 8 items: arousal, localization to pain, visual fixation, visual pursuit, oriented behaviors, command-following, and communication (both intentional and functional). A total of 57 individuals with DoC were assessed on 2 consecutive days by 3 blinded examiners: one CRS-R and one SECONDs were performed on 1 day, whereas 2 SECONDs were performed on the other day. A Mann-Whitney U test was used to compare the duration of administration of the SECONDs versus the CRS-R, and weighted Fleiss' kappa coefficients were used to assess inter-/intra-rater reliability as well as concurrent validity. RESULTS In the 57 participants, the SECONDs was about 2.5 times faster to administer than the CRS-R. The comparison of the CRS-R versus the SECONDs on the same day or the best of the 3 SECONDs led to "substantial" or "almost perfect" agreement (kappa coefficients ranging from 0.78 to 0.85). Intra-/inter-rater reliability also showed almost perfect agreement (kappa coefficients from 0.85 to 0.91 and 0.82 to 0.85, respectively). CONCLUSIONS The SECONDs appears to be a fast, reliable and easy-to-use scale to diagnose DoC and may be a good alternative to other scales in clinical settings where time constraints preclude a more thorough assessment.
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Affiliation(s)
- Charlène Aubinet
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège, Liège, Belgium; Centre du Cerveau - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium.
| | - Helena Cassol
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège, Liège, Belgium; Centre du Cerveau - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Olivier Bodart
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège, Liège, Belgium; Centre du Cerveau - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Leandro R D Sanz
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège, Liège, Belgium; Centre du Cerveau - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Sarah Wannez
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège, Liège, Belgium; Centre du Cerveau - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège, Liège, Belgium; Centre du Cerveau - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège, Liège, Belgium; Centre du Cerveau - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Géraldine Martens
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège, Liège, Belgium; Centre du Cerveau - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Manon Carrière
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège, Liège, Belgium; Centre du Cerveau - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège, Liège, Belgium; Centre du Cerveau - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège, Liège, Belgium; Centre du Cerveau - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Camille Chatelle
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège, Liège, Belgium; Centre du Cerveau - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
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Naro A, Calabrò RS. Towards New Diagnostic Approaches in Disorders of Consciousness: A Proof of Concept Study on the Promising Use of Imagery Visuomotor Task. Brain Sci 2020; 10:brainsci10100746. [PMID: 33080823 PMCID: PMC7603054 DOI: 10.3390/brainsci10100746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/08/2020] [Accepted: 10/14/2020] [Indexed: 12/16/2022] Open
Abstract
Background: advanced paraclinical approaches using functional neuroimaging and electroencephalography (EEG) allow identifying patients who are covertly aware despite being diagnosed as unresponsive wakefulness syndrome (UWS). Bedside detection of covert awareness employing motor imagery tasks (MI), which is a universally accepted clinical indicator of awareness in the absence of overt behavior, may miss some of these patients, as they could still have a certain level of awareness. We aimed at assessing covert awareness in patients with UWS using a visuomotor-guided motor imagery task (VMI) during EEG recording. Methods: nine patients in a minimally conscious state (MCS), 11 patients in a UWS, and 15 healthy individuals (control group—CG) were provided with an VMI (imagine dancing while watching a group dance video to command), a simple-MI (imagine squeezing their right hand to command), and an advanced-MI (imagine dancing without watching a group dance video to command) to detect command-following. We analyzed the command-specific EEG responses (event-related synchronization/desynchronization—ERS/ERD) of each patient, assessing whether these responses were appropriate, consistent, and statistically similar to those elicited in the CG, as reliable markers of motor imagery. Results: All patients in MCS, all healthy individuals and one patient in UWS repeatedly and reliably generated appropriate EEG responses to distinct commands of motor imagery with a classification accuracy of 60–80%. Conclusions: VMI outperformed significantly MI tasks. Therefore, patients in UWS may be still misdiagnosed despite a rigorous clinical assessment and an appropriate MI assessment. It is thus possible to suggest that motor imagery tasks should be delivered to patients with chronic disorders of consciousness in visuomotor-aided modality (also in the rehabilitation setting) to greatly entrain patient’s participation. In this regard, the EEG approach we described has the clear advantage of being cheap, portable, widely available, and objective. It may be thus considered as, at least, a screening tool to identify the patients who deserve further, advanced paraclinical approaches.
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Abstract
INTRODUCTION New guidelines regarding the diagnosis of disorders of consciousness (DOC) (such as vegetative state and minimally conscious state) have recently been published by the American Academy of Neurology and the European Academy of Neurology. This follows an impressive number of prospective studies performed on DOC and recent multi-centric studies with larger sample size, which have gathered precious information on the recovery of cohort of patients through years and which now call for a better management of patients with DOC. AREAS COVERED This review will discuss recent updates on the clinical entities of DOC, the challenges for an accurate diagnosis and the last developments in diagnostic tools. EXPERT OPINION The authors will also discuss the impact of the new guidelines on their way of diagnosing patients and how diagnosis will most likely change in a near future.
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Affiliation(s)
- Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare , Pomona, CA, USA
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Sattin D, Rossi Sebastiano D, D’Incerti L, Guido D, Marotta G, Benti R, Tirelli S, Magnani FG, Bersano A, Duran D, Ferraro S, Minati L, Nigri A, Rosazza C, Bianchi Marzoli S, Leonardi M. Visual behaviors in disorders of consciousness: Disentangling conscious visual processing by a multimodal approach. Eur J Neurosci 2020; 52:4345-4355. [DOI: 10.1111/ejn.14875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Davide Sattin
- Neurology, Public health, Disability Unit / Coma Research Centre Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Davide Rossi Sebastiano
- Neurophysiology and Diagnostic Epileptology Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Ludovico D’Incerti
- Neuroradiology Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Davide Guido
- Neurology, Public health, Disability Unit / Coma Research Centre Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Giorgio Marotta
- Department of Nuclear Medicine Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Riccardo Benti
- Department of Nuclear Medicine Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Simone Tirelli
- Neurology, Public health, Disability Unit / Coma Research Centre Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Francesca Giulia Magnani
- Neurology, Public health, Disability Unit / Coma Research Centre Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Anna Bersano
- Neurology Unit UCV Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Dunja Duran
- Neurophysiology and Diagnostic Epileptology Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Stefania Ferraro
- Neuroradiology Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Ludovico Minati
- Direzione Scientifica Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Anna Nigri
- Neuroradiology Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Cristina Rosazza
- Neuroradiology Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
- Dipartimento di Studi Umanistici (DISTUM) Università degli Studi di Urbino Carlo Bo Urbino PU Italy
| | - Stefania Bianchi Marzoli
- Neuro‐Ophthalmology Center IRCCS Istituto Auxologico Italiano, Scientific Institute Capitanio Hospital Milan Italy
| | - Matilde Leonardi
- Neurology, Public health, Disability Unit / Coma Research Centre Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
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