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Murtaugh B, Morrissey AM, Fager S, Knight HE, Rushing J, Weaver J. Music, occupational, physical, and speech therapy interventions for patients in disorders of consciousness: An umbrella review. NeuroRehabilitation 2024; 54:109-127. [PMID: 38277314 DOI: 10.3233/nre-230149] [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: 01/28/2024]
Abstract
BACKGROUND Current clinical guidelines recommend that a multidisciplinary team inclusive of allied healthcare practitioners deliver assessment and intervention for disorders of consciousness. Allied health professionals include music, occupational, physical, and speech therapists. These allied health clinicians are challenged to select interventions due to a lack of evidence-based recommendations regarding rehabilitation interventions that support recovery of consciousness. This umbrella review synthesizes available systematic reviews (SRs) that describe occupational, speech and language, physical and/or musical therapeutic interventions for people with disorders of consciousness. OBJECTIVES Identify and summarize evidence from systematic reviews (SRs) that examine allied healthcare interventions for patients with disorders of consciousness. Additionally, this umbrella review aims to evaluate the impact of allied health interventions on recovery of consciousness, methodological quality and risk of bias for the included systematic reviews. METHODS An umbrella review was completed. The review was reported according to the Preferred Reporting Items for Overview of Reviews (PRIOR) guidance. Five academic databases (PubMed, CINAHL, PsycInfo, Web of Science, and the Cochrane Library) were searched for SRs and/or meta-analyses of allied health (i.e., music, occupational, physical, and speech therapy) interventions for disorders of consciousness. For included studies, data were extracted and quality of the SRs appraised using the A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 checklist. Data extracted from each SR identified the authors and years of primary studies, interventions, comparators, and outcomes related to recovery of consciousness (i.e., neurobehavioral/cognitive), functional status, physiological response pain, and adverse events. Rehabilitation interventions were categorized and described. RESULTS Fifteen SRs were included and three of these reviews conducted meta-analyses. Identified rehabilitation interventions included: 1) sensory stimulation, 2) median nerve stimulation, 3) communication/environmental control through assistive technology, 4) mobilization, and 5) music-based therapy. SRs were published between 2002 and 2022 and included 2286 participants. Using the AMSTAR 2, the quality of reviews was critically low (k = 6), low (k = 3), moderate (k = 4), and high (k = 2). SRs within this umbrella review demonstrated significant heterogeneity in research methods and use of outcome measures to evaluate the recovery of consciousness within the primary studies. These factors influenced the ability to conduct meta-analyses. CONCLUSIONS Sensory stimulation, median nerve stimulation, music therapy and mobilization are all interventions that demonstrate some level of benefit, but current SRs fail to prove benefit through high-level quality evidence. There is an indisputable need for continued rehabilitation research to expand options for treatment modalities and to ensure that the interventions being applied to DoC rehabilitation are evidence-based to improve consciousness and recovery.
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Affiliation(s)
- Brooke Murtaugh
- Department of Rehabilitation Programs, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Ann-Marie Morrissey
- School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Susan Fager
- Communication Center, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Heather E Knight
- Department of Physical Therapy, School of Pharmacy & Health Professions, Creighton University, Omaha, NE, USA
| | - Jess Rushing
- Colorado State University, Fort Collins, CO, USA
| | - Jennifer Weaver
- Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA
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Stasolla F, Vinci LA, Cusano M. The Integration of Assistive Technology and Virtual Reality for Assessment and Recovery of Post-coma Patients With Disorders of Consciousness: A New Hypothesis. Front Psychol 2022; 13:905811. [PMID: 35899005 PMCID: PMC9309568 DOI: 10.3389/fpsyg.2022.905811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
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Sattin D, Leonardi M, Nelli B, Bramanti P, Marino S, Ferro S, Basaglia N, Guido D. Effect of Rehabilitation Treatments on Disability in Persons With Disorders of Consciousness: A Propensity Score Study. Arch Phys Med Rehabil 2019; 101:95-105. [PMID: 31465762 DOI: 10.1016/j.apmr.2019.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/17/2019] [Accepted: 07/02/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effects of rehabilitation (physical and cognitive) treatments on the diagnosis severity and Disability Rating Scale (DRS) scores, adjusted for a number of potential confounders measured at baseline, in a large cohort of patients with disorders of consciousness across time. DESIGN AND SETTING An observational, longitudinal (2 evaluations), multicenter project was made in 90 Italian centers. PARTICIPANTS Patients (N=364) with a diagnosis of disorders of consciousness. MAIN OUTCOME MEASURES Primary outcome was the severity of diagnosis, expressed on an ordinal scale (Other<MCS<VS<death). In the Other group were included patients who emerged from an MCS and recovered consciousness. The secondary outcome was the DRS score (range of 0-30 with 30 being the worst value). The DRS is a tool used to define the level of residual disability, commonly used to classify the level of functional impairment in patients with acquired brain injury. Both outcomes were measured for each wave. RESULTS A total of 364 subjects having a complete set of demographic, clinical, and pharmacologic data were included in the propensity score (PS) analysis. Results showed that the rehabilitation treatments (physical and cognitive) reduced the clinical worsening over time in both severity diagnosis and DRS (around 6.5 points) in patients with disorders of consciousness across different propensity score strategies (ie, PS matching, PS adjustment, and PS-weighted procedures). In addition, cognitive protocols seem to be limited to patients with a median value of DRS=23. CONCLUSIONS Our propensity score analysis suggests that rehabilitation treatment protocols seem effective and should be applied to a broader spectrum of patients with disorders of consciousness.
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Affiliation(s)
- Davide Sattin
- Neurology, Public Health, Disability Unit Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Barbara Nelli
- Neurology, Public Health, Disability Unit Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Silvia Marino
- IRCCS Bonino Pulejo Neurolesi Center, Messina, Italy
| | - Salvatore Ferro
- Emilia Romagna Region, General Directorate for Personal Care, Health and Welfare, Bologna, Italy
| | - Nino Basaglia
- Emilia Romagna Region, General Directorate for Personal Care, Health and Welfare, Bologna, Italy
| | - Davide Guido
- Neurology, Public Health, Disability Unit Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Sattin D, Bruzzone MG, Ferraro S, Nigri A, Leonardi M, Guido D. Olfactory discrimination in disorders of consciousness: A new sniff protocol. Brain Behav 2019; 9:e01273. [PMID: 31251479 PMCID: PMC6710199 DOI: 10.1002/brb3.1273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/20/2019] [Accepted: 02/26/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The identification of salient stimuli useful for rehabilitation purposes is important in patients with disorders of consciousness (DOC): among these, olfactory stimuli might play an important role due to the functional coupling between olfactory and emotional processing. However, a high percentage of post brain injury patients present anosmia. AIMS OF THE STUDY The aim of this pilot research is to present an innovative approach to test olfactory functions at the bedside using four selected odors in patients with DOC. METHODS Sixteen patients with DOC were tested with two assessment techniques the new olfactory discrimination protocol (ODP) and a functional magnetic resonance imaging paradigm to evaluate olfactory neural process. The Frequentist and Bayesian methods were used to analyze reliability properties of the new tool. RESULTS Analysis showed a good agreement between assessment techniques and a substantial test-retest reliability of the ODP. Cohen's Ks were equal to 0.814 (95% CI = 0.471, 1) and 0.607 (0.118; 1) respectively, using the Frequentist approach, while they were 0.762 (95% HPD = 0.470; 0.966) and 0.650 (0.320; 0.913) with the Bayesian approach in the 11 patients analyzed. CONCLUSIONS Despite the limits of this preliminary research, the ODP can be useful for clinicians for the preliminary assessment of the olfactory discrimination in patients with DOC.
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Affiliation(s)
- Davide Sattin
- Neurology, Public Health and Disability Unit, Coma Research CenterFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Maria Grazia Bruzzone
- Neuroradiology DepartmentFondazione IRCCS Istituto Neurologico “Carlo Besta”MilanItaly
| | - Stefania Ferraro
- Neuroradiology DepartmentFondazione IRCCS Istituto Neurologico “Carlo Besta”MilanItaly
| | - Anna Nigri
- Neuroradiology DepartmentFondazione IRCCS Istituto Neurologico “Carlo Besta”MilanItaly
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Coma Research CenterFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Davide Guido
- Neurology, Public Health and Disability Unit, Coma Research CenterFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
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Brunner M, Hemsley B, Togher L, Palmer S. Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI). Brain Inj 2017; 31:1028-1043. [DOI: 10.1080/02699052.2017.1292429] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Melissa Brunner
- Speech Pathology, Faculty of Education and Arts, University of Newcastle, Newcastle, Australia
| | - Bronwyn Hemsley
- Speech Pathology, Faculty of Education and Arts, University of Newcastle, Newcastle, Australia
| | - Leanne Togher
- Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, Australia
| | - Stuart Palmer
- Faculty of Science, Engineering & Built Environment, Deakin University, Geelong, Australia
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Liberati G, Hünefeldt T, Olivetti Belardinelli M. Questioning the dichotomy between vegetative state and minimally conscious state: a review of the statistical evidence. Front Hum Neurosci 2014; 8:865. [PMID: 25404905 PMCID: PMC4217390 DOI: 10.3389/fnhum.2014.00865] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/07/2014] [Indexed: 01/24/2023] Open
Abstract
Given the enormous consequences that the diagnosis of vegetative state (VS) vs. minimally conscious state (MCS) may have for the treatment of patients with disorders of consciousness, it is particularly important to empirically legitimate the distinction between these two discrete levels of consciousness. Therefore, the aim of this contribution is to review all the articles reporting statistical evidence concerning the performance of patients in VS vs. patients in MCS, on behavioral or neurophysiological measures. Twenty-three articles matched these inclusion criteria, and comprised behavioral, electroencephalographic (EEG), positron emission tomography (PET) and magnetic resonance imaging (MRI) measures. The analysis of these articles yielded 47 different statistical findings. More than half of these findings (n = 24) did not reveal any statistically significant difference between VS and MCS. Overall, there was no combination of variables that allowed reliably discriminating between VS and MCS. This pattern of results casts doubt on the empirical validity of the distinction between VS and MCS.
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Affiliation(s)
- Giulia Liberati
- Institute of Neuroscience, Université Catholique de Louvain Brussels, Belgium
| | - Thomas Hünefeldt
- ECONA - Interuniversity Centre for Research on Cognitive Processing in Natural and Artificial Systems, "Sapienza" University of Rome Rome, Italy ; Department of Philosophy, Catholic University of Eichstätt-Ingolstadt Eichstätt, Germany
| | - Marta Olivetti Belardinelli
- ECONA - Interuniversity Centre for Research on Cognitive Processing in Natural and Artificial Systems, "Sapienza" University of Rome Rome, Italy ; Department of Psychology, Sapienza, University of Rome Rome, Italy
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Lancioni GE, Bosco A, Olivetti Belardinelli M, Singh NN, O'Reilly MF, Sigafoos J, Buonocunto F, Navarro J, Lanzilotti C, D'Amico F, De Tommaso M. Assessing learning as a possible sign of consciousness in post-coma persons with minimal responsiveness. Front Hum Neurosci 2014; 8:25. [PMID: 24574989 PMCID: PMC3918875 DOI: 10.3389/fnhum.2014.00025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 01/11/2014] [Indexed: 11/13/2022] Open
Abstract
A learning test procedure based on operant principles may be useful in the diagnosis (and eventually rehabilitation) of post-coma persons with minimal responsiveness. This study was aimed at extending the evaluation of such a procedure with seven participants who presented with very limited behavior and apparently severe disorders of consciousness. The procedure was evaluated through an ABACB design, in which A represented baseline phases without stimulation, B intervention phases with brief stimulation periods contingent on specific responses of the participants, and C a control phase in which stimulation was available all the time. Increased responding during the B phases, as opposed to the A and C phases, was taken to indicate learning and possibly a non-reflective expression of phenomenal consciousness. All participants were also evaluated with the coma recovery scale-revised (CRS-R) prior to the start of the learning test procedure and at the end of it. The results of the learning test showed that all participants had significantly higher responding levels during the B phases. The CRS-R scores suggested minimally conscious state for four of them prior to the learning test and for five of them after the completion of the learning test. The implications of the findings are discussed in terms of potential and time cost of the learning test.
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Affiliation(s)
- Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari Bari, Italy
| | - Andrea Bosco
- Department of Educational Science, Psychology, Communication, University of Bari Bari, Italy
| | | | - Nirbhay N Singh
- Medical College of Georgia, Georgia Regents University Augusta, GA, USA
| | | | - Jeff Sigafoos
- Victoria University of Wellington Wellington, New Zealand
| | | | - Jorge Navarro
- S. Raffaele Rehabilitation and Care Centers Ceglie and Alberobello, Italy
| | | | - Fiora D'Amico
- S. Raffaele Rehabilitation and Care Centers Ceglie and Alberobello, Italy
| | - Marina De Tommaso
- Department of Neuroscience and Sense Organs, University of Bari Bari, Italy
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Assistive Technology for People with Severe/Profound Intellectual and Multiple Disabilities. AUTISM AND CHILD PSYCHOPATHOLOGY SERIES 2014. [DOI: 10.1007/978-1-4899-8029-8_10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Bagnato S, Boccagni C, Sant'angelo A, Fingelkurts AA, Fingelkurts AA, Galardi G. Emerging from an unresponsive wakefulness syndrome: Brain plasticity has to cross a threshold level. Neurosci Biobehav Rev 2013; 37:2721-36. [PMID: 24060531 DOI: 10.1016/j.neubiorev.2013.09.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/29/2013] [Accepted: 09/12/2013] [Indexed: 12/27/2022]
Affiliation(s)
- Sergio Bagnato
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injury, Rehabilitation Department, Fondazione Istituto San Raffaele G. Giglio, Cefalù, PA, Italy.
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Amenduni MT, Navarro J, Buonocunto F, Scarabino T, Belardinelli MO. Microswitch technology and contingent stimulation to promote adaptive engagement in persons with minimally conscious state: a case evaluation. Cogn Process 2011; 13:133-7. [PMID: 22131129 DOI: 10.1007/s10339-011-0428-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 11/15/2011] [Indexed: 11/28/2022]
Abstract
This study assessed whether a post-coma woman functioning at the lower end of the minimally conscious state would (a) develop adaptive responding through the use of microswitch technology and contingent stimulation, (b) consolidate and maintain her responding over time, and (c) show evidence of response-consequences awareness (learning and discrimination). The study involved an ABABB1CB1 sequence in which the A represented baseline phases, the B and B1 intervention phases, and the C a control phase with continuous stimulation. Results indicated that the woman developed adaptive responding and consolidated it over the intervention phases of the study. The woman also showed evidence of being aware of response-consequences links. Potential implications and limitations of these findings are discussed.
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Affiliation(s)
- Giulio E Lancioni
- Department of Psychology, University of Bari, Via Quintino Sella 268, 70100, Bari, Italy.
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Lancioni GE, Bosco A, Belardinelli MO, Singh NN, O'Reilly MF, Sigafoos J. An overview of intervention options for promoting adaptive behavior of persons with acquired brain injury and minimally conscious state. RESEARCH IN DEVELOPMENTAL DISABILITIES 2010; 31:1121-1134. [PMID: 20663643 DOI: 10.1016/j.ridd.2010.06.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 06/22/2010] [Indexed: 05/29/2023]
Abstract
This paper presents an overview of the studies directed at helping post-coma persons with minimally conscious state improve their adaptive behavior. Twenty-one studies were identified for the 2000-2010 period (i.e., a period in which an intense debate has occurred about diagnostic, rehabilitative, prognostic, and ethical issues concerning people with severe acquired brain injury). Three of the 21 studies involved transcortical magnetic or deep brain stimulation. Six studies focused on the provision of multisensory stimulation or music therapy. The remaining 12 studies involved the use of response-related (contingent) stimulation and assistive technology. The outcomes of the studies, which were generally reported as positive, were discussed in terms of (a) the size (quantitative relevance) of the changes obtained, (b) the credibility/reliability of the changes, in light of the methodological conditions of the studies, and (c) the level of engagement and interaction involvement of the participants. Relevant issues for future research were also examined.
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Vegetative state: efforts to curb misdiagnosis. Cogn Process 2009; 11:87-90. [PMID: 20043186 DOI: 10.1007/s10339-009-0355-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 12/15/2009] [Indexed: 10/20/2022]
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