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Weitzel L, Bavishi S. Disorders of Consciousness. Phys Med Rehabil Clin N Am 2024; 35:493-506. [PMID: 38945646 DOI: 10.1016/j.pmr.2024.02.003] [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: 07/02/2024]
Abstract
This article reviews the definition, assessment, neuroimaging, treatment, and rehabilitation for disorders of consciousness after an acquired brain injury. It also explores special considerations and new neuromodulation treatment options.
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Affiliation(s)
- Levi Weitzel
- Department of Physical Medicine and Rehabilitation, Ohio State University College of Medicine, 370 W 9th Avenue, Columbus, OH 43210, USA.
| | - Sheital Bavishi
- Department of Physical Medicine and Rehabilitation, Brain Injury Program, Dodd Inpatient Rehabilitation Hospital, Ohio State University Wexner Medical Center, 480 Medical Center Drive, Room 1036, Columbus, OH 43210, USA
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He Q, Yang C, Xu Y, Niu H, Wu H, Huang H, Chai X, Cao T, Wang N, Wong P, He J, Yang Y, Zhao J. Anatomical-related factors and outcome of percutaneous short-term spinal cord stimulation electrode shift in patients with disorders of consciousness: a retrospective study. Front Aging Neurosci 2024; 16:1403156. [PMID: 39015472 PMCID: PMC11249574 DOI: 10.3389/fnagi.2024.1403156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024] Open
Abstract
Background Disorders of consciousness (DoC) represent a spectrum of neurological conditions that pose significant treatment challenges. Percutaneous short-term spinal cord stimulation (SCS) has emerged as a promising experimental diagnostic treatment to assess and potentially improve consciousness levels. However, the effectiveness of this intervention is frequently compromised by the shift of electrodes, particularly in the cervical region, which can negatively affect therapeutic outcomes. Methods This retrospective study aimed to study if electrodes shift in percutaneous short-term SCS in patients with DoC would affect the outcome. We analyzed the relationship between electrode shift length and patient outcome, as well as the correlation with various anatomical parameters, including the actual length of the cervical spine, linear length, spinal canal transverse diameter, spinal canal diameter, and C2 cone height, in a cohort of patients undergoing the procedure. Results Our findings revealed that in patients with better outcome, there are significant less patient with electrode shift (p = 0.019). Further, a linear correlation was found between the length of electrode shift and patients' outcome (Rho = 0.583, p = 0.002), with longer shift lengths associated with poorer outcomes. Contrary to our expectations, there was no significant association between the measured anatomical parameters and the extent of electrode shift. However, a trend was found between the actual length of the cervical spine and the shift of the electrode (p = 0.098). Notably, the shorter spinal canal transverse diameter was found to be significantly associated with better outcome in patients with DoC receiving percutaneous short-term SCS (p = 0.033). Conclusion These results highlight the clinical importance of electrode stability in the cervical region during SCS treatment for patients with DoC. Ensuring secure placement of electrodes may play a crucial role in enhancing patients' outcome and minimize postoperative complications. Given the lack of association with expected anatomical parameters, future research should investigate other factors that could impact electrode stability to optimize this therapeutic intervention.
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Affiliation(s)
- Qiheng He
- Brain Computer Interface Transitional Research Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chaozhi Yang
- Department of Neurosurgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yangxi Xu
- Department of Neurosurgery, The People’s Hospital of Liaoning Province, Shengyang, China
| | - Hongchuan Niu
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Haitao Wu
- Department of Neurosurgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Haitao Huang
- Department of Neurosurgery, The People’s Hospital of Liaoning Province, Shengyang, China
| | - Xiaoke Chai
- Brain Computer Interface Transitional Research Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Center for Neurological Disorders, Beijing, China
| | - Tianqing Cao
- Brain Computer Interface Transitional Research Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Nan Wang
- Brain Computer Interface Transitional Research Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peiling Wong
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Yang
- Brain Computer Interface Transitional Research Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Center for Neurological Disorders, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- Beijing Institute of Brain Disorders, Beijing, China
| | - Jizong Zhao
- China National Center for Neurological Disorders, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
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Pingue V, Mirando M, Cazzulani B, Bellaviti G, Saporiti F, Zanga C, Nardone A. Neck muscle spasticity in patients with disorder of consciousness: a pilot study. Eur J Phys Rehabil Med 2024; 60:412-419. [PMID: 38502553 PMCID: PMC11255878 DOI: 10.23736/s1973-9087.24.08176-0] [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] [Received: 08/05/2023] [Revised: 01/15/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Disorder of consciousness (DOC) is a state of prolonged altered consciousness due to severe acquired brain injury (ABI). DOC can be differentiated into coma, unresponsive wakefulness syndrome (UWS), or minimally conscious state (MCS) depending on the behavioral features observed and their relationship to the level of consciousness. Spasticity is one of the most frequently reported medical comorbidities in DOC patients. Since there is a critical lack of spasticity-focused studies and, in turn, of target treatment, we designed this pilot prospective study to evaluate cervical spine muscle spasticity and its effect on rehabilitation outcome in a large cohort of patients followed from the post-acute phase to 6 months after severe ABI. AIM To evaluate neck muscle spasticity and investigate its impact on neurological and functional outcome in a large cohort of adult patients with DOC followed from post-acute to 6 months after severe ABI. DESIGN Single-center prospective pilot study. SETTING Highly specialized inpatient neurorehabilitation clinic. POPULATION Patients with severe ABI admitted within 3 months after the acute event to our Neurorehabilitation Unit between May 21st, 2019 and April 23rd, 2020 for treatment of DOC as a part of their rehabilitation program. METHODS In this single-center prospective pilot study demographic data, etiology of ABI (traumatic versus non-traumatic), DOC evaluated with the revised Coma Recovery Scale (CRS-R), and neurological and functional outcome assessed respectively with the Glasgow Coma Scale (GCS) and Functional Independence Measure (FIM) were considered. During cervical examination, we assessed spasticity with the Modified Ashworth Scale (MAS), deviation of head alignment with a goniometer, and pain with the Nociception Coma Scale-Revised (NCS-R). RESULTS Of the 48 patients, 41.7% were diagnosed with UWS and 58.3% were in a minimally conscious state (MCS). We found spasticity of neck muscles in 91.7% of patients, with no difference in severity (assessed with MAS) between UWV and MCS. The NCS-R score at cervical spine examination was lower in UWS than MCS. Spasticity was severer in patients with traumatic brain injury (TBI) compared to non-traumatic. At multiple linear regression analysis, younger age, hemisyndrome, and tetraparesis were independent predictors of severity of neck muscle spasticity in MCS. More severe spasticity was a predictor of worse neurological and functional outcome at discharge in UWS patients, independently of the other confounding variables at admission (e.g., age, severity of brain injury, functional assessment, and pain). CONCLUSIONS Spasticity of neck muscles frequently develops in patients with DOC and is more severe in those after TBI. UWV and MCS have different spasticity profiles as regards risk factors and neurological and functional outcome. Severity of neck muscle spasticity in UWV patients may represent an early indicator of worse neurological and functional outcome after inpatient rehabilitation. CLINICAL REHABILITATION IMPACT Our findings could prompt clinicians to redefine the rehabilitation aims regarding spasticity and to estimate the functional outcome in patients undergoing intensive rehabilitation after severe ABI.
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Affiliation(s)
- Valeria Pingue
- Neurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy -
| | - Marta Mirando
- Centro Studi Attività Motorie (CSAM), ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Benedetta Cazzulani
- Neurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Gianluca Bellaviti
- Neurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Filippo Saporiti
- Department of Neuroscience, Division of Specialistic Rehabilitation, ASST Ovest Milanese, Legnano, Milan, Italy
| | - Cristina Zanga
- Neurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Antonio Nardone
- Neurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Gillespie J, Trammell M, Ochoa C, Driver S, Callender L, Dubiel R, Swank C. Feasibility of overground exoskeleton gait training during inpatient rehabilitation after severe acquired brain injury. Brain Inj 2024; 38:459-466. [PMID: 38369861 DOI: 10.1080/02699052.2024.2317259] [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] [Received: 01/18/2023] [Accepted: 02/07/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To describe the safety, feasibility, and tolerability of overground exoskeleton gait training (OEGT) integrated into clinical practice for patients after severe acquired brain injury (ABI). SETTING Inpatient rehabilitation hospital. PARTICIPANTS Eligible patients with severe ABI met the following criteria: age > 18, medically stable, met exoskeleton frame limitations, and a score of ≤ 3 on the motor function portion of the Coma Recovery Scale - Revised (CRS-R). Presence of consciousness disorder was not exclusionary. DESIGN Prospective observational study. MAIN MEASURES Outcomes examined safety (adverse events), feasibility (session count and barriers to session completion), and tolerability of OEGT (session metrics and heart rate). RESULTS Ten patients with ABI completed 10.4 ± 4.8 OEGT sessions with no adverse events. Barriers to session completion included clinical focus on prioritized interventions. Sessions [median up time = 17 minutes, (IQR: 7); walk time = 13 minutes, (IQR: 9); step count = 243, (IQR: 161); device assist = 74, (IQR: 28.0)] were primarily spent in Very Light to Light heart rate intensities [89%, (IQR: 42%) and 9%, (IQR: 33%), respectively]. CONCLUSION OEGT incorporated into the rehabilitation plan of care during inpatient rehabilitation after severe ABI was observed to be safe, feasible, and tolerable. However, intentional steps must be taken to facilitate patient safety.
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Affiliation(s)
- Jaime Gillespie
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - Molly Trammell
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - Christa Ochoa
- Physical Medicine and Rehabilitation, Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Simon Driver
- Physical Medicine and Rehabilitation, Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Librada Callender
- Physical Medicine and Rehabilitation, Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Rosemary Dubiel
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - Chad Swank
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
- Physical Medicine and Rehabilitation, Baylor Scott and White Research Institute, Dallas, Texas, USA
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Woo JE, Azariah A, Reed EA, Gut N. Medical, Neurologic, and Neuromusculoskeletal Complications. Phys Med Rehabil Clin N Am 2024; 35:127-144. [PMID: 37993183 DOI: 10.1016/j.pmr.2023.06.024] [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: 11/24/2023]
Abstract
For patients with disorders of consciousness (DoC), treating the medical, neurologic, and neuromuscular complications not only stabilizes their medical disturbances, but minimizes confounding factors that may obscure the ability to accurately identify the level of consciousness and increase the chance of patients' neurologic and functional recovery. Lack of reliable communication and low-level function of patients with DoC make it challenging to diagnose some of the complications. Skilled clinical observation will be imperative to appropriately care for the patients.
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Affiliation(s)
- Jean E Woo
- TIRR Memorial Hermann, 1333 Moursund Street, Houston, TX 77030, USA; H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA.
| | - Abana Azariah
- TIRR Memorial Hermann, 1333 Moursund Street, Houston, TX 77030, USA; Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, 1333 Moursund Street, Houston, TX 77030, USA
| | - Eboni A Reed
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA
| | - Nicholas Gut
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, 1333 Moursund Street, Houston, TX 77030, USA
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Estraneo A, Briand MM, Noé E. Medical comorbidities in patients with prolonged disorder of consciousness: A narrative review. NeuroRehabilitation 2024; 54:61-73. [PMID: 38217620 DOI: 10.3233/nre-230130] [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: 01/15/2024]
Abstract
BACKGROUND A few studies specifically addressed medical comorbidities (MCs) in patients with severe acquired traumatic or non-traumatic brain injury and prolonged disorders of consciousness (pDoC; i.e., patients in vegetative state/unresponsive wakefulness syndrome, VS/UWS, or in minimally conscious state, MCS). OBJECTIVE To provide an overview on incidence of MCs in patients with pDoC. METHODS Narrative review on most impacting MCs in patients with pDoC, both those directly related to brain damage (epilepsy, neurosurgical complications, spasticity, paroxysmal sympathetic hyperactivity, PSH), and those related to severe disability and prolonged immobility (respiratory comorbidities, endocrine disorders, metabolic abnormalities, heterotopic ossifications). RESULTS Patients with pDoC are at high risk to develop at least one MC. Moderate or severe respiratory and musculoskeletal comorbidities are the most common MCs. Epilepsy and PSH seem to be more frequent in patients in VS/UWS compared to patients in MCS, likely because of higher severity in the brain damage in VS. Endocrine metabolic, PSH and respiratory complications are less frequent in traumatic etiology, whereas neurogenic heterotopic ossifications are more frequent in traumatic etiology. Spasticity did not significantly differ between VS/UWS and MCS and in the three etiologies. MCs are associated with higher mortality rates, worse clinical improvement and can impact accuracy in the clinical diagnosis. CONCLUSIONS The frequent occurrence of several MCs requires a specialized rehabilitative setting with high level of multidisciplinary medical expertise to prevent, appropriately recognize and treat them. Comprehensive rehabilitation could avoid possible progression to more serious complications that can negatively impact clinical outcomes.
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Affiliation(s)
- Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Marie-Michele Briand
- Research Center of Hôpital du Sacré-Coeur de Montréal, CIUSSS-NÎM, Montreal, QC, Canada
- Institutde Réadaptation en Déficience Physique de Québec, Quebec, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Enrique Noé
- IRENEA-Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, Valencia, Spain
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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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Thibaut A, Aloisi M, Dreessen J, Alnagger N, Lejeune N, Formisano R. Neuro-orthopaedic assessment and management in patients with prolonged disorders of consciousness: A review. NeuroRehabilitation 2024; 54:75-90. [PMID: 38251069 DOI: 10.3233/nre-230137] [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
BACKGROUND Following a severe acquired brain injury, neuro-orthopaedic disorders are commonplace. While these disorders can impact patients' functional recovery and quality of life, little is known regarding the assessment, management and treatment of neuro-orthopaedic disorders in patients with disorders of consciousness (DoC). OBJECTIVE To describe neuro-orthopaedic disorders in the context of DoC and provide insights on their management and treatment. METHODS A review of the literature was conducted focusing on neuro-orthopaedic disorders in patients with prolonged DoC. RESULTS Few studies have investigated the prevalence of spastic paresis in patients with prolonged DoC, which is extremely high, as well as its correlation with pain. Pilot studies exploring the effects of pharmacological treatments and physical therapy show encouraging results yet have limited efficacy. Other neuro-orthopaedic disorders, such as heterotopic ossification, are still poorly investigated. CONCLUSION The literature of neuro-orthopaedic disorders in patients with prolonged DoC remains scarce, mainly focusing on spastic paresis. We recommend treating neuro-orthopaedic disorders in their early phases to prevent complications such as pain and improve patients' recovery. Additionally, this approach could enhance patients' ability to behaviourally demonstrate signs of consciousness, especially in the context of covert awareness.
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Affiliation(s)
- Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Marta Aloisi
- Post-Coma Unit and Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Joëlle Dreessen
- Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
| | - Naji Alnagger
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
- Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
| | - Rita Formisano
- Post-Coma Unit and Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy
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Murtaugh B, Shapiro Rosenbaum A. Clinical application of recommendations for neurobehavioral assessment in disorders of consciousness: an interdisciplinary approach. Front Hum Neurosci 2023; 17:1129466. [PMID: 37502093 PMCID: PMC10368884 DOI: 10.3389/fnhum.2023.1129466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/05/2023] [Indexed: 07/29/2023] Open
Abstract
Accurate diagnosis, prognosis, and subsequent rehabilitation care planning for persons with Disorders of Consciousness (DoC) has historically posed a challenge for neurological care professionals. Evidence suggests rates of misdiagnosis may be as high as 40% when informal beside evaluations are used to determine level of consciousness. The presence of myriad medical, neurological, functional (motor, sensory, cognitive) and environmental confounds germane to these conditions complicates behavioral assessment. Achieving diagnostic certainty is elusive but critical to inform care planning, clinical decision making, and prognostication. Standardized neurobehavioral rating scales has been shown to improve accuracy in distinguishing between coma, unresponsive wakefulness syndrome/vegetative state and minimally consciousness state as compared to informal assessment methods. Thus, these scales are currently recommended for use as the informal "gold standard" for diagnostic assessment in DoC. The following paper will present an evidence-based approach to neurobehavioral assessment for use in clinical practice. Strategies for optimizing assessment and aiding in identification and management of confounds that can limit diagnostic accuracy will be provided. Finally, clinical application of an interdisciplinary approach to identifying and managing confounds will be discussed and how assessment results can be used to identify trends in performance and guide prognostic counseling with families.
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Affiliation(s)
- Brooke Murtaugh
- Department of Rehabilitation Programs, Madonna Rehabilitation Hospitals, Lincoln, NE, United States
| | - Amy Shapiro Rosenbaum
- Department of Brain Injury Rehabilitation, Park Terrace Care Center, Queens, NY, United States
- TBI Model System, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Brainmatters Neuropsychological Services, PLLC, Plainview, NY, United States
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Bonin EAC, Lejeune N, Szymkowicz E, Bonhomme V, Martial C, Gosseries O, Laureys S, Thibaut A. Assessment and management of pain/nociception in patients with disorders of consciousness or locked-in syndrome: A narrative review. Front Syst Neurosci 2023; 17:1112206. [PMID: 37021037 PMCID: PMC10067681 DOI: 10.3389/fnsys.2023.1112206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
The assessment and management of pain and nociception is very challenging in patients unable to communicate functionally such as patients with disorders of consciousness (DoC) or in locked-in syndrome (LIS). In a clinical setting, the detection of signs of pain and nociception by the medical staff is therefore essential for the wellbeing and management of these patients. However, there is still a lot unknown and a lack of clear guidelines regarding the assessment, management and treatment of pain and nociception in these populations. The purpose of this narrative review is to examine the current knowledge regarding this issue by covering different topics such as: the neurophysiology of pain and nociception (in healthy subjects and patients), the source and impact of nociception and pain in DoC and LIS and, finally, the assessment and treatment of pain and nociception in these populations. In this review we will also give possible research directions that could help to improve the management of this specific population of severely brain damaged patients.
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Affiliation(s)
- Estelle A. C. Bonin
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre Hospitalier Neurologique (CHN) William Lennox, Saint-Luc Hospital Group, Ottignies-Louvain-la-Neuve, Belgium
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Emilie Szymkowicz
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Vincent Bonhomme
- Department of Anesthesia and Intensive Care Medicine, Liège University Hospital, Liège, Belgium
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSS), University Laval, Québec City, QC, Canada
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
- *Correspondence: Aurore Thibaut,
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Changes of Spasticity across Time in Prolonged Disorders of Consciousness: A Retrospective Study. Brain Sci 2022; 12:brainsci12020295. [PMID: 35204057 PMCID: PMC8870216 DOI: 10.3390/brainsci12020295] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES In this retrospective study, we investigated how spasticity developed in patients diagnosed with a prolonged DOC over an almost two-year observation period (21 months), and how it related to the patients' age, gender, time since injury, etiology, level of consciousness, and anti-spastic medications. METHODS In total, 19 patients with a severe brain injury and prolonged DOC admitted to a long-term care facility were included in this study (14 male, age: 45.8 ± 15.3 years, 10 traumatic brain injury, 1.01 ± 0.99 years after brain injury, 11 minimally conscious state vs. 8 vegetative state). Each patient was assessed at admission and then quarterly, totaling eight assessments over 21 months. Spasticity was measured with the Modified Ashworth Scale (MAS) for both upper and lower limbs. The Western Neuro Sensory Stimulation Profile (WNSSP) was administered to assess the level of consciousness. Any other medical and demographic information of interest was obtained through medical records. Linear mixed models were used to assess each variable's impact on the change of spasticity over time. RESULTS Significant differences were observed in the evolution of spasticity in patients based on their etiology for the upper limbs [F (7, 107.29) = 2.226; p = 0.038], and on their level of consciousness for the lower limbs [F (7, 107.07) = 3.196; p = 0.004]. CONCLUSION Our preliminary results suggest that spasticity evolves differently according to the type of brain lesion and the level of consciousness. Spasticity in DOCs might therefore be mediated by different mechanisms and might have to be treated differently among patients. Future longitudinal studies should be performed prospectively in a bigger cohort and with data collection beginning earlier after brain injury to confirm our results and better understand the evolution of spasticity in this population.
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Therapies to Restore Consciousness in Patients with Severe Brain Injuries: A Gap Analysis and Future Directions. Neurocrit Care 2021; 35:68-85. [PMID: 34236624 PMCID: PMC8266715 DOI: 10.1007/s12028-021-01227-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023]
Abstract
Background/Objective For patients with disorders of consciousness (DoC) and their families, the search for new therapies has been a source of hope and frustration. Almost all clinical trials in patients with DoC have been limited by small sample sizes, lack of placebo groups, and use of heterogeneous outcome measures. As a result, few therapies have strong evidence to support their use; amantadine is the only therapy recommended by current clinical guidelines, specifically for patients with DoC caused by severe traumatic brain injury. To foster and advance development of consciousness-promoting therapies for patients with DoC, the Curing Coma Campaign convened a Coma Science Work Group to perform a gap analysis. Methods We consider five classes of therapies: (1) pharmacologic; (2) electromagnetic; (3) mechanical; (4) sensory; and (5) regenerative. For each class of therapy, we summarize the state of the science, identify gaps in knowledge, and suggest future directions for therapy development. Results Knowledge gaps in all five therapeutic classes can be attributed to the lack of: (1) a unifying conceptual framework for evaluating therapeutic mechanisms of action; (2) large-scale randomized controlled trials; and (3) pharmacodynamic biomarkers that measure subclinical therapeutic effects in early-phase trials. To address these gaps, we propose a precision medicine approach in which clinical trials selectively enroll patients based upon their physiological receptivity to targeted therapies, and therapeutic effects are measured by complementary behavioral, neuroimaging, and electrophysiologic endpoints. Conclusions This personalized approach can be realized through rigorous clinical trial design and international collaboration, both of which will be essential for advancing the development of new therapies and ultimately improving the lives of patients with DoC. Supplementary Information The online version contains supplementary material available at 10.1007/s12028-021-01227-y.
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Estraneo A, Masotta O, Bartolo M, Pistoia F, Perin C, Marino S, Lucca L, Pingue V, Casanova E, Romoli A, Gentile S, Formisano R, Salvi GP, Scarponi F, De Tanti A, Bongioanni P, Rossato E, Santangelo A, Diana AR, Gambarin M, Intiso D, Antenucci R, Premoselli S, Bertoni M, De Bellis F. Multi-center study on overall clinical complexity of patients with prolonged disorders of consciousness of different etiologies. Brain Inj 2020; 35:1-7. [PMID: 33331792 DOI: 10.1080/02699052.2020.1861652] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Aim: to assess overall clinical complexity of patients with acquired disorders of consciousness (DoC) in vegetative state/unresponsive wakefulness syndrome (VS/UWS) vs. minimally conscious state- MCS) and in different etiologies..Design: Multi-center cross-sectional observational study.Setting: 23 intensive neurorehabilitation units.Subjects: 264 patients with DoC in the post-acute phase: VS/UWS = 141, and MCS = 123 due to vascular (n = 125), traumatic (n = 83) or anoxic (n = 56) brain injury.Main Measures: Coma Recovery Scale-Revised, and Disability Rating Scale (DRS); presence of medical devices (e.g., for eating or breathing); occurrence and severity of medical complications.Results: patients in DoC, and particularly those in VS/UWS, showed severe overall clinical complexity. Anoxic patients had higher overall clinical complexity, lower level of responsiveness/consciousness, higher functional disability, and higher needs of medical devices. Vascular patients had worse premorbid clinical comorbidities. The two etiologies showed a comparable rate of MC, higher than that observed in traumatic etiology.Conclusion: overall clinical complexity is significantly higher in VS/UWS than in MCS, and in non-traumatic vs. traumatic etiology. These findings could explain the worse clinical evolution reported in anoxic and vascular etiologies and in VS/UWS patients and contribute to plan patient-tailored care and rehabilitation programmes.
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Affiliation(s)
- A Estraneo
- Department of Acquired Brain Injury, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Neurology Unit, Santa Maria Della Pietà General Hospital, Nola, Italy
| | - O Masotta
- Lab for DoC Study, Istituti Clinici Scientifici Maugeri IRCCS, SB S.p.A. Lab for DoC Study, Telese Terme, Italy
| | - M Bartolo
- Neurorehabilitation Unit, HABILITA Zingonia/Ciserano, Bergamo, Italy
| | - F Pistoia
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, L'Aquila, Italy
| | - C Perin
- Unità di Neuroriabilitazione Cognitiva, Istituti Clinici Zucchi, Carate Brianza, Italy
| | - S Marino
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - L Lucca
- Unità di Riabilitazione Gravi Cerebrolesioni, Istituto S. Anna, Crotone, Italy
| | - V Pingue
- Unità Medicina Riabilitativa Neuromotoria, Istituti Clinici Scientifici Maugeri IRCCS, SB S.p.A, Pavia, Italy
| | - E Casanova
- Casa dei Risvegli Luca De Nigris, IRCCS Ospedale Maggiore, Bologna, Italy
| | - A Romoli
- Department of Acquired Brain Injury, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - S Gentile
- Dip. di Riabilitazione, F.T. Camplani Clinica Ancelle Carità, Cremona, Italy
| | - R Formisano
- Unità Post-Coma e di Ricerca Traslazionale, IRCCS, Fondazione Santa Lucia, Rome, Italy
| | - G P Salvi
- U.F. Riabilitazione Neuromotoria, Istituto Clinico Quarenghi, S. Pellegrino Terme, Italy
| | - F Scarponi
- Dip. di Neurologia - UGCA, Ospedale S. Giovanni Battista, Foligno, Italy
| | - A De Tanti
- Centro Cardinal Ferrari, S. Stefano Riabilitazione, Fontanellato di Parma, Italy
| | - P Bongioanni
- Severe Acquired Brain Injuries Dept Section, Integrated Care Dept of Medical Specialties, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - E Rossato
- Centro Medicina del Sonno, Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - A Santangelo
- Unit for Severe Acquired Brain Injuries, Rehabilitation Dept, Giuseppe Giglio Foundation, Cefalù, Italy
| | - A R Diana
- Dip. Neuroscienze e Riabilitazione, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - M Gambarin
- Unità Medicina Fisica e Riabilitazione, Ospedale Riabilitativo Di Marzana, Verona, Italy
| | - D Intiso
- Unità di Medicina Fisica e Neuroriabilitazione, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - R Antenucci
- Unità di Medicina Riabilitativa Intensiva, Ospedale Castel San Giovanni, Italy
| | - S Premoselli
- Struttura di Riabilitazione Neuromotoria, Presidio Ospedaliero Vimercate, Monza, Italy
| | - M Bertoni
- Presidio di Riabilitazione Neuromotoria, Azienda Socio Sanitaria Territoriale dei Sette Laghi, Cuasso Al Monte, Italy
| | - F De Bellis
- Dept. of Acquired Brain Injury, Fondazione Don Carlo Gnocchi, Sant'Angelo dei Lombardi, Italy
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Zhang B, Karri J, O'Brien K, DiTommaso C, Kothari S, Li S. Spasticity Management in Persons with Disorders of Consciousness. PM R 2020; 13:657-665. [DOI: 10.1002/pmrj.12458] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/13/2020] [Accepted: 07/21/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Bei Zhang
- Department of Physical Medicine and Rehabilitation, McGovern Medical School University of Texas Health Science Center – Houston Houston, TX
- Disorder of Consciousness Program TIRR Memorial Hermann Hospital Houston, TX
| | - Jay Karri
- Disorder of Consciousness Program TIRR Memorial Hermann Hospital Houston, TX
- Department of Physical Medicine and Rehabilitation Baylor College of Medicine Houston, TX
| | - Katherine O'Brien
- Disorder of Consciousness Program TIRR Memorial Hermann Hospital Houston, TX
| | | | - Sunil Kothari
- Disorder of Consciousness Program TIRR Memorial Hermann Hospital Houston, TX
- Department of Physical Medicine and Rehabilitation Baylor College of Medicine Houston, TX
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School University of Texas Health Science Center – Houston Houston, TX
- Disorder of Consciousness Program TIRR Memorial Hermann Hospital Houston, TX
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Pingue V, Gentili M, Losurdo A, Clementi E, Nardone A. Levetiracetam Improves Upper Limb Spasticity in a Patient With Unresponsive Wakefulness Syndrome: A Case Report. Front Neurosci 2020; 14:70. [PMID: 32116516 PMCID: PMC7015971 DOI: 10.3389/fnins.2020.00070] [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: 05/03/2019] [Accepted: 01/17/2020] [Indexed: 11/24/2022] Open
Abstract
Severe spasticity is a frequent and disabling complication in patients presenting disorders of consciousness (DOC) that hinders their rehabilitative process, and is strongly correlated with pain reducing patients' quality of life. In these patients, abnormal postures may occur as an expression of severe brain damage. Here we present the case of a 52-year-old man in decorticate rigidity following a hypoxic-ischemic encephalopathy due to myocardial infarction who showed improvement of spasticity of upper limbs following intake of levetiracetam combined with the conventional neurorehabilitation program.
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Affiliation(s)
- Valeria Pingue
- Neurorehabilitation and Spinal Unit, Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Marta Gentili
- Pharmacy Service, Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Anna Losurdo
- Pharmacy Service, Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, University Hospital “Luigi Sacco”, Università di Milano, Milan, Italy
- Scientific Institute IRCCS Eugenio Medea, Lecco, Italy
| | - Antonio Nardone
- Neurorehabilitation and Spinal Unit, Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Thibaut A, Piarulli A, Martens G, Chatelle C, Laureys S. Effect of multichannel transcranial direct current stimulation to reduce hypertonia in individuals with prolonged disorders of consciousness: A randomized controlled pilot study. Ann Phys Rehabil Med 2019; 62:418-425. [DOI: 10.1016/j.rehab.2019.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/26/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022]
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17
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Does acupuncture help patients with spasticity? A narrative review. Ann Phys Rehabil Med 2019; 62:297-301. [DOI: 10.1016/j.rehab.2018.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 09/30/2018] [Accepted: 09/30/2018] [Indexed: 11/17/2022]
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Molteni E, Slomine BS, Castelli E, Zasler N, Schnakers C, Estraneo A. International survey on diagnostic and prognostic procedures in pediatric disorders of consciousness. Brain Inj 2019; 33:517-528. [PMID: 30663416 DOI: 10.1080/02699052.2019.1565899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS 1. to investigate diagnostic and prognostic procedures routinely used by international professionals to assess children with disorders of consciousness (DoC); 2. to explore use and availability of internal and national guidelines for pediatric DoC; 3. to identify international differences in diagnostic/prognostic protocols. METHODS The International Brain Injury Association DoC Special Interest Group emailed a survey link to 43,469 professionals. The survey included questions on diagnostic/prognostic procedures and guidelines for children with DoC. RESULTS Data on 82 respondents [(50% physicians) primarily from Europe (43.9%)and North America (37.8%)] were analyzed. Common diagnostic tools included the Glasgow Coma Scale for clinical assessment (94%), the Coma Recovery Scale-Revised for outcome measurement (57%), and cerebral MRI (94%). Clinical features used most frequently to inform prognosis varied with patient age. Few respondents used national (28%) admission protocols for children with DoC, and most were unaware of published national guidelines for diagnostic (72%) and prognostic (85%) procedures. Compared to North American respondents, more European respondents were physicians and used neurophysiological data for prognosis. CONCLUSIONS This international survey provides useful information about diagnostic and prognostic procedures currently used for children with DoC and highlights the need for guidelines to promote best practices for diagnosis/prognosis in pediatric DoC.
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Affiliation(s)
- Erika Molteni
- a Acquired Brain Injury Unit, IRCCS E. Medea , Scientific Institute , Lecco , Italy.,b School of Biomedical Engineering and Imaging Sciences , King's College London , UK
| | - Beth S Slomine
- c Department of Neuropsychology , Kennedy Krieger Institute, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Enrico Castelli
- d Paediatric Neurorehabilitation Units, Neuroscience and Neurorehabilitation Department , Bambino Gesù Children's Hospital , Rome , Italy
| | - Nathan Zasler
- e Concussion Care Centre of Virginia, Ltd., Tree of Life Services, Inc., Department of Physical Medicine and Rehabilitation , Virginia Commonwealth University , Richmond , Virginia , USA.,f Department of Physical Medicine and Rehabilitation , University of Virginia , Charlottesville , Virginia , USA
| | - Caroline Schnakers
- g Research Institute , Casa Colina Hospital and Centers for Healthcare , Pomona , CA , USA
| | - Anna Estraneo
- h DOC Research Laboratory and Neurorehabilitation Unit for DOC patients , Maugeri Clinical Scientific Institutes, IRCCS , Telese Terme , Italy
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Martens G, Deltombe T, Foidart-Dessalle M, Laureys S, Thibaut A. Clinical and electrophysiological investigation of spastic muscle overactivity in patients with disorders of consciousness following severe brain injury. Clin Neurophysiol 2018; 130:207-213. [PMID: 30580243 DOI: 10.1016/j.clinph.2018.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/18/2018] [Accepted: 10/27/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The clinical and electrophysiological profile of spastic muscle overactivity (SMO) is poorly documented in patients with disorders of consciousness (DOC) following severe cortical and subcortical injury. We aim at investigating the link between the clinical observations of SMO and the electrophysiological spastic over-reactivity in patients with prolonged DOC. METHODS We prospectively enrolled adult patients with DOC at least 3 months post traumatic or non-traumatic brain injury. The spastic profile was investigated using the Modified Ashworth Scale and the Hmax/Mmax ratio. T1 MRI data and impact of medication were analyzed as well. RESULTS 21 patients were included (mean age: 41 ± 11 years; time since injury: 4 ± 5 years; 9 women; 10 traumatic etiologies). Eighteen patients presented signs of SMO and 11 had an increased ratio. Eight patients presented signs of SMO but no increased ratio. We did not find any significant correlation between the ratio and the MAS score for each limb (all ps > 0.05). The presence of medication was not significantly associated with a reduction in MAS scores or Hmax/Mmax ratios. CONCLUSIONS In this preliminary study, the Hmax/Mmax ratio does not seem to reflect the clinical MAS scores in patients with DOC. This supports the fact they do not only present spasticity but other forms of SMO and contracture. SIGNIFICANCE Patients with DOC are still in need of optimized tools to evaluate their spastic profile and therapeutic approaches should be adapted accordingly.
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Affiliation(s)
- G Martens
- Coma Science Group, GIGA Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium.
| | - T Deltombe
- Departments of Physical Medicine and Rehabilitation, CHU UCL (Université catholique de Louvain) Namur site Godinne, Belgium
| | - M Foidart-Dessalle
- Departments of Physical Medicine and Rehabilitation, University and University Hospital of Liege, Liege, Belgium
| | - S Laureys
- Coma Science Group, GIGA Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium
| | - A Thibaut
- Coma Science Group, GIGA Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium
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Role of Acupuncture in the Management of Severe Acquired Brain Injuries (sABIs). EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:8107508. [PMID: 30298094 PMCID: PMC6157173 DOI: 10.1155/2018/8107508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/25/2018] [Accepted: 08/15/2018] [Indexed: 01/05/2023]
Abstract
Acupuncture therapy has been used to treat several disorders in Asian countries and its use is increasing in Western countries as well. Current literature assessed the safety and efficacy of acupuncture in the acute management and rehabilitation of patients with neurologic disorders. In this paper, the role of acupuncture in the treatment of acute severe acquired brain injuries is described, acting on neuroinflammation, intracranial oedema, oxidative stress, and neuronal regeneration. Moreover, beneficial effects of acupuncture on subacute phase and chronic outcomes have been reported in controlling the imbalance of IGF-1 hormone and in decreasing spasticity, pain, and the incidence of neurovegetative crisis. Moreover, acupuncture may have a positive action on the arousal recovery. Further work is needed to understand the effects of specific acupoints on the brain. Allegedly concurrent neurophysiological measurements (e.g., EEG) may help in studying acupuncture-related changes in central nervous system activity and determining its potential as an add-on rehabilitative treatment for patients with consciousness disorders.
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