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Aubinet C, Schnakers C, Majerus S. Language Assessment in Patients with Disorders of Consciousness. Semin Neurol 2022; 42:273-282. [PMID: 36100226 DOI: 10.1055/s-0042-1755561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The assessment of residual language abilities in patients with disorders of consciousness (DoC) after severe brain injury is particularly challenging due to their limited behavioral repertoire. Moreover, associated language impairment such as receptive aphasia may lead to an underestimation of actual consciousness levels. In this review, we examine past research on the assessment of residual language processing in DoC patients, and we discuss currently available tools for identifying language-specific abilities and their prognostic value. We first highlight the need for validated and sensitive bedside behavioral assessment tools for residual language abilities in DoC patients. As regards neuroimaging and electrophysiological methods, the tasks involving higher level linguistic commands appear to be the most informative about level of consciousness and have the best prognostic value. Neuroimaging methods should be combined with the most appropriate behavioral tools in multimodal assessment protocols to assess receptive language abilities in DoC patients in the most complete and sensitive manner.
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Affiliation(s)
- Charlène Aubinet
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium.,Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California
| | - Steve Majerus
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
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Aubinet C, Chatelle C, Gosseries O, Carrière M, Laureys S, Majerus S. Residual implicit and explicit language abilities in patients with disorders of consciousness: A systematic review. Neurosci Biobehav Rev 2021; 132:391-409. [PMID: 34864003 DOI: 10.1016/j.neubiorev.2021.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/13/2021] [Accepted: 12/01/2021] [Indexed: 01/14/2023]
Abstract
Language assessment in post-comatose patients is difficult due to their limited behavioral repertoire; yet associated language deficits might lead to an underestimation of consciousness levels in unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS; -/+) diagnoses. We present a systematic review of studies from 2002 assessing residual language abilities with neuroimaging, electrophysiological or behavioral measures in patients with severe brain injury. Eighty-five articles including a total of 2278 patients were assessed for quality. The median percentages of patients showing residual implicit language abilities (i.e., cortical responses to specific words/sentences) were 33 % for UWS, 50 % for MCS- and 78 % for MCS + patients, whereas explicit language abilities (i.e., command-following using brain-computer interfaces) were reported in 20 % of UWS, 33 % of MCS- and 50 % of MCS + patients. Cortical responses to verbal stimuli increased along with consciousness levels and the progressive recovery of consciousness after a coma was paralleled by the reappearance of both implicit and explicit language processing. This review highlights the importance of language assessment in patients with disorders of consciousness.
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Affiliation(s)
- Charlène Aubinet
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium.
| | - Camille Chatelle
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium; Fund for Scientific Research, FNRS, Belgium
| | - Manon Carrière
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium; Fund for Scientific Research, FNRS, Belgium
| | - Steve Majerus
- Fund for Scientific Research, FNRS, Belgium; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Belgium.
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Emotional Processing and Experience in Amyotrophic Lateral Sclerosis: A Systematic and Critical Review. Brain Sci 2021; 11:brainsci11101356. [PMID: 34679420 PMCID: PMC8534224 DOI: 10.3390/brainsci11101356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
Even though increasing literature describes changes in emotional processing in Amyotrophic Lateral Sclerosis (ALS), efforts to summarize relevant findings are lacking in the field. A systematic literature review was performed to provide a critical and up-to-date account of emotional abilities in ALS. References were identified by searches of PubMed, Web of Science and Scopus (1980–2021, English literature), with the following key terms: (“Amyotrophic Lateral Sclerosis” or “Primary Lateral Sclerosis” or “Motor Neuron”) and “Emotion*” and (“Processing” or “Attribution” or “Elaboration” or “Perception” or “Recognition”). Studies concerning only caregivers, pseudobulbar affect, and social cognition were excluded. Forty-one articles were included, all concerning ALS, and seven topics were identified: Emotion recognition, Emotional responsiveness, Emotional reactivity, Faces approachability rating, Valence rating, Memory for emotional materials and Alexithymia. The majority of these aspects have only been sparsely addressed. The evidence confirms altered emotional processing in ALS. The most consistent findings regard the recognition of facial expressions for negative emotions, but also alterations in the subjective responsiveness to emotional stimuli (arousal, valence and approachability), in psychophysiological and cerebral reactivity and in emotional memory, together with alexithymia traits, were reported. According to this evidence, emotional abilities should be included in the clinical assessment and therapeutic interventions.
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Kotchoubey B, Pavlov YG. A Signature of Passivity? An Explorative Study of the N3 Event- Related Potential Component in Passive Oddball Tasks. Front Neurosci 2019; 13:365. [PMID: 31068776 PMCID: PMC6491624 DOI: 10.3389/fnins.2019.00365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 03/29/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Many passive oddball experiments show a sharp negative deflection N3 after P3b, peaking between 400 and 500 ms, but this wave has never been analyzed properly. We conducted five passive oddball experiments, in which the number of deviants (i.e., one or two), their alleged meaning, and their distinctiveness varied. RESULTS Mastoid- or common-referenced waveforms showed a fronto-central N3 in all experiments. The data were CSD (Current Source Density) transformed and underwent a Principal Component Analysis (PCA). The PCA revealed N3 containing two subcomponents with very stable peak latencies of about 415 and 455 ms, respectively. Both topography of the subcomponents and their variation with experimental conditions were very similar, indicating a midfrontal sink and a posterior temporal source. An analysis of P3a and P3b components replicated previously known effects. CONCLUSION We discuss the similarities and differences between the passive N3 and other components including the MMN, N1, late positive Slow Wave, and reorienting negativity. We also make general hypotheses about a possible functional meaning of N3; on this basis, specific hypotheses are formulated and further experiments are suggested to test these hypotheses.
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Affiliation(s)
- Boris Kotchoubey
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Yuri G. Pavlov
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Department of Psychology, Ural Federal University, Yekaterinburg, Russia
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Graham M, Owen AM, Çipi K, Weijer C, Naci L. Minimizing the Harm of Accidental Awareness Under General Anesthesia: New Perspectives From Patients Misdiagnosed as Being in a Vegetative State. Anesth Analg 2018; 126:1073-1076. [PMID: 28922237 DOI: 10.1213/ane.0000000000002495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mackenzie Graham
- From the Rotman Institute of Philosophy, Western University, London, Ontario, Canada
| | - Adrian M Owen
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Kaman Çipi
- Department of Anesthesia, Saint Anthony Hospital, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Charles Weijer
- From the Rotman Institute of Philosophy, Western University, London, Ontario, Canada
| | - Lorina Naci
- Brain and Mind Institute, Western University, London, Ontario, Canada
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Review and Classification of Emotion Recognition Based on EEG Brain-Computer Interface System Research: A Systematic Review. APPLIED SCIENCES-BASEL 2017. [DOI: 10.3390/app7121239] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Carminati M, Fiori-Duharcourt N, Isel F. Neurophysiological differentiation between preattentive and attentive processing of emotional expressions on French vowels. Biol Psychol 2017; 132:55-63. [PMID: 29102707 DOI: 10.1016/j.biopsycho.2017.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/17/2017] [Accepted: 10/30/2017] [Indexed: 12/29/2022]
Abstract
The present electrophysiological study investigated the processing of emotional prosody by minimizing as much as possible the effect of emotional information conveyed by the lexical-semantic context. Emotionally colored French vowels (i.e., happiness, sadness, fear, and neutral) were presented in a mismatch negativity (MMN) oddball paradigm. Both the MMN, i.e., an event-related potential (ERP) component thought to reflect preattentive change detection, and the P3a, i.e., an ERP marker of involuntary orientation of attention toward deviant stimuli, were significantly modulated by the emotional deviants compared to the neutral ones. Critically, the largest amplitude (MMN, P3a) and the shortest peak latency (MMN) were observed for fear deviants, all other things being equal. Taken together, the present findings lend support to a sequential neurocognitive model of emotion processing (Scherer, 2001) which postulates, among other checks, a first stage of automatic emotion detection (MMN) followed by a second stage of subjective evaluation of the stimulus or event (P3a). Consistently with previous studies, our data suggest that among the six universal emotions, fear could have a special status probably because of its adaptive role in the evolution of the human species.
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Affiliation(s)
- Mathilde Carminati
- Laboratory Vision Action Cognition - EA 7326, Institute of Psychology, Paris Descartes University - Sorbonne Paris Cité, France.
| | - Nicole Fiori-Duharcourt
- Laboratory Vision Action Cognition - EA 7326, Institute of Psychology, Paris Descartes University - Sorbonne Paris Cité, France
| | - Frédéric Isel
- University Paris Nanterre - Paris Lumières, CNRS, UMR 7114 Models, Dynamics, Corpora, France
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8
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Kotchoubey B. Evoked and event-related potentials in disorders of consciousness: A quantitative review. Conscious Cogn 2017; 54:155-167. [DOI: 10.1016/j.concog.2017.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/18/2017] [Accepted: 05/10/2017] [Indexed: 11/25/2022]
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9
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Is laughter a better vocal change detector than a growl? Cortex 2017; 92:233-248. [DOI: 10.1016/j.cortex.2017.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/26/2017] [Accepted: 03/27/2017] [Indexed: 11/23/2022]
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10
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What is the Melody of That Voice? Probing Unbiased Recognition Accuracy with the Montreal Affective Voices. JOURNAL OF NONVERBAL BEHAVIOR 2017. [DOI: 10.1007/s10919-017-0253-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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11
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Blume C, Del Giudice R, Lechinger J, Wislowska M, Heib DPJ, Hoedlmoser K, Schabus M. Preferential processing of emotionally and self-relevant stimuli persists in unconscious N2 sleep. BRAIN AND LANGUAGE 2017; 167:72-82. [PMID: 27039169 DOI: 10.1016/j.bandl.2016.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 02/03/2016] [Accepted: 02/11/2016] [Indexed: 06/05/2023]
Abstract
Information processing has been suggested to depend on the current state of the brain as well as stimulus characteristics (e.g. salience). We compared processing of salient stimuli (subject's own names [SONs] and angry voice [AV] stimuli) to processing of unfamiliar names (UNs) and neutral voice (NV) stimuli across different vigilance stages (i.e. wakefulness as well as sleep stages N1 and N2) by means of event-related oscillatory responses during wakefulness and a subsequent afternoon nap. Our findings suggest that emotional prosody and self-relevance drew more attentional resources during wakefulness with specifically AV stimuli being processed more strongly. During N1, SONs were more arousing than UNs irrespective of prosody. Moreover, emotional and self-relevant stimuli evoked stronger responses also during N2 sleep suggesting a 'sentinel processing mode' of the brain during this state of naturally occurring unconsciousness. Finally, this initial preferential processing of salient stimuli during N2 sleep seems to be followed by an inhibitory sleep-protecting process, which is reflected by a K-complex-like response.
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Affiliation(s)
- Christine Blume
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Renata Del Giudice
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Julia Lechinger
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Malgorzata Wislowska
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Dominik P J Heib
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Kerstin Hoedlmoser
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Manuel Schabus
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
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12
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How Supportive Are Romanian Consumers of the Circular Economy Concept: A Survey. SUSTAINABILITY 2016. [DOI: 10.3390/su8080789] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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del Giudice R, Blume C, Wislowska M, Wielek T, Heib DPJ, Schabus M. The Voice of Anger: Oscillatory EEG Responses to Emotional Prosody. PLoS One 2016; 11:e0159429. [PMID: 27442445 PMCID: PMC4956258 DOI: 10.1371/journal.pone.0159429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/01/2016] [Indexed: 11/18/2022] Open
Abstract
Emotionally relevant stimuli and in particular anger are, due to their evolutionary relevance, often processed automatically and able to modulate attention independent of conscious access. Here, we tested whether attention allocation is enhanced when auditory stimuli are uttered by an angry voice. We recorded EEG and presented healthy individuals with a passive condition where unfamiliar names as well as the subject's own name were spoken both with an angry and neutral prosody. The active condition instead, required participants to actively count one of the presented (angry) names. Results revealed that in the passive condition the angry prosody only elicited slightly stronger delta synchronization as compared to a neutral voice. In the active condition the attended (angry) target was related to enhanced delta/theta synchronization as well as alpha desynchronization suggesting enhanced allocation of attention and utilization of working memory resources. Altogether, the current results are in line with previous findings and highlight that attention orientation can be systematically related to specific oscillatory brain responses. Potential applications include assessment of non-communicative clinical groups such as post-comatose patients.
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Affiliation(s)
- Renata del Giudice
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Hellbrunner Strasse 34, 5020, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Hellbrunner Strasse 34, 5020, Salzburg, Austria
| | - Christine Blume
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Hellbrunner Strasse 34, 5020, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Hellbrunner Strasse 34, 5020, Salzburg, Austria
| | - Malgorzata Wislowska
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Hellbrunner Strasse 34, 5020, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Hellbrunner Strasse 34, 5020, Salzburg, Austria
| | - Tomasz Wielek
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Hellbrunner Strasse 34, 5020, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Hellbrunner Strasse 34, 5020, Salzburg, Austria
| | - Dominik P. J. Heib
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Hellbrunner Strasse 34, 5020, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Hellbrunner Strasse 34, 5020, Salzburg, Austria
| | - Manuel Schabus
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Hellbrunner Strasse 34, 5020, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Hellbrunner Strasse 34, 5020, Salzburg, Austria
- * E-mail:
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14
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Kotchoubey B, Pavlov YG, Kleber B. Music in Research and Rehabilitation of Disorders of Consciousness: Psychological and Neurophysiological Foundations. Front Psychol 2015; 6:1763. [PMID: 26640445 PMCID: PMC4661237 DOI: 10.3389/fpsyg.2015.01763] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/03/2015] [Indexed: 01/18/2023] Open
Abstract
According to a prevailing view, the visual system works by dissecting stimuli into primitives, whereas the auditory system processes simple and complex stimuli with their corresponding features in parallel. This makes musical stimulation particularly suitable for patients with disorders of consciousness (DoC), because the processing pathways related to complex stimulus features can be preserved even when those related to simple features are no longer available. An additional factor speaking in favor of musical stimulation in DoC is the low efficiency of visual stimulation due to prevalent maladies of vision or gaze fixation in DoC patients. Hearing disorders, in contrast, are much less frequent in DoC, which allows us to use auditory stimulation at various levels of complexity. The current paper overviews empirical data concerning the four main domains of brain functioning in DoC patients that musical stimulation can address: perception (e.g., pitch, timbre, and harmony), cognition (e.g., musical syntax and meaning), emotions, and motor functions. Music can approach basic levels of patients' self-consciousness, which may even exist when all higher-level cognitions are lost, whereas music induced emotions and rhythmic stimulation can affect the dopaminergic reward-system and activity in the motor system respectively, thus serving as a starting point for rehabilitation.
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Affiliation(s)
- Boris Kotchoubey
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany
| | - Yuri G. Pavlov
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany
- Department of Psychology, Ural Federal University, Yekaterinburg, Russia
| | - Boris Kleber
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany
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15
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Bagnato S, Boccagni C, Prestandrea C, Galardi G. Autonomic correlates of seeing one's own face in patients with disorders of consciousness. Neurosci Conscious 2015; 2015:niv005. [PMID: 30619622 PMCID: PMC6307552 DOI: 10.1093/nc/niv005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/30/2015] [Accepted: 06/06/2015] [Indexed: 11/13/2022] Open
Abstract
The ability to recognize one's own face is a hallmark of self-awareness. In healthy subjects, the sympathetic skin response evoked by self-face recognition has a greater area under the curve of the signal than responses evoked by other visual stimuli. We evaluated the sympathetic skin responses evoked by self-face images and by six other visual stimuli (conditions) in 15 patients with severe disorders of consciousness and in 15 age-matched healthy subjects. Under all conditions, the evoked area of the sympathetic skin response was smaller in patients with unresponsive wakefulness syndrome, intermediate in patients in a minimally conscious state, and greater in healthy subjects. In patients with unresponsive wakefulness syndrome, no differences were found between the sympathetic skin response area evoked by self-face images and those evoked by other conditions. In patients in a minimally conscious state, the area of the sympathetic skin response evoked by self-face presentation was greater than those evoked by other conditions, even if statistical significance was reached only in the comparison to other stimuli not involving a real face. This finding may be due to the inability of these patients to differentiate their own face from those of others. Taken together, these results probably reflect a varying level of self-awareness between patients with unresponsive wakefulness syndrome and patients in a minimally conscious state, and suggest that the autonomic correlate of self-awareness may have some diagnostic implications for these patients.
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Affiliation(s)
- Sergio Bagnato
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto “San Raffaele - G. Giglio,” Viale G. Giardina, 90015 Cefalù (PA), Italy
| | - Cristina Boccagni
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto “San Raffaele - G. Giglio,” Viale G. Giardina, 90015 Cefalù (PA), Italy
| | - Caterina Prestandrea
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto “San Raffaele - G. Giglio,” Viale G. Giardina, 90015 Cefalù (PA), Italy
| | - Giuseppe Galardi
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto “San Raffaele - G. Giglio,” Viale G. Giardina, 90015 Cefalù (PA), Italy
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16
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Affiliation(s)
- Boris Kotchoubey
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen , Germany
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17
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O'Kelly J, James L, Palaniappan R, Taborin J, Fachner J, Magee WL. Neurophysiological and behavioral responses to music therapy in vegetative and minimally conscious States. Front Hum Neurosci 2013; 7:884. [PMID: 24399950 PMCID: PMC3872324 DOI: 10.3389/fnhum.2013.00884] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/05/2013] [Indexed: 01/18/2023] Open
Abstract
Assessment of awareness for those with disorders of consciousness is a challenging undertaking, due to the complex presentation of the population. Debate surrounds whether behavioral assessments provide greatest accuracy in diagnosis compared to neuro-imaging methods, and despite developments in both, misdiagnosis rates remain high. Music therapy may be effective in the assessment and rehabilitation with this population due to effects of musical stimuli on arousal, attention, and emotion, irrespective of verbal or motor deficits. However, an evidence base is lacking as to which procedures are most effective. To address this, a neurophysiological and behavioral study was undertaken comparing electroencephalogram (EEG), heart rate variability, respiration, and behavioral responses of 20 healthy subjects with 21 individuals in vegetative or minimally conscious states (VS or MCS). Subjects were presented with live preferred music and improvised music entrained to respiration (procedures typically used in music therapy), recordings of disliked music, white noise, and silence. ANOVA tests indicated a range of significant responses (p ≤ 0.05) across healthy subjects corresponding to arousal and attention in response to preferred music including concurrent increases in respiration rate with globally enhanced EEG power spectra responses (p = 0.05-0.0001) across frequency bandwidths. Whilst physiological responses were heterogeneous across patient cohorts, significant post hoc EEG amplitude increases for stimuli associated with preferred music were found for frontal midline theta in six VS and four MCS subjects, and frontal alpha in three VS and four MCS subjects (p = 0.05-0.0001). Furthermore, behavioral data showed a significantly increased blink rate for preferred music (p = 0.029) within the VS cohort. Two VS cases are presented with concurrent changes (p ≤ 0.05) across measures indicative of discriminatory responses to both music therapy procedures. A third MCS case study is presented highlighting how more sensitive selective attention may distinguish MCS from VS. The findings suggest that further investigation is warranted to explore the use of music therapy for prognostic indicators, and its potential to support neuroplasticity in rehabilitation programs.
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Affiliation(s)
- Julian O'Kelly
- Research Department, Royal Hospital for Neuro-disability , London , UK ; Department of Communication and Psychology, Aalborg University , Aalborg , Denmark
| | - L James
- Research Department, Royal Hospital for Neuro-disability , London , UK
| | - R Palaniappan
- Faculty of Science and Engineering, Wolverhampton University , Wolverhampton , UK
| | - J Taborin
- Department of Neuroscience, King's College London , London , UK
| | - J Fachner
- Department of Music and Performing Arts, Anglia Ruskin University , Cambridge , UK
| | - W L Magee
- Boyer College of Music and Dance, Temple University Philadelphia , Philadelphia, PA , USA
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18
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Activation of auditory cortex by anticipating and hearing emotional sounds: an MEG study. PLoS One 2013; 8:e80284. [PMID: 24278270 PMCID: PMC3835909 DOI: 10.1371/journal.pone.0080284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 09/26/2013] [Indexed: 11/19/2022] Open
Abstract
To study how auditory cortical processing is affected by anticipating and hearing of long emotional sounds, we recorded auditory evoked magnetic fields with a whole-scalp MEG device from 15 healthy adults who were listening to emotional or neutral sounds. Pleasant, unpleasant, or neutral sounds, each lasting for 6 s, were played in a random order, preceded by 100-ms cue tones (0.5, 1, or 2 kHz) 2 s before the onset of the sound. The cue tones, indicating the valence of the upcoming emotional sounds, evoked typical transient N100m responses in the auditory cortex. During the rest of the anticipation period (until the beginning of the emotional sound), auditory cortices of both hemispheres generated slow shifts of the same polarity as N100m. During anticipation, the relative strengths of the auditory-cortex signals depended on the upcoming sound: towards the end of the anticipation period the activity became stronger when the subject was anticipating emotional rather than neutral sounds. During the actual emotional and neutral sounds, sustained fields were predominant in the left hemisphere for all sounds. The measured DC MEG signals during both anticipation and hearing of emotional sounds implied that following the cue that indicates the valence of the upcoming sound, the auditory-cortex activity is modulated by the upcoming sound category during the anticipation period.
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Harrison AH, Connolly JF. Finding a way in: A review and practical evaluation of fMRI and EEG for detection and assessment in disorders of consciousness. Neurosci Biobehav Rev 2013; 37:1403-19. [PMID: 23680699 DOI: 10.1016/j.neubiorev.2013.05.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/26/2013] [Accepted: 05/06/2013] [Indexed: 01/28/2023]
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Affiliation(s)
- Adrian M. Owen
- The Brain and Mind Institute, Department of Psychology, The University of Western Ontario, London, Ontario N6A 5B7, Canada;
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Gantner IS, Bodart O, Laureys S, Demertzi A. Our rapidly changing understanding of acute and chronic disorders of consciousness: challenges for neurologists. FUTURE NEUROLOGY 2013. [DOI: 10.2217/fnl.12.77] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A number of recent studies suggest that some ‘vegetative state’ patients have been misdiagnosed, judging by their ability to follow commands and in some cases even communicate through brain activity. Such studies highlight the difficulty in forming a diagnosis based only on behavioral assessments. We think that neuroimaging and electrophysiology methods will be used more frequently in clinical settings, integrated with existing behavioral assessments. Such efforts are expected to lead to a more accurate understanding of individual patients’ cognitive abilities or even provide prognostic indicators. In terms of treatment planning (i.e., pain management and end-of-life decision-making), patients with disorders of consciousness are now offered the possibility of expressing their preferences by means of brain–computer interfaces. What remains to be clarified is the degree to which such indirect responses can be considered reliable and of legal representation.
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Affiliation(s)
- Ithabi S Gantner
- Coma Science Group, Cyclotron Research Center & CHU Neurology Department, University of Liège, Allée du 6 Août no 8, Sart Tilman B30, 4000 Liège, Belgium
| | - Olivier Bodart
- Coma Science Group, Cyclotron Research Center & CHU Neurology Department, University of Liège, Allée du 6 Août no 8, Sart Tilman B30, 4000 Liège, Belgium
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Center & CHU Neurology Department, University of Liège, Allée du 6 Août no 8, Sart Tilman B30, 4000 Liège, Belgium
| | - Athena Demertzi
- Coma Science Group, Cyclotron Research Center & CHU Neurology Department, University of Liège, Allée du 6 Août no 8, Sart Tilman B30, 4000 Liège, Belgium
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Naci L, Monti MM, Cruse D, Kübler A, Sorger B, Goebel R, Kotchoubey B, Owen AM. Brain-computer interfaces for communication with nonresponsive patients. Ann Neurol 2012; 72:312-23. [DOI: 10.1002/ana.23656] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Pain Perception in Disorders of Consciousness: Neuroscience, Clinical Care, and Ethics in Dialogue. NEUROETHICS-NETH 2012. [DOI: 10.1007/s12152-011-9149-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
Awake but not aware: This puzzling dissociation of the two central elements of consciousness defines the vegetative state. Traditionally, this condition has been believed to imply a brain with preserved hypothalamic and brainstem autonomic functions but with no capacity for cortical cognitive processes. As is discussed in this review, over a 20-year span neuroimaging techniques have clearly demonstrated that this characterization of patients in a vegetative state is incorrect. Contrary to the initial belief, the "vegetative" brain can retain several high-level aspects of cognitive functions, across sensory modalities, including language processing and learning dynamics. Nonetheless, the residual cognitive functions observed in vegetative patients might reflect intact but functionally disconnected cortical modules that do not give rise to the subjective feeling of phenomenological awareness.
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Affiliation(s)
- Martin M Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, California 90095, USA.
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Chronaki G, Broyd S, Garner M, Hadwin JA, Thompson MJJ, Sonuga-Barke EJS. Isolating N400 as neural marker of vocal anger processing in 6-11-year old children. Dev Cogn Neurosci 2011; 2:268-76. [PMID: 22483076 PMCID: PMC6987668 DOI: 10.1016/j.dcn.2011.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 10/28/2011] [Accepted: 11/25/2011] [Indexed: 11/28/2022] Open
Abstract
Introduction Vocal anger is a salient social signal serving adaptive functions in typical child development. Despite recent advances in the developmental neuroscience of emotion processing with regard to visual stimuli, little remains known about the neural correlates of vocal anger processing in childhood. This study represents the first attempt to isolate a neural marker of vocal anger processing in children using electrophysiological methods. Methods We compared ERP wave forms during the processing of non-word emotional vocal stimuli in a population sample of 55 6–11-year-old typically developing children. Children listened to three types of stimuli expressing angry, happy, and neutral prosody and completed an emotion identification task with three response options (angry, happy and neutral/‘ok’). Results A distinctive N400 component which was modulated by emotional content of vocal stimulus was observed in children over parietal and occipital scalp regions—amplitudes were significantly attenuated to angry compared to happy and neutral voices. Discussion Findings of the present study regarding the N400 are compatible with adult studies showing reduced N400 amplitudes to negative compared to neutral emotional stimuli. Implications for studies of the neural basis of vocal anger processing in children are discussed.
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Affiliation(s)
- Georgia Chronaki
- Developmental Brain Behaviour Laboratory, Psychology, University of Southampton, UK.
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Assessment of consciousness with electrophysiological and neurological imaging techniques. Curr Opin Crit Care 2011; 17:146-51. [PMID: 21206267 DOI: 10.1097/mcc.0b013e328343476d] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Brain MRI (diffusion tensor imaging and spectroscopy) and functional neuroimaging (PET, functional MRI, EEG and evoked potential studies) are changing our understanding of patients with disorders of consciousness encountered after coma such as the 'vegetative' or minimally conscious states. RECENT FINDINGS Increasing evidence from functional neuroimaging and electrophysiology demonstrates some residual cognitive processing in a subgroup of patients who clinically fail to show any response to commands, leading to the recent proposal of 'unresponsive wakefulness syndrome' as an alternative name for patients previously coined 'vegetative' or 'apallic'. SUMMARY Consciousness can be viewed as the emergent property of the collective behavior of widespread thalamocortical frontoparietal network connectivity. Data from physiological, pharmacological and pathological alterations of consciousness provide evidence in favor of this hypothesis. Increasing our understanding of the neural correlates of consciousness is helping clinicians to do a better job in terms of diagnosis, prognosis and finally treatment and drug development for these severely brain-damaged patients. The current challenge remains to continue translating this research from the bench to the bedside. Only well controlled large multicentric neuroimaging and electrophysiology studies will enable to identify which paraclinical diagnostic or prognostic test is necessary for our routine evidence-based assessment of individuals with disorders of consciousness.
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Recognition of the mom’s voice with an emotional content in a PVS patient. Clin Neurophysiol 2011; 122:1059-60; author reply 1061-2. [DOI: 10.1016/j.clinph.2010.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Revised: 08/04/2010] [Accepted: 09/09/2010] [Indexed: 11/23/2022]
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Kleih SC, Kaufmann T, Zickler C, Halder S, Leotta F, Cincotti F, Aloise F, Riccio A, Herbert C, Mattia D, Kübler A. Out of the frying pan into the fire--the P300-based BCI faces real-world challenges. PROGRESS IN BRAIN RESEARCH 2011; 194:27-46. [PMID: 21867792 DOI: 10.1016/b978-0-444-53815-4.00019-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Brain-computer interfaces (BCIs) have been investigated for more than 20 years. Many BCIs use noninvasive electroencephalography as a measurement technique and the P300 event-related potential as an input signal (P300 BCI). Since the first experiment with a P300 BCI system in 1988 by Farwell and Donchin, not only data processing has improved but also stimuli presentation has been varied and a plethora of applications was developed and refined. Nowadays, these applications are facing the challenge of being transferred from the research laboratory into real-life situations to serve motor-impaired people in their homes as assistive technology.
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Affiliation(s)
- Sonja C Kleih
- Department of Psychology I, University of Würzburg, Würzburg, Germany
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Consciousness revealed: new insights into the vegetative and minimally conscious states. Curr Opin Neurol 2010; 23:656-60. [DOI: 10.1097/wco.0b013e32833fd4e7] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The diagnosis and management of patients with persistent vegetative (PVS) and minimally conscious (MCS) states entail powerful medical, ethical and legal debates. The recent description of the MCS highlights the crucial role of unexpected and well-documented recoveries of cognitive functions. Functional neuroimaging has provided new insights for assessing neuropathology and cerebral activity in these patients, providing information on the presence, degree, and location of any residual brain function in patients with PVS or MCS. We present a review on this topic, emphasizing the clinical and neuroimaging assessment of these states, with some of our recent results in this area. We conclude that the development of rehabilitation techniques for patients with PVS and others suffering long-lasting effects of brain injury is a crucial challenge for actual and future generations of neuroscientists.
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