scholarly journals Neurophysiological Indicators of Residual Cognitive Capacity in the Minimally Conscious State

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Solveig L. Hauger ◽  
Caroline Schnakers ◽  
Stein Andersson ◽  
Frank Becker ◽  
Torgeir Moberget ◽  
...  
Keyword(s):  
Minimally Conscious State ◽  
Event Related Potentials ◽  
Conscious State ◽  
Cognitive Capacity ◽  
Healthy Controls ◽  
Individual Patient Level ◽  
Patient Level ◽  
Counting Task ◽  
Related Potentials ◽  
Minimally Conscious

Background. The diagnostic usefulness of electrophysiological methods in assessing disorders of consciousness (DoC) remains to be established on an individual patient level, and there is need to determine what constitutes robust experimental paradigm to elicit electrophysiological indices of covert cognitive capacity.Objectives. Two tasks encompassing active and passive conditions were explored in an event-related potentials (ERP) study. The task robustness was studied in healthy controls, and their utility to detect covert signs of command-following on an individual patient level was investigated in patients in a minimally conscious state (MCS).Methods. Twenty healthy controls and 20 MCS patients participated. The active tasks included (1) listening for a change of pitch in the subject’s own name (SON) and (2) counting SON, both contrasted to passive conditions. Midline ERPs are reported.Results. A larger P3 response was detected in the counting task compared to active listening to pitch change in the healthy controls. On an individual level, the counting task revealed a higher rate of responders among both healthy subjects and MCS patients.Conclusion. ERP paradigms involving actively counting SON represent a robust paradigm in probing for volitional cognition in minimally conscious patients and add important diagnostic information in some patients.

Brain–Computer and Brain-to-Brain Interfaces for Communication

2021 ◽  
pp. 112-144
Author(s):  
Walter Glannon
Keyword(s):  
Motor Impairment ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Collaborative Problem Solving ◽  
Cognitive Capacity ◽  
Artificial Nutrition ◽  
Mediated Communication ◽  
Artificial Nutrition And Hydration ◽  
Life Sustaining Treatment ◽  
Minimally Conscious

This chapter explores how a brain–computer interface (BCI) could allow some patients with locked-in syndrome, amyotrophic lateral sclerosis, or in the minimally conscious state to reliably communicate with others. BCI-mediated communication may enable these patients to clearly express their wishes when they cannot communicate because of motor impairment. Depending on their cognitive capacity for reasoning and decision-making, some patients could use a BCI to express their wishes about life-sustaining treatment and meet criteria of informed consent. Patients who could use a BCI to communicate could decide for themselves whether they want to continue or discontinue artificial nutrition and hydration, ventilation, or other life-sustaining interventions and act in their own best interests. The chapter also discusses how brain-to-brain interfaces may enable communication between brains and minds in a social network of collaborative problem-solving in visuomotor and cognitive tasks.

scholarly journals Mindsight: Diagnostics in Disorders of Consciousness

2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
P. Guldenmund ◽  
J. Stender ◽  
L. Heine ◽  
S. Laureys
Keyword(s):  
Brain Activity ◽  
Vegetative State ◽  
Activity Patterns ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
High Rate ◽  
Healthy Controls ◽  
Unresponsive Wakefulness Syndrome ◽  
Minimally Conscious

Diagnosis of patients with disorders of consciousness (comprising coma, vegetative state/unresponsive wakefulness syndrome, and minimally conscious state) has long been dependent on unstandardized behavioral tests. The arrival of standardized behavioral tools, and especially the Coma Recovery Scale revised, uncovered a high rate of misdiagnosis. Ancillary techniques, such as brain imaging and electrophysiological examinations, are ever more often being deployed to aid in the search for remaining consciousness. They are used to look for brain activity patterns similar to those found in healthy controls. The development of portable and cheaper devices will make these techniques more widely available.

Disabilities and Well-Being

2019 ◽  
pp. 121-137
Author(s):  
Joshua Shepherd
Keyword(s):  
Broad Class ◽  
Minimally Conscious State ◽  
Well Being ◽  
Conscious State ◽  
Minimally Conscious

This chapter argues for a normative distinction between disabilities that are inherently negative with respect to well-being and disabilities that are inherently neutral. After clarifying terms, the author discusses recent arguments according to which possession of a disability is inherently neutral with respect to well-being. He notes that although these arguments are compelling, they are only intended to cover certain disabilities and, in fact, that there exists a broad class regarding which they do not apply. He then discusses two problem cases: locked-in syndrome and the minimally conscious state, and explains why these are cases in which possession of these disabilities makes one worse off overall. He argues that disabilities that significantly impair control over one’s situation tend to be inherently negative with respect to well-being; other disabilities do not. The upshot is that we must draw an important normative distinction between disabilities that undermine this kind of control and disabilities that do not.

scholarly journals When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Neurobehavioral Progress

2021 ◽  
Vol 11 (1) ◽  
pp. 126
Author(s):  
Enrique Noé ◽  
Joan Ferri ◽  
José Olaya ◽  
María Dolores Navarro ◽  
Myrtha O’Valle ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Minimally Conscious State ◽  
Clinical Decision ◽  
Total Sample ◽  
Conscious State ◽  
Accurate Estimation ◽  
Functional Communication ◽  
Unresponsive Wakefulness Syndrome ◽  
Object Use ◽  
Minimally Conscious

Accurate estimation of the neurobehavioral progress of patients with unresponsive wakefulness syndrome (UWS) is essential to anticipate their most likely clinical course and guide clinical decision making. Although different studies have described this progress and possible predictors of neurobehavioral improvement in these patients, they have methodological limitations that could restrict the validity and generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the prognostic factors of changes in their neurobehavioral condition. Our results showed that, during the analyzed period, 34% of the patients were able to progress from UWS to minimally conscious state (MCS), 12% of the total sample (near one third from those who progressed to MCS) were able to emerge from MCS, and 10% of the patients died. Transition to MCS was mostly denoted by visual signs, which appeared either alone or in combination with motor signs, and was predicted by etiology and the score on the Coma Recovery Scale-Revised at admission with an accuracy of 75%. Emergence from MCS was denoted in the same proportion by functional communication and object use. Predictive models of emergence from MCS and mortality were not valid and the identified predictors could not be accounted for.

scholarly journals Pain Perception in Disorder of Consciousness: A Scoping Review on Current Knowledge, Clinical Applications, and Future Perspective

2021 ◽  
Vol 11 (5) ◽  
pp. 665
Author(s):  
Rocco Salvatore Calabrò ◽  
Loris Pignolo ◽  
Claudia Müller-Eising ◽  
Antonino Naro
Keyword(s):  
Functional Connectivity ◽  
Scoping Review ◽  
Pain Perception ◽  
Current Knowledge ◽  
Conscious Experience ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Future Perspective ◽  
Disorder Of Consciousness ◽  
Minimally Conscious

Pain perception in individuals with prolonged disorders of consciousness (PDOC) is still a matter of debate. Advanced neuroimaging studies suggest some cortical activations even in patients with unresponsive wakefulness syndrome (UWS) compared to those with a minimally conscious state (MCS). Therefore, pain perception has to be considered even in individuals with UWS. However, advanced neuroimaging assessment can be challenging to conduct, and its findings are sometimes difficult to be interpreted. Conversely, multichannel electroencephalography (EEG) and laser-evoked potentials (LEPs) can be carried out quickly and are more adaptable to the clinical needs. In this scoping review, we dealt with the neurophysiological basis underpinning pain in PDOC, pointing out how pain perception assessment in these individuals might help in reducing the misdiagnosis rate. The available literature data suggest that patients with UWS show a more severe functional connectivity breakdown among the pain-related brain areas compared to individuals in MCS, pointing out that pain perception increases with the level of consciousness. However, there are noteworthy exceptions, because some UWS patients show pain-related cortical activations that partially overlap those observed in MCS individuals. This suggests that some patients with UWS may have residual brain functional connectivity supporting the somatosensory, affective, and cognitive aspects of pain processing (i.e., a conscious experience of the unpleasantness of pain), rather than only being able to show autonomic responses to potentially harmful stimuli. Therefore, the significance of the neurophysiological approach to pain perception in PDOC seems to be clear, and despite some methodological caveats (including intensity of stimulation, multimodal paradigms, and active vs. passive stimulation protocols), remain to be solved. To summarize, an accurate clinical and neurophysiological assessment should always be performed for a better understanding of pain perception neurophysiological underpinnings, a more precise differential diagnosis at the level of individual cases as well as group comparisons, and patient-tailored management.

Experiences of family of individuals in a locked in, minimally conscious state, or vegetative state with the health care system

Brain Injury ◽  
2020 ◽  
pp. 1-7
Author(s):  
Sarah Elizabeth Patricia Munce ◽  
Fiona Webster ◽  
Jennifer Christian ◽  
Laura E. Gonzalez-Lara ◽  
Adrian M. Owen ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Minimally Conscious ◽  
Care System

scholarly journals Treating Traumatic Brain Injuries with Electroceuticals: Implications for the Neuroanatomy of Consciousness

NeuroSci ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 254-265
Author(s):  
Jihad Aburas ◽  
Areej Aziz ◽  
Maryam Butt ◽  
Angela Leschinsky ◽  
Marsha L. Pierce
Keyword(s):  
Brain Stimulation ◽  
Brain Injuries ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Permanent Disability ◽  
United States Food ◽  
Control And Prevention ◽  
Minimally Conscious

According to the Centers for Disease Control and Prevention (CDC), traumatic brain injury (TBI) is the leading cause of loss of consciousness, long-term disability, and death in children and young adults (age 1 to 44). Currently, there are no United States Food and Drug Administration (FDA) approved pharmacological treatments for post-TBI regeneration and recovery, particularly related to permanent disability and level of consciousness. In some cases, long-term disorders of consciousness (DoC) exist, including the vegetative state/unresponsive wakefulness syndrome (VS/UWS) characterized by the exhibition of reflexive behaviors only or a minimally conscious state (MCS) with few purposeful movements and reflexive behaviors. Electroceuticals, including non-invasive brain stimulation (NIBS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS) have proved efficacious in some patients with TBI and DoC. In this review, we examine how electroceuticals have improved our understanding of the neuroanatomy of consciousness. However, the level of improvements in general arousal or basic bodily and visual pursuit that constitute clinically meaningful recovery on the Coma Recovery Scale-Revised (CRS-R) remain undefined. Nevertheless, these advancements demonstrate the importance of the vagal nerve, thalamus, reticular activating system, and cortico-striatal-thalamic-cortical loop in the process of consciousness recovery.

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