scholarly journals RECOVERY OF CONSCIOUSNESS: OPPORTUNITIES FOR NEUROPSYCHOLOGICAL ASSESSMENT AND REHABILITATION

2021 ◽  
pp. 102-128
Author(s):  
Ekaterina V. Fufaeva ◽  
Yuri V. Mikadze ◽  
Anastasiia N. Cherkasova ◽  
Maria S. Kovyazina ◽  
Maria E. Baulina ◽  
...  
Keyword(s):  
Neuropsychological Assessment ◽  
Brain Lesions ◽  
Disorders Of Consciousness ◽  
Diagnostic Tools ◽  
Clinical Psychologist ◽  
Neuropsychological Rehabilitation ◽  
Rehabilitation System ◽  
Level Of Consciousness ◽  
Practical Guidelines ◽  
Recovery Of Consciousness

Relevance. Neuropsychological rehabilitation and assessment are the priority tasks in practice of a clinical psychologist. The modern rehabilitation system can be considered as a partnership between patients, their families and different specialists participating in the rehabilitation process. The existing approaches to neurorehabilitation are aimed at the earliest possible intervention. It`s of particular importance for patients with disorders of consciousness, whose number has been increasing in connection with the development of medicine in recent decades. This leads to the need to develop tools for specialized neuropsychological assessment and methods of neuropsychological rehabilitation of patients in the early stages of recovery of consciousness. Objective. To summarize neuropsychological diagnostic and rehabilitation experience of working with patients with disorders of consciousness after brain lesions. Methods. We analyze practical guidelines, applied research and our own hands-on experience of working with patients with disorders of consciousness after brain lesions. Results. Based on the analysis, the recommended diagnostic tools are formulated that can be used to identify the current level of consciousness and to assess various parameters of psychic activity of patients with disorders of consciousness. In addition, the main directions and neuropsychological methods of rehabilitation work recommended for recovery of consciousness and continuing to be developed now are highlighted. Conclusion. A new diagnostic and rehabilitation material is presented, which is recommended for use in neuropsychological practice by practicing clinical psychologists with patients with disorders of consciousness after brain lesions.

scholarly journals Neuropsychological diagnostics and rehabilitation of patients with memory impairments in amnestic syndrome as a result of brain damage of various etiologies

2020 ◽  
Vol 40 (4) ◽  
pp. 137-148
Author(s):  
Maria E. Baulina ◽  
Nataliya A. Varako ◽  
Maria S. Kovyazina ◽  
Yury P. Zinchenko ◽  
Uriy V. Mikadze ◽  
...  
Keyword(s):  
Brain Damage ◽  
Diagnostic Tools ◽  
Clinical Psychologist ◽  
Rehabilitation Team ◽  
Neuropsychological Rehabilitation ◽  
Memory Impairments ◽  
Rehabilitation Work ◽  
Neuropsychological Diagnostics ◽  
Amnestic Syndrome ◽  
With Memory

Background. Neuropsychological diagnostics and rehabilitation are among the fundamental practical tasks facing a clinical psychologist. Today, rehabilitation goes beyond the usual framework in which it was 40–50 years ago. The course of the disease, stressful influences radically change the physical, psychological and social functioning of a person. It is the functioning of a person (and not the state of his functions) in new, often limiting living conditions that becomes an object in the modern rehabilitation system, which is a joint activity of the patient, his relatives and specialists of the multidisciplinary rehabilitation team. Objective: analysis and generalization of the diagnostic and rehabilitation experience accumulated in neuropsychological rehabilitation;identification of quality criteria for neuropsychological diagnostics and rehabilitation of patients with memory impairments in case of brain damage, which should be followed by a practicing psychologist in the process of rehabilitation work. Results. Based on the analysis of applied research and practical guidelines, the recommended diagnostic tools for detecting memory impairments are presentedand the main directions and effective methods of rehabilitation work in amnestic syndrome are highlighted. It is shown that different degrees of severity of a amnestic defect requires the choice of an appropriate direction of work in the process of neuropsychological rehabilitation: the formation of new mnestic means; the organization of “suggestive and reminiscent” environments and new strategies for behavior in this environment; general (non-specific) principles of restorative learning. Conclusions. The presented material can serve as a “support” in the practical work of a clinical psychologist with patients with memory impairments and brain lesions.The text outlines the main directions of diagnostic and rehabilitation work which a practicing psychologist must be aware of.

scholarly journals Effect of Retinohypothalamic Tract Dysfunction on Melatonin Level in Patients with Chronic Disorders of Consciousness

2021 ◽  
Vol 11 (5) ◽  
pp. 559
Author(s):  
Mikhail Kanarskii ◽  
Julia Nekrasova ◽  
Svetlana Vitkovskaya ◽  
Pranil Pradhan ◽  
Sergey Peshkov ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Direct Relationship ◽  
Disorders Of Consciousness ◽  
Melatonin Level ◽  
Melatonin Secretion ◽  
Peripheral Part ◽  
Level Of Consciousness ◽  
Retinohypothalamic Tract ◽  
Chronic Disorders ◽  
Chronic Disorders Of Consciousness

Objective: The aim of this study is to compare the secretion level of nocturnal melatonin and the characteristics of the peripheral part of the visual analyzer in patients with chronic disorders of consciousness (DOC). Materials and Methods: We studied the level of melatonin in 22 patients with chronic DOC and in 11 healthy volunteers. The fundus condition was assessed using the ophthalmoscopic method. Results: The average level of nocturnal melatonin in patients with DOC differed by 80% from the level of indole in healthy volunteers. This reveals a direct relationship between etiology, the level of consciousness, gaze fixation, coma recovery scale-revised score and the level of melatonin secretion. Examination by an ophthalmologist revealed a decrease in the macular reflex in a significant number of DOC patients, which in turn correlates negatively with the time from brain injury and positively with low values of nocturnal melatonin.

Evaluation of structural variations in the pituitary gland, hormonal status and laboratory markers of the central nervous system functioning in patients with chronic disorders of consciousness

2021 ◽  
Vol 70 (5) ◽  
pp. 23-36
Author(s):  
Ekaterina A. Kondratyeva ◽  
Alina O. Ivanova ◽  
Maria I. Yarmolinskaya ◽  
Elena G. Potyomkina ◽  
Natalya V. Dryagina ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Blood Serum ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Unresponsive Wakefulness Syndrome ◽  
Level Of Consciousness ◽  
Chronic Disorders ◽  
Minimally Conscious ◽  
Chronic Disorders Of Consciousness

BACKGROUND: Consciousness is the state of being awake and aware of oneself and the environment. The disorders of consciousness result from pathologies that impair awareness. The development of effective comprehensive personalized interventions contributing to the recovery of consciousness in patients with chronic disorders of consciousness is one of the most pressing and challenging tasks in modern rehabilitation. AIM: The aim of this study was to understand structural problems of the pituitary gland, blood levels of gonadotropins and melatonin as well as brain damage markers in the blood and cerebrospinal fluid in patients with chronic disorders of consciousness and to analyze the levels of the above markers among different groups of patients depending on the level of impaired consciousness. MATERIALS AND METHODS: We examined 61 chronic disorders of consciousness patients and identified three groups depending on the level of consciousness including 24 patients with unresponsive wakefulness syndrome, 24 patients with a minus minimally conscious state, and 13 patients with minimally conscious state plus. We performed magnetic resonance imaging of chiasmatic-sellar region and determined blood serum levels of follicle-stimulating and luteinizing hormones and melatonin, as well as urinary level of 6-sulfatoxymelatonin and the content of brain derived neurotrophic factor (BDNF), apoptosis antigen (APO-1), FasL, glutamate, and S100 protein in the blood serum and cerebrospinal fluid. RESULTS: The patients were examined in the age ranging from 15 to 61 years old. Patient groups were homogeneous by the level of consciousness in terms of age and duration of chronic disorders of consciousness by the time of examination. The patients did not differ in the pituitary volume regardless of the level of consciousness. No significant differences were found between the groups with different levels of consciousness when studying the levels of melatonin in the blood serum and its metabolite in the urine. A peak in melatonin secretion was detected at 3 a.m. in 54.5 % of the patients, which can be considered as a favorable prognostic marker for further recovery of consciousness. Hypogonadotropic ovarian failure was found in 34 % of the patients, with normogonadotropic ovarian failure in the remaining patients. Serum APO-1 and BDNF levels were significantly higher in patients with minimally conscious state relative to those with unresponsive wakefulness syndrome. Significantly lower levels of glutamate in the cerebrospinal fluid were detected in women with unresponsive wakefulness syndrome compared to patients with minimally conscious state. CONCLUSIONS: Further in-depth examination and accumulation of data on patients with chronic disorders of consciousness may provide an opportunity to identify highly informative markers for predicting outcomes and to develop new effective approaches to rehabilitation of consciousness in this category of patients.

Neuropsychological assessment in older people: old principles and new directions

2000 ◽  
Vol 6 (5) ◽  
pp. 362-370 ◽  
Author(s):  
Robin G. Morris ◽  
Claire Worsley ◽  
David Matthews
Keyword(s):  
Older Adults ◽  
Clinical Practice ◽  
Older People ◽  
Neuropsychological Assessment ◽  
Rating Scales ◽  
Clinical Psychologist ◽  
Narrow Sense ◽  
New Directions ◽  
Different Types ◽  
Common Clinical Practice

Neuropsychological assessment, in the broader sense, is common clinical practice with older adults because of the widespread use of mental status examinations and dementia rating scales. In the more narrow sense, a neuropsychological assessment conducted by a clinical psychologist or clinical neuropsychologist is used less frequently and for more specific purposes. This paper outlines these uses and provides a brief overview of the different types of test that might be used, with a clinical example to illustrate the type of information gained. This review is designed not to be comprehensive, but to provide a pointer towards the latest trends in test development.

scholarly journals Prolonged Disorders of Consciousness

2020 ◽  
Vol 38 (1) ◽  
pp. 9-15
Author(s):  
Daeyoung Kim
Keyword(s):  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Assessment Tools ◽  
Impaired Consciousness ◽  
Transitional State ◽  
Impaired Awareness ◽  
Minimally Conscious ◽  
Recovery Of Consciousness

Prolonged disorders of consciousness comprise a spectrum of impaired consciousness where arousal is preserved with impaired awareness, which last more than 4 weeks. Vegetative state is a prototype of the prolonged disorders of consciousness. A patient in the vegetative state has no signs of awareness. The minimally conscious state is characterized by inconsistent but reproducible signs of awareness and is regarded as a transitional state of recovery of consciousness. Differentiating patients in minimally conscious state from those in vegetative state is still challenging. Utilizing standardized neurobehavioral assessment tools could improve diagnostic accuracy. Recent advances in neuroimaging and electrophysiologic tools may aid the diagnosis and prognostication. Treatment for recovery of consciousness is still limited. More research on the diagnosis and treatment of prolonged disorders of consciousness is needed not only for improved care of patients with prolonged disorders of consciousness but also a greater understanding of human consciousness.

scholarly journals A compulsive act of excess water intake leading to hyponatraemia and rhabdomyolysis: a case report

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Sudheera Fernando ◽  
Francisca Sivagnanam ◽  
Devarajan Rathish
Keyword(s):  
Water Intake ◽  
Clonic Seizure ◽  
Case Presentation ◽  
Psychiatric Illnesses ◽  
Ureteric Calculus ◽  
Anticholinergic Medications ◽  
Excess Water ◽  
Severe Hyponatraemia ◽  
Level Of Consciousness ◽  
Recovery Of Consciousness

Abstract Background Primary polydipsia is commonly seen in patients with psychiatric illnesses. Excess water intake is also seen in patient with anorexia and anticholinergic medications. We report a patient who had hyponatraemia and rhabdomyolysis after consuming excess water for ureteric calculus. Case presentation A healthy middle-aged male presented with an episode of generalized tonic-clonic seizure and reduced level of consciousness preceded by consumption of excess water. He was recently diagnosed to have a ureteric calculus and was advised to consume plenty of water. On examination, he was disoriented in place, person and time. Except for the generalized diminished reflexes, other neurological and systemic examinations were normal. He had severe hyponatraemia, mild hypokalaemia and myoglobulinuria. His serum creatinine phosphokinase and aspartate aminotransferase were markedly elevated. The diagnosis of rhabdomyolysis in the setting of acute water intoxication was made. Optimum fluid and electrolyte management achieved a dramatic recovery of consciousness, hyponatraemia and rhabdomyolysis. Discussion The patient has had excess water intake due to a compulsive act in the background fear of ureteric calculus. Such act could lead to severe hyponatraemia and rhabdomyolysis. Therefore, future similar acts could be prevented by proper medical advice. Further, emergency physicians should be vigilant for rhabdomyolysis in patients with hyponatraemia or hypokalaemia.

Spectrum Model of Brain and Consciousness

2018 ◽  
pp. 79-104
Author(s):  
Georg Northoff
Keyword(s):  
Empirical Evidence ◽  
Vegetative State ◽  
Disorders Of Consciousness ◽  
Loss Of Consciousness ◽  
Hybrid Nature ◽  
Level Of Consciousness ◽  
Spectrum Model ◽  
Spatiotemporal Integration

Is the spectrum model of brain and its assumption of the hybrid nature of stimulus-induced activity relevant for consciousness? That is the focus in the present chapter. I here present various lines of empirical evidence focusing on disorders of consciousness like vegetative state, anesthesia, and sleep. These findings suggest that the loss of consciousness in vegetative state, anesthesia, and sleep is characterized by the loss of the hybrid nature of stimulus-induced activity which shifts more towards the passive pole. This lets me suppose that the hybrid nature of stimulus-induced activity including its spatiotemporal integration as postulated in the spectrum model is central for the level of consciousness. I therefore conclude that the spectrum model of brain is relevant for consciousness.

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