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Steven Laureys - One of the best experts on this subject based on the ideXlab platform.
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minimally Conscious State plus diagnostic criteria and relation to functional recovery
Journal of Neurology, 2020Co-Authors: Aurore Thibaut, Yelena G. Bodien, Steven Laureys, Joseph T GiacinoAbstract:We investigated the relationship between three language-dependent behaviors (i.e., command-following, intelligible verbalization, and intentional communication) and the functional status of patients with disorders of Consciousness (DoC). We hypothesized that patients in minimally Conscious State (MCS) who retain behavioral evidence of preserved language function would have similar levels of functional disability, while patients who lack these behaviors would demonstrate significantly greater disability. We reasoned that these results could then be used to establish empirically-based diagnostic criteria for MCS+. In this retrospective cohort study we included rehabilitation inpatients diagnosed with DoC following severe-acquired brain injury (MCS = 57; vegetative State/unresponsive wakefulness syndrome [VS/UWS] = 63); women: 46; mean age: 47 ± 19 years; traumatic etiology: 68; time post-injury: 40 ± 23 days). We compared the scores of the Disability Rating Scale score (DRS) at time of transition from VS/UWS to MCS or from MCS– to MCS+, and at discharge between groups. Level of disability on the DRS was similar in patients with any combination of the three language-related behaviors. MCS patients with no behavioral evidence of language function (i.e., MCS–) were more functionally impaired than patients with MCS+ at time of transition and at discharge. Command-following, intelligible verbalization, and intentional communication are not associated with different levels of functional disability. Thus, the MCS+ syndrome can be diagnosed based on the presence of any one of these language-related behaviors. Patients in MCS+ may evidence less functional disability compared to those in MCS who fail to demonstrate language function (i.e., MCS–).
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clinical subcategorization of minimally Conscious State according to resting functional connectivity
Human Brain Mapping, 2018Co-Authors: Charlène Aubinet, Steven Laureys, Stephen Karl Larroque, Charlotte Martial, Steve Majerus, Lizette Heine, Carol Di PerriAbstract:Patients in minimally Conscious State (MCS) have been subcategorized in MCS plus and MCS minus, based on command-following, intelligible verbalization or intentional communication. We here aimed to better characterize the functional neuroanatomy of MCS based on this clinical subcategorization by means of resting State functional magnetic resonance imaging (fMRI). Resting State fMRI was acquired in 292 MCS patients and a seed-based analysis was conducted on a convenience sample of 10 MCS plus patients, 9 MCS minus patients and 35 healthy subjects. We investigated the left and right frontoparietal networks (FPN), auditory network, default mode network (DMN), thalamocortical connectivity and DMN between-network anticorrelations. We also employed an analysis based on regions of interest (ROI) to examine interhemispheric connectivity and investigated intergroup differences in gray/white matter volume by means of voxel-based morphometry. We found a higher connectivity in MCS plus as compared to MCS minus in the left FPN, specifically between the left dorso-lateral prefrontal cortex and left temporo-occipital fusiform cortex. No differences between patient groups were observed in the auditory network, right FPN, DMN, thalamocortical and interhemispheric connectivity, between-network anticorrelations and gray/white matter volume. Our preliminary group-level results suggest that the clinical subcategorization of MCS may involve functional connectivity differences in a language-related executive control network. MCS plus and minus patients are seemingly not differentiated by networks associated to auditory processing, perception of surroundings and internal awareness/self-mentation, nor by interhemispheric integration and structural brain damage.
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randomized controlled trial of home based 4 week tdcs in chronic minimally Conscious State
Brain Stimulation, 2018Co-Authors: Géraldine Martens, Steven Laureys, Charlotte Martial, Sarah Wannez, Nicolas Lejeune, Anthony Terrence Obrien, Felipe Fregni, Aurore ThibautAbstract:Abstract Background Patients with chronic disorders of Consciousness face a significant lack of treatment options. Objective We aimed at investigating the feasibility and the behavioral effects of home-based transcranial direct current stimulation (tDCS), applied by relatives or caregivers, in chronic patients in minimally Conscious State (MCS). Methods Each participant received, in a randomized order, 20 sessions of active and 20 sessions of sham tDCS applied over the prefrontal cortex for 4 weeks; separated by 8 weeks of washout. Level of Consciousness was assessed using the Coma Recovery Scale-Revised before the first stimulation (baseline), at the end of the 20 tDCS sessions (direct effects) and 8 weeks after the end of each stimulation period (long-term effects). Reported adverse events and data relative to the adherence (i.e., amount of sessions effectively received) were collected as well. Results Twenty-seven patients completed the study and 22 patients received at least 80% of the stimulation sessions. All patients tolerated tDCS well, no severe adverse events were noticed after real stimulation and the overall adherence (i.e., total duration of stimulation) was good. A moderate effect size (0.47 and 0.53, for modified intention to treat and per protocol analysis, respectively) was observed at the end of the 4 weeks of tDCS in favor of the active treatment. Conclusions We demonstrated that home-based tDCS can be used adequately outside a research facility or hospital by patients' relatives or caregivers. In addition, 4 weeks of tDCS moderately improved the recovery of signs of Consciousness in chronic MCS patients.
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Mirror efficiency in the assessment of visual pursuit in patients in minimally Conscious State.
Brain injury, 2017Co-Authors: Sarah Wannez, Steven Laureys, Audrey Vanhaudenhuyse, Serge BrédartAbstract:ABSTRACTObjective: Visual pursuit should be tested with a mirror in patients with disorders of Consciousness. This stimulus was indeed more efficient than a person or an object, and the auto-referential aspect was supposed to be the key feature. The present study tested the hypothesis that the mirror was more efficient because of its self-aspect.Methods: The mirror was compared (1) to the patient’s picture and to the picture of a famous face, in 22 patients in minimally Conscious State and (2) to the patient’s picture and a fake mirror, which had dynamical and bright aspects of the mirror, without reflecting the face, in 26 other patients in minimally Conscious State.Results: The mirror was more efficient than the patient’s picture, which was not statistically different from the famous face. The second part of the study confirmed the statistical difference between the mirror and the picture. However, the fake mirror was neither statistically different from the mirror nor from the picture.Conclusions: Alth...
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controlled clinical trial of repeated prefrontal tdcs in patients with chronic minimally Conscious State
Brain Injury, 2017Co-Authors: Aurore Thibaut, Camille Chatelle, Marieaurelie Bruno, Olivia Gosseries, Sarah Wannez, Annefrancoise Donneau, Steven LaureysAbstract:ABSTRACTObjectives: To assess the effects of repeated transcranial direct current stimulation (tDCS) sessions on the level of Consciousness in chronic patients in minimally Conscious State (MCS).Methods: In this randomized double-blind sham-controlled crossover study, we enrolled 16 patients in chronic MCS. For 5 consecutive days, each patient received active or sham tDCS over the left prefrontal cortex (2 mA during 20 min). Consciousness was assessed with the Coma Recovery Scale-Revised (CRS-R) before the first stimulation (baseline), after each stimulation (day 1–day 5) and 1 week after the end of each session (day 12).Results: A treatment effect (p = 0.013; effect size = 0.43) was observed at the end of the active tDCS session (day 5) as well as 1 week after the end of the active tDCS session (day 12; p = 0.002; effect size = 0.57). A longitudinal increase of the CRS-R total scores was identified for the active tDCS session (p < 0.001), while no change was found for the sham session (p = 0.64). Nine pa...
Nicholas D. Schiff - One of the best experts on this subject based on the ideXlab platform.
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Presynaptic dopamine deficit in minimally Conscious State patients following traumatic brain injury
Brain : a journal of neurology, 2019Co-Authors: Esteban A. Fridman, Joseph R. Osborne, Paul Mozley, Jonathan D. Victor, Nicholas D. SchiffAbstract:Dopaminergic stimulation has been proposed as a treatment strategy for post-traumatic brain injured patients in minimally Conscious State based on a clinical trial using amantadine, a weak dopamine transporter blocker. However, a specific contribution of dopaminergic neuromodulation in minimally Conscious State is undemonstrated. In a phase 0 clinical trial, we evaluated 13 normal volunteers and seven post-traumatic minimally Conscious State patients using 11C-raclopride PET to estimate dopamine 2-like receptors occupancy in the striatum and central thalamus before and after dopamine transporter blockade with dextroamphetamine. If a presynaptic deficit was observed, a third and a fourth 11C-raclopride PET were acquired to evaluate changes in dopamine release induced by l-DOPA and l-DOPA+dextroamphetamine. Permutation analysis showed a significant reduction of dopamine release in patients, demonstrating a presynaptic deficit in the striatum and central thalamus that could not be reversed by blocking the dopamine transporter. However, administration of the dopamine precursor l-DOPA reversed the presynaptic deficit by restoring the biosynthesis of dopamine from both ventral tegmentum and substantia nigra. The advantages of alternative pharmacodynamic approaches in post-traumatic minimally Conscious State patients should be tested in clinical trials, as patients currently refractory to amantadine might benefit from them.
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neuromodulation of the Conscious State following severe brain injuries
Current Opinion in Neurobiology, 2014Co-Authors: Esteban A. Fridman, Nicholas D. SchiffAbstract:Disorders of Consciousness (DOC) following severe structural brain injuries globally affect the Conscious State and the expression of goal-directed behaviors. In some subjects, neuromodulation with medications or electrical stimulation can markedly improve the impaired Conscious State present in DOC. We briefly review recent studies and provide an organizing framework for considering the apparently widely disparate collection of medications and approaches that may modulate the Conscious State in subjects with DOC. We focus on neuromodulation of the anterior forebrain mesocircuit in DOC and briefly compare mechanisms supporting recovery from structural brain injuries to those underlying facilitated emergence from unConsciousness produced by anesthesia. We derive some general principles for approaching the problem of restoration of Consciousness after severe structural brain injuries, and suggest directions for future research.
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Central thalamic deep brain stimulation for support of forebrain arousal regulation in the minimally Conscious State.
Handbook of clinical neurology, 2013Co-Authors: Nicholas D. SchiffAbstract:This chapter considers the use of central thalamic deep brain stimulation (CT/DBS) to support arousal regulation mechanisms in the minimally Conscious State (MCS). CT/DBS for selected patients in a MCS is first placed in the historical context of prior efforts to use thalamic electrical brain stimulation to treat the unConscious clinical conditions of coma and vegetative State. These previous studies and a proof of concept result from a single-subject study of a patient in a MCS are reviewed against the background of new population data providing benchmarks of the natural history of vegetative and MCSs. The conceptual foundations for CT/DBS in selected patients in a MCS are then presented with consideration of both circuit and cellular mechanisms underlying recovery of Consciousness identified from empirical studies. Directions for developing future generalizable criteria for CT/DBS that focus on the integrity of necessary brain systems and behavioral profiles in patients in a MCS that may optimally response to support of arousal regulation mechanisms are proposed.
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arterial spin labeling and altered cerebral blood flow patterns in the minimally Conscious State
Neurology, 2011Co-Authors: Anli Liu, Jonathan P. Dyke, Henning U. Voss, Linda Heier, Nicholas D. SchiffAbstract:Objective: To use arterial spin labeling (ASL) to compare cerebral blood flow (CBF) patterns in minimally Conscious State (MCS) patients with those in normal controls in an observational study design. Methods: Subjects meeting MCS criteria and normal controls were identified. A pseudocontinuous ASL sequence was performed with subjects and controls in the resting awake State. Multiple CBF values for 10 predetermined regions of interest were sampled and average CBF was calculated and compared between controls and subjects. Results: Ten normal controls were identified, with ages ranging from 26 to 54 years. Four subjects met the MCS criteria and received an ASL study, with one patient receiving a second study at a later date. Subjects ranged in age from 19 to 58 years and had traumatic brain injury, stroke, or hypoxic-ischemic encephalopathy. Regional CBF for controls ranged from 21.6 to 57.2 mL/100 g/min, with a pattern of relatively increased blood flow posteriorly including the posterior cingulate, parietal, and occipital cortices. CBF patterns for MCS subjects showed greater variability (from 7.7 to 33.1 mL/100 g/min), demonstrating globally decreased CBF in gray matter compared with that in normal controls, especially in the medial prefrontal and midfrontal regions. In the one subject studied longitudinally, global CBF values increased over time, which correlated with clinical improvement. Conclusions: We identified globally decreased CBF and a selective reduction of CBF within the medial prefrontal and midfrontal cortical regions as well as gray matter in MCS patients. ASL may serve as an adjunctive method to assess functional reserve in patients recovering from severe brain injuries.
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Deep brain stimulation, neuroethics, and the minimally Conscious State: moving beyond proof of principle.
Archives of neurology, 2009Co-Authors: Nicholas D. Schiff, Joseph T Giacino, Joseph J. FinsAbstract:We briefly review the motivation, ethical framing, and results of a recent single-subject study of central thalamic deep brain stimulation (DBS) in a patient remaining in the chronic minimally Conscious State (MCS). In the study, a severely brain-injured human subject showed behavioral improvements in attentive responsiveness, limb control, recovery of oral feeding, and spoken language following central thalamic DBS. 1 These findings are placed into the context of, and contrasted with, prior efforts applying thalamic brain stimulation to patients in the vegetative State (VS). Efforts to develop DBS for recovery of function in the setting of disorders of Consciousness must meet several challenges presented by the expected wide variance of underlying brain injuries and need to carefully identify potential goals of therapeutic intervention. Although the study involved only a single subject, the results demonstrate a causal relationship between brain stimulation and cognitive recovery. The generalizability of these findings is completely unknown and the complexity of the problem will require careful and systematic research to move forward.
Giulio E. Lancioni - One of the best experts on this subject based on the ideXlab platform.
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a further evaluation of microswitch aided intervention for fostering responding and stimulation control in persons in a minimally Conscious State
Advances in Neurodevelopmental Disorders, 2018Co-Authors: Giulio E. Lancioni, Francesca Buonocunto, Jeff Sigafoos, Jorge Navarro, Mark F Oreilly, Fiora Damico, Guya Devalle, Pietro Davide Trimarchi, Crocifissa LanzilottiAbstract:These two studies were aimed at replicating and extending previous research on the use of microswitch-aided intervention for persons in a minimally Conscious State (MCS). Study 1 was a new assessment of the effectiveness of such intervention in helping MCS persons increase functional responding to control environmental stimulation. Ten participants were included. Study 2 compared the effects of microswitch-aided intervention with the effects of typical environmental stimulation strategies on participants’ alertness and involvement (i.e., on keeping eyes open and/or displaying body movements). Eight of the ten participants of study 1 were involved in study 2. The results of study 1 confirmed the suitability of microswitch-aided intervention for promoting adaptive/functional responding and stimulation control in MCS persons. The results of study 2 showed that microswitch-aided intervention may have advantages over basic and elaborate stimulation strategies in terms of participants’ alertness and involvement. Based on the results of the two studies, microswitch-aided intervention might be considered a practical tool for helping MCS persons.
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cortical responses to salient nociceptive and not nociceptive stimuli in vegetative and minimal Conscious State
Frontiers in Human Neuroscience, 2015Co-Authors: Marina De Tommaso, Francesca Buonocunto, Jorge Navarro, Crocifissa Lanzillotti, Katia Ricci, P Livrea, Giulio E. LancioniAbstract:Aims Questions regarding perception of pain in non-communicating patients and the management of pain continue to raise controversy both at a clinical and ethical level. The aim of this study was to examine the cortical response to salient multimodal visual, acoustic, somatosensory electric non nociceptive and nociceptive laser stimuli and their correlation with the clinical evaluation. Methods: Five Vegetative State (VS), 4 Minimally Conscious State (MCS) patients and 11 age- and sex-matched controls were examined. Evoked responses were obtained by 64 scalp electrodes, while delivering auditory, visual, non-noxious electrical and noxious laser stimulation, which were randomly presented every 10 sec. Laser, somatosensory, auditory and visual evoked responses were identified as a negative-positive (N2-P2) vertex complex in the 500 msec post-stimulus time. We used Nociception Coma Scale-Revised (NCS-R) and Coma Recovery Scale (CRS-R) for clinical evaluation of pain perception and Consciousness impairment. Results: The laser evoked potentials (LEPs) were recognizable in all cases. Only one MCS patient showed a reliable cortical response to all the employed stimulus modalities. One VS patient did not present cortical responses to any other stimulus modality. In the remaining participants, auditory, visual and electrical related potentials were inconstantly present. Significant N2 and P2 latency prolongation occurred in both VS and MCS patients. The presence of a reliable cortical response to auditory, visual and electric stimuli was able to correctly classify VS and MCS patients with 90% accuracy. Laser P2 and N2 amplitudes were not correlated with the CRS-R and NCS-R scores, while auditory and electric related potentials amplitude were associated with the motor response to pain and Consciousness recovery. Discussion: pain arousal may be a primary function also in vegetative State patients while the relevance of other stimulus modalities may indicate the degre
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assistive technology to help persons in a minimally Conscious State develop responding and stimulation control performance assessment and social rating
NeuroRehabilitation, 2015Co-Authors: Giulio E. Lancioni, Nirbhay N. Singh, Francesca Buonocunto, Jeff Sigafoos, Jorge Navarro, Mark F Oreilly, Fiora Damico, Crocifissa Lanzilotti, Piero Fiore, Marisa MegnaAbstract:BACKGROUND: Post-coma persons in a minimally Conscious State (MCS) and with extensive motor impairment and lack of speech tend to be passive and isolated. OBJECTIVE: This study aimed to (a) further assess a technology-aided approach for fostering MCS participants’ responding and stimulation control and (b) carry out a social validation check about the approach. METHODS: Eight MCS participants were exposed to the aforementioned approach according to an ABAB design. The technology included optic, pressure or touch microswitches to monitor eyelid, hand or finger responses and a computer system that allowed those responses to produce brief periods of positive stimulation during the B (intervention) phases of the study. Eighty-four university psychology students and 42 care and health professionals were involved in the social validation check. RESULTS: The MCS participants showed clear increases in their response frequencies, thus producing increases in their levels of environmental stimulation input, during the B phases of the study. The students and care and health professionals involved in the social validation check rated the technology-aided approach more positively than a control condition in which stimulation was automatically presented to the participants. CONCLUSIONS: A technology-aided approach to foster responding and stimulation control in MCS persons may be effective and socially desirable.
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technology aided programs for post coma patients emerged from or in a minimally Conscious State
Frontiers in Human Neuroscience, 2014Co-Authors: Giulio E. Lancioni, Nirbhay N. Singh, Francesca Buonocunto, Marta Olivetti Belardinelli, Jeff Sigafoos, Jorge Navarro, Mark F Oreilly, Fiora Damico, Crocifissa Lanzilotti, Gabriele FerlisiAbstract:Post-coma persons in a minimally Conscious State (MCS) or emerged/emerging from such State (E-MCS), who are affected by extensive motor impairment and lack of speech, may develop an active role and interact with their environment with the help of technology-aided intervention programs. Although a number of studies have been conducted in this area during the last few years, new evidence about the efficacy of those programs is warranted. These three studies were an effort in that direction. Study I assessed a technology-aided program to enable six MCS participants to access preferred environmental stimulation independently. Studies II and III assessed technology-aided programs to enable six E-MCS participants to make choices. In Study II, three of those participants were led to choose among leisure and social stimuli, and caregiver interventions automatically presented to them. In Study III, the remaining three participants were led to choose (a) among general stimulus/intervention options (e.g., songs, video-recordings of family members, and caregiver interventions) and then (b) among variants of those options. The results of all three studies were largely positive with substantial increases of independent stimulation access for the participants of Study I and independent choice behavior for the participants of Studies II and III. The results were analyzed in relation to previous data and in terms of their implications for daily contexts working with MCS and E-MCS persons affected by multiple disabilities.
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technology aided leisure and communication opportunities for two post coma persons emerged from a minimally Conscious State and affected by multiple disabilities
Research in Developmental Disabilities, 2013Co-Authors: Giulio E. Lancioni, Nirbhay N. Singh, Francesca Buonocunto, Jeff Sigafoos, Valentina Sacco, Jorge Navarro, Mark F Oreilly, Crocifissa Lanzilotti, Marina De Tommaso, Marisa MegnaAbstract:This study assessed technology-aided programs for helping two post-coma persons, who had emerged from a minimally Conscious State and were affected by multiple disabilities, to (a) engage with leisure stimuli and request caregiver's procedures, (b) send out and listen to text messages for communication with distant partners, and (c) combine leisure engagement and procedure requests with text messaging within the same sessions. The program for leisure engagement and procedure requests relied on the use of a portable computer with commercial software, and a microswitch for the participants' response. The program for text messaging communication involved the use of a portable computer, a GSM modem, a microswitch for the participants' response, and specifically developed software. Results indicated that the participants were successful at each of the three stages of the study, thus providing relevant evidence concerning performance achievements only minimally documented. The implications of the findings in terms of technology and practical opportunities for post-coma persons with multiple disabilities are discussed.
Joseph T Giacino - One of the best experts on this subject based on the ideXlab platform.
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minimally Conscious State plus diagnostic criteria and relation to functional recovery
Journal of Neurology, 2020Co-Authors: Aurore Thibaut, Yelena G. Bodien, Steven Laureys, Joseph T GiacinoAbstract:We investigated the relationship between three language-dependent behaviors (i.e., command-following, intelligible verbalization, and intentional communication) and the functional status of patients with disorders of Consciousness (DoC). We hypothesized that patients in minimally Conscious State (MCS) who retain behavioral evidence of preserved language function would have similar levels of functional disability, while patients who lack these behaviors would demonstrate significantly greater disability. We reasoned that these results could then be used to establish empirically-based diagnostic criteria for MCS+. In this retrospective cohort study we included rehabilitation inpatients diagnosed with DoC following severe-acquired brain injury (MCS = 57; vegetative State/unresponsive wakefulness syndrome [VS/UWS] = 63); women: 46; mean age: 47 ± 19 years; traumatic etiology: 68; time post-injury: 40 ± 23 days). We compared the scores of the Disability Rating Scale score (DRS) at time of transition from VS/UWS to MCS or from MCS– to MCS+, and at discharge between groups. Level of disability on the DRS was similar in patients with any combination of the three language-related behaviors. MCS patients with no behavioral evidence of language function (i.e., MCS–) were more functionally impaired than patients with MCS+ at time of transition and at discharge. Command-following, intelligible verbalization, and intentional communication are not associated with different levels of functional disability. Thus, the MCS+ syndrome can be diagnosed based on the presence of any one of these language-related behaviors. Patients in MCS+ may evidence less functional disability compared to those in MCS who fail to demonstrate language function (i.e., MCS–).
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cognitive impairment clinical symptoms and functional disability in patients emerging from the minimally Conscious State
NeuroRehabilitation, 2020Co-Authors: Yelena G. Bodien, Géraldine Martens, Joseph Ostrow, Kristen Sheau, Joseph T GiacinoAbstract:Background Although emergence from the minimally Conscious State (eMCS) is associated with symptoms including disorientation, memory and attention impairment, restlessness, and significant functional disability, the neurobehavioral profile of eMCS has not been empirically characterized. Objective Determine degree of cognitive impairment, presence of clinical symptoms and functional disability at time eMCS in patients with traumatic and non-traumatic brain injury (TBI, nTBI). Methods Retrospective observational study of 169 adults (median [interquartile range] age: 51 [29, 62] years; male: 116; TBI: 103) who emerged from MCS based on the Coma Recovery Scale-Revised while in an inpatient Disorders of Consciousness program. Outcome measures include the Confusion Assessment Protocol (CAP) and Disability Rating Scale (DRS). Results CAP administration was attempted in 54 subjects. Twenty-eight subjects had valid scores on all CAP items, with a median [interquartile range] of 4 [3-5] symptoms of confusion. Scores in 93% of this subsample were consistent with an acute confusional State. The most common symptoms were cognitive impairment (98% of subjects), disorientation (93%), and agitation (69%). The median DRS score upon emergence from MCS was 14.5 [13, 16], indicating severe disability (n = 140). Conclusions eMCS is associated with an acute confusional State and severe disability. This finding may inform the lower boundary of confusion as well as approach to treatment and caregiver education.
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Minimally Conscious State
The Neurology of Conciousness, 2016Co-Authors: Caroline Schnakers, Brian L. Edlow, Camille Chatelle, Joseph T GiacinoAbstract:The minimally Conscious State (MCS) is a condition of severely altered Consciousness that is distinguished from the vegetative State (VS) by the presence of minimal but clearly discernible behavioral evidence of self or environmental awareness. There is increasing evidence from neurobehavioral and neuroimaging studies that important differences in clinical presentation, neuropathology and functional outcome exist between MCS and VS. This chapter describes the characteristic features of MCS, discusses specialized assessment techniques required for accurate diagnosis, outlines potential pathophysiologic mechanisms underlying MCS, describes the effectiveness of existing treatment interventions, identifies key issues in clinical practice and offers new directions for further scientific inquiry.
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a multicentre study of intentional behavioural responses measured using the coma recovery scale revised in patients with minimally Conscious State
Clinical Rehabilitation, 2015Co-Authors: Anna Estraneo, Joseph T Giacino, Pasquale Moretta, Viviana Cardinale, Antonio De Tanti, Giordano Gatta, Luigi TrojanoAbstract:Objective:To investigate which Conscious behaviour is most frequently detected using the Coma Recovery Scale-Revised in patients with minimally Conscious State.Design:Multicentre, cross-sectional study.Setting:One intensive care unit, 8 post-acute rehabilitation centres and 2 long-term facilities.Subjects:Fifty-two patients with established diagnosis of minimally Conscious State of different aetiology.Main measures:All patients were assessed by the Coma Recovery Scale-Revised.Results:In most patients (34/52) non-reflexive responses were identified by two or more subscales of the Coma Recovery Scale-Revised, whereas in 14 patients only the visual subscale could identify cortically-mediated behaviours, and in the remaining 4 patients only the motor subscale did so.The clinical signs of intentional behaviour were most often detected by the visual subscale (43/52 patients) and by the motor subscale (31/52), and least frequently by the oromotor/verbal subscale (3/52) of the Coma Recovery Scale-Revised. This cl...
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Neurophysiological Indicators of Residual Cognitive Capacity in the Minimally Conscious State.
Behavioural Neurology, 2015Co-Authors: Solveig Lægreid Hauger, Joseph T Giacino, Caroline Schnakers, Stein Andersson, Frank Becker, Torgeir Moberget, Anne-kristine Schanke, Marianne LøvstadAbstract: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.
Jeff Sigafoos - One of the best experts on this subject based on the ideXlab platform.
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a further evaluation of microswitch aided intervention for fostering responding and stimulation control in persons in a minimally Conscious State
Advances in Neurodevelopmental Disorders, 2018Co-Authors: Giulio E. Lancioni, Francesca Buonocunto, Jeff Sigafoos, Jorge Navarro, Mark F Oreilly, Fiora Damico, Guya Devalle, Pietro Davide Trimarchi, Crocifissa LanzilottiAbstract:These two studies were aimed at replicating and extending previous research on the use of microswitch-aided intervention for persons in a minimally Conscious State (MCS). Study 1 was a new assessment of the effectiveness of such intervention in helping MCS persons increase functional responding to control environmental stimulation. Ten participants were included. Study 2 compared the effects of microswitch-aided intervention with the effects of typical environmental stimulation strategies on participants’ alertness and involvement (i.e., on keeping eyes open and/or displaying body movements). Eight of the ten participants of study 1 were involved in study 2. The results of study 1 confirmed the suitability of microswitch-aided intervention for promoting adaptive/functional responding and stimulation control in MCS persons. The results of study 2 showed that microswitch-aided intervention may have advantages over basic and elaborate stimulation strategies in terms of participants’ alertness and involvement. Based on the results of the two studies, microswitch-aided intervention might be considered a practical tool for helping MCS persons.
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assistive technology to help persons in a minimally Conscious State develop responding and stimulation control performance assessment and social rating
NeuroRehabilitation, 2015Co-Authors: Giulio E. Lancioni, Nirbhay N. Singh, Francesca Buonocunto, Jeff Sigafoos, Jorge Navarro, Mark F Oreilly, Fiora Damico, Crocifissa Lanzilotti, Piero Fiore, Marisa MegnaAbstract:BACKGROUND: Post-coma persons in a minimally Conscious State (MCS) and with extensive motor impairment and lack of speech tend to be passive and isolated. OBJECTIVE: This study aimed to (a) further assess a technology-aided approach for fostering MCS participants’ responding and stimulation control and (b) carry out a social validation check about the approach. METHODS: Eight MCS participants were exposed to the aforementioned approach according to an ABAB design. The technology included optic, pressure or touch microswitches to monitor eyelid, hand or finger responses and a computer system that allowed those responses to produce brief periods of positive stimulation during the B (intervention) phases of the study. Eighty-four university psychology students and 42 care and health professionals were involved in the social validation check. RESULTS: The MCS participants showed clear increases in their response frequencies, thus producing increases in their levels of environmental stimulation input, during the B phases of the study. The students and care and health professionals involved in the social validation check rated the technology-aided approach more positively than a control condition in which stimulation was automatically presented to the participants. CONCLUSIONS: A technology-aided approach to foster responding and stimulation control in MCS persons may be effective and socially desirable.
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technology aided programs for post coma patients emerged from or in a minimally Conscious State
Frontiers in Human Neuroscience, 2014Co-Authors: Giulio E. Lancioni, Nirbhay N. Singh, Francesca Buonocunto, Marta Olivetti Belardinelli, Jeff Sigafoos, Jorge Navarro, Mark F Oreilly, Fiora Damico, Crocifissa Lanzilotti, Gabriele FerlisiAbstract:Post-coma persons in a minimally Conscious State (MCS) or emerged/emerging from such State (E-MCS), who are affected by extensive motor impairment and lack of speech, may develop an active role and interact with their environment with the help of technology-aided intervention programs. Although a number of studies have been conducted in this area during the last few years, new evidence about the efficacy of those programs is warranted. These three studies were an effort in that direction. Study I assessed a technology-aided program to enable six MCS participants to access preferred environmental stimulation independently. Studies II and III assessed technology-aided programs to enable six E-MCS participants to make choices. In Study II, three of those participants were led to choose among leisure and social stimuli, and caregiver interventions automatically presented to them. In Study III, the remaining three participants were led to choose (a) among general stimulus/intervention options (e.g., songs, video-recordings of family members, and caregiver interventions) and then (b) among variants of those options. The results of all three studies were largely positive with substantial increases of independent stimulation access for the participants of Study I and independent choice behavior for the participants of Studies II and III. The results were analyzed in relation to previous data and in terms of their implications for daily contexts working with MCS and E-MCS persons affected by multiple disabilities.
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technology aided leisure and communication opportunities for two post coma persons emerged from a minimally Conscious State and affected by multiple disabilities
Research in Developmental Disabilities, 2013Co-Authors: Giulio E. Lancioni, Nirbhay N. Singh, Francesca Buonocunto, Jeff Sigafoos, Valentina Sacco, Jorge Navarro, Mark F Oreilly, Crocifissa Lanzilotti, Marina De Tommaso, Marisa MegnaAbstract:This study assessed technology-aided programs for helping two post-coma persons, who had emerged from a minimally Conscious State and were affected by multiple disabilities, to (a) engage with leisure stimuli and request caregiver's procedures, (b) send out and listen to text messages for communication with distant partners, and (c) combine leisure engagement and procedure requests with text messaging within the same sessions. The program for leisure engagement and procedure requests relied on the use of a portable computer with commercial software, and a microswitch for the participants' response. The program for text messaging communication involved the use of a portable computer, a GSM modem, a microswitch for the participants' response, and specifically developed software. Results indicated that the participants were successful at each of the three stages of the study, thus providing relevant evidence concerning performance achievements only minimally documented. The implications of the findings in terms of technology and practical opportunities for post-coma persons with multiple disabilities are discussed.
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technology based intervention to help persons with minimally Conscious State and pervasive motor disabilities perform environmentally relevant adaptive behavior
Cognitive Processing, 2012Co-Authors: Giulio E. Lancioni, Nirbhay N. Singh, Jeff Sigafoos, Mark F Oreilly, Marta Olivetti BelardinelliAbstract:Persons with a diagnosis of minimally Conscious State and pervasive motor disabilities tend to be passive and isolated. A way to help them improve their adaptive behavior (relate to their environment) involves the use of intervention packages combining assistive technology with motivational strategies. The types of assistive technology included in those packages may consist of (a) microswitches allowing direct access to environmental stimuli, (b) combinations of microswitches and voice output communication devices (VOCAs) allowing stimulus access and calls for caregivers’ attention, respectively, and (c) computer presentations of stimulus options and microswitches allowing choice among those options and access to them.
