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Neurology in Documentaries
Published in Eelco F. M. Wijdicks, Neurocinema—The Sequel, 2022
Most comatose patients and those in a minimally conscious state are cared for in a nursing home, but there are uniquely specialized centers, such as the JFK Medical Center, that admit patients for care and research. Disorders of consciousness, particularly when severe or prolonged, are artificially divided into minimally conscious state and persistent vegetative state, and physicians use several clinical tools to differentiate between the two. For families, discerning the different disorders is difficult, and there are moments when they think they see “more responsiveness.” For physicians, the challenge is to judge these reactions accurately and not to easily dismiss them as “reflexes.” Unfortunately, there are too many instances in which physicians have ignored families’ observations. Then, when patients improve, there is much consternation and distrust. Prolonged observation by multiple healthcare providers skilled in this work is the only way to ascertain a lack of awareness or improved responsiveness.50
Clinical aspects of head injury
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
A combination of local brain injuries, periods of reduced cerebral perfusion and shearing forces, which ‘disconnect’ the cerebral cortex from lower brainstem centres, leaves the vital brainstem centres functioning, providing homeostatic support for other body organs. Unfortunately, there may be little or no evidence of cognitive response or communication, even though brainstem reflexes, such as breathing and even swallowing, remain intact. If the victim displays some awareness of his or her surroundings, albeit inconsistently, the term minimally conscious state is used. The expression ‘’prolonged disorders of consciousness” encompasses both conditions (Royal College of Physicians 2013).
Best Interests in the Absence of Suffering
Published in Robert Wheeler, Clinical Law for Clinical Practice, 2020
As is usual in these cases, the judge employed the ‘Welfare checklist’ as an aide memoire to identify relevant factors that needed to be balanced against each other before he could reach a conclusion on where Tafida's best interests lay. Considering her wishes, feelings and emotional needs, characteristics relevant to her background that he derived from this enquiry, the religious context of her family life was plain to see. Using this approach, he found himself balancing evidence of Tafida's formative appreciation that life is precious and a wish to follow her parents’ religious practice against little or no evidence that she would have to endure pain or suffering. Noting there was a prospect that Tafida could ultimately be cared for by her family at home in the same manner as other children in a similar position in the United Kingdom, the judge concluded that he was ‘… satisfied that if Tafida was asked, she would not reject out of hand a situation in which she continued to live, albeit in a moribund and at best minimally conscious state, without pain and in the loving care of her dedicated family, consistent with her formative appreciation that life is precious, a wish to follow a parent's religious practice and a non-judgemental attitude to disability’.
Behavioral intervention approaches for people with disorders of consciousness: a scoping review
Published in Disability and Rehabilitation, 2022
Giulio E. Lancioni, Nirbhay N. Singh, Mark F. O’Reilly, Jeff Sigafoos, Lorenzo Desideri
The issue of intervention practicality may need to be addressed with regard to the different groups of people with disorders of consciousness. For comatose patients or patients in a vegetative state, the use of stories/messages seems to be the most practical intervention approach. In essence, stories/messages can be recorded and presented at preset times with very limited effort and time cost. On the other hand, the use of multiple stimulation strategies can be much more time consuming and demanding. Obviously, this comparison is very basic/partial and a cost–benefit comparison would be much more informative and accurate. Unfortunately, a cost–benefit comparison is at the moment impossible, given that the impact of the different intervention strategies was not compared by the studies reviewed. For patients in a minimally conscious state, all the different intervention strategies have been used with reasonably encouraging results. Again, from a purely practical standpoint, one could argue that the story/message-based strategy appears simpler and more economical than the others. The use of multiple stimulation involving the active presence of therapists, nurses, or family members [e.g., 34,55,56,58,64,65] or therapists and animals [e.g., 31] might be considered the most demanding strategy in terms of time and effort. Indeed, professionals or family members are required to play an active role throughout the intervention sessions. Moreover, animals need to be properly handled during the sessions and maintained in good health with consistent care.
Animal presence modulates frontal brain activity of patients in a minimally conscious state: A pilot study
Published in Neuropsychological Rehabilitation, 2022
Wanda Arnskötter, Valentine L. Marcar, Martin Wolf, Margret Hund-Georgiadis, Karin Hediger
Patients in a minimally conscious state (MCS) need early treatment to facilitate physical as well as cognitive recovery and to reduce the risk of long-term disability and institutionalization (Seel et al., 2013). Early onset stimulation in an enriching environment as an integrative part of early rehabilitation programmes has emerged as an effective treatment for encouraging MCS patients’ recovery (La Gattuta et al., 2018; Pistarini & Maggioni, 2018). A central component of this approach is an individualized and integral activation of the patient as well as the promotion of inner perception and emotional sensation (Zieger, 2002). Biographical or emotionally loaded stimuli lead to increased consciousness as well as an increase in vegetative responses and psychomotor reactions in MCS patients (Perrin et al., 2015). Animals are emotionally relevant stimuli for most people (Zieger, 2016) and animal-assisted therapy (AAT) is increasingly seen as an important component in early rehabilitation of patients with severe disorders of consciousness (Blankenburg et al., 2011; Böttger, 2008; Janssen & Zieger, 2009).
An assistive technology program for enabling five adolescents emerging from a minimally conscious state to engage in communication, occupation, and leisure opportunities
Published in Developmental Neurorehabilitation, 2022
Fabrizio Stasolla, Alessandro O. Caffò, Sara Bottiroli, Donatella Ciarmoli
People who have emerged from a coma may face significant challenges in their daily routines and activities. Whether residing in medical centers or family homes, they may require specific therapeutic and pharmacological attention with treatments delivered by specialists.1,2 Additionally, patients with traumatic brain injuries (TBI) and neurological disorders can require individualized rehabilitative programs capable of (a) promoting self-determination and independence, (b) emphasizing an active role and constructive engagement, (c) enhancing positive participation and improving their quality of life, and (d) reducing caregivers’ and families’ burden.3–6 Individuals emerging from a minimally conscious state may progressively acquire awareness of their clinical conditions (e.g., extensive motor disabilities and lack of speech added to communication failures) and may need individualized rehabilitation programs.7,8 Depending upon their behavioral repertoire and their level of consciousness (i.e., communication abilities), they may be supported with different functional and/or occupational interventions. For instance, social interaction and request and choice of preferred stimuli could be relevantly compromised among post-coma children and adolescents.9 In addition to music therapy, stimulation therapy, brain-computer interfaces, and transcranial deep stimulation, assistive technology-based interventions (AT) may be planned.10,11