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Disorders of Consciousness, Disability Rights, and Triage During the Covid-19 Pandemic
Published in Joel Michael Reynolds, Christine Wieseler, The Disability Bioethics Reader, 2022
When a coma does not resolve to consciousness, patients progress to the vegetative state which represents the isolated recovery of the brain stem without higher cortical function. Patients in the vegetative state are clinically paradoxical to the untrained eye as theirs is an eyes opened state of unawareness. Because we often ascribe awareness to the opening of the eyes, this brain state can be very difficult for expectant families who expect that the opening of a loved one’s eyes coming out of a coma heralds recovery and the person that they knew. But when a coma evolves into the vegetative state, the eyes are open but there is neither awareness nor responsiveness.
Traumatic axonal injury
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Experimental work shows that extreme forces are necessary for axons to rupture immediately and that in virtually all head injuries, axotomy is likely to be a secondary, delayed event after injury as a result of damage to the axonal cytoskeleton. In those dying instantaneously to near-instantaneously after a severe head injury, whose brains show widespread white matter petechial and larger haemorrhages (referred to as diffuse traumatic vascular injury), it is generally assumed that widespread primary axotomy has occurred and that this is incompatible with life (Figure 11.1). This is an assumption made on the basis of widespread microvascular shearing (vessels having a higher tolerance for shearing than axons, thus implying widespread accompanying axonal injury as well). Apart from such circumstances dTAI is rarely a cause of death on its own. It is, however, a cause of prolonged coma and an important cause of vegetative state (Graham et al. 1983; Kinney and Samuels 1994; Adams et al. 1999) or severe post-traumatic neurological disability. TAI localised to the brainstem may be a cause of respiratory failure – indeed, this is probably an important mechanism of death in infant head injury (Geddes et al. 2001) and in those who have high cervical injuries.
Disorders of Consciousness
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Any unambiguous sign of clinical perception or deliberate action is incompatible with the vegetative state, and prolonged observation is required before concluding that apparent wakefulness is unaccompanied by awareness. The diagnosis of vegetative state should only be rendered by medical practitioners with appropriate training and experience in assessing the nervous system.
Prolonged disorders of consciousness: identification using the UK FIM + FAM and cohort analysis of outcomes from a UK national clinical database
Published in Disability and Rehabilitation, 2023
Lynne Turner-Stokes, Hilary Rose, Alison Knight, Heather Williams, Richard J. Siegert, Stephen A. Ashford
The National Clinical Guidelines for PDOC [2] define three levels of consciousness.Patients in vegetative states (VS) are awake but unaware of themselves or their surroundings, showing spontaneous and reflex responses only.Patients in a minimally conscious state (MCS) have inconsistent (but reproducible) localising or discriminative responses, indicating some awareness of their surroundings.Patients who have emerged into consciousness demonstrate consistent functional use of objects or communication, although they may still have profound physical, cognitive and communicative 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
Comatose state, vegetative state, (now frequently reported as unresponsive wakefulness syndrome), and minimally conscious state are three conditions associated to disorders of consciousness following brain injury [1,2]. Comatose state implies that the person is not arousable or difficult to arouse and allegedly not aware of him- or herself and the surrounding environment [2,3]. Vegetative state (or unresponsive wakefulness) implies that the person is awake but apparently unaware of (unresponsive to) the environment. Even so, the person may present a number of reflex responses such as grinding teeth and yawning [2,4]. Minimally conscious state implies that the person has fluctuating but reproducible signs of awareness, which may or may not involve the ability to follow some verbal commands and utter understandable words [1,2,5].
Conceptualizations of consciousness and continuation of care among family members and health professionals caring for patients in a minimally conscious state
Published in Disability and Rehabilitation, 2021
Kristin M. Kostick, Abby Halm, Katherine O'Brien, Sunil Kothari, Jennifer S. Blumenthal-Barby
Some providers (6, or 30%) took the opposite view (more similar to family views): that some consciousness is always better than none, even if pain is involved. Some providers rationalized that quality of life can be good and moments of pleasure can be experienced, and that a minimal level of consciousness opens a window for progress. One professional offered, “Even though they’re in pain, it’s better to be aware that they’re in pain as opposed to just being in a vegetative state where they can’t really feel it” (C12; exp.<x̄). One stated, “I think minimally conscious, there's still ability to have pleasure, have relationships, be able to communicate, so I do think there's a good quality of life for minimally conscious patients” (C5; exp.> x̄). On the point about the value of some consciousness for progress, one professional said: