How should functional imaging of patients with disorders of consciousness contribute to their clinical rehabilitation needs?

Purpose of reviewWe discuss the problems of evidence-based neurorehabilitation in disorders of consciousness, and recent functional neuroimaging data obtained in the vegetative state and minimally conscious state. Recent findingsPublished data are insufficient to make recommendations for or against any of the neurorehabilitative treatments in vegetative state and minimally conscious state patients. Electrophysiological and functional imaging studies have been shown to be useful in measuring residual brain function in noncommunicative brain-damaged patients. Despite the fact that such studies could in principle allow an objective quantification of the putative cerebral effect of rehabilitative treatment in the vegetative state and minimally conscious state, they have so far not been used in this context. SummaryWithout controlled studies and careful patient selection criteria it will not be possible to evaluate the potential of therapeutic interventions in disorders of consciousness. There also is a need to elucidate the neurophysiological effects of such treatments. Integration of multimodal neuroimaging techniques should eventually improve our ability to disentangle differences in outcome on the basis of underlying mechanisms and better guide our therapeutic options in the challenging patient populations encountered following severe acute brain damage.

[1]  Y. Katayama,et al.  Deep brain stimulation therapy for the vegetative state , 2005, Neuropsychological rehabilitation.

[2]  K. Andrews,et al.  Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit , 1996, BMJ.

[3]  C. Fischer,et al.  Evoked potentials for the prediction of vegetative state in the acute stage of coma , 2005, Neuropsychological Rehabilitation.

[4]  N. Schiff,et al.  Neurophysiological correlates of persistent vegetative and minimally conscious states , 2005, Neuropsychological rehabilitation.

[5]  D K Menon,et al.  Neurometabolic coupling in the vegetative and minimally conscious states: preliminary findings , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[6]  Matthew H. Davis,et al.  The neural mechanisms of speech comprehension: fMRI studies of semantic ambiguity. , 2005, Cerebral cortex.

[7]  Matthew H. Davis,et al.  Residual auditory function in persistent vegetative state: a combined pet and fmri study , 2005, Neuropsychological rehabilitation.

[8]  M. Boly,et al.  Cerebral processing of auditory and noxious stimuli in severely brain injured patients: Differences between VS and MCS , 2005, Neuropsychological rehabilitation.

[9]  J. Bernat.  Chronic disorders of consciousness , 2006, The Lancet.

[10]  Matthew H. Davis,et al.  Detecting awareness in the vegetative state. , 2006, Science.

[11]  Dominique Morlet,et al.  Predictive value of sensory and cognitive evoked potentials for awakening from coma , 2004, Neurology.

[12]  B. Kotchoubey,et al.  Apallic syndrome is not apallic: is vegetative state vegetative? , 2005, Neuropsychological rehabilitation.

[13]  J. Giacino,et al.  Predictors of outcome in prolonged posttraumatic disorders of consciousness and assessment of medication effects: A multicenter study. , 2005, Archives of physical medicine and rehabilitation.

[14]  Lippincott Williams Wilkins.  Practice parameters , 1995, Neurology.

[15]  Nicholas D Schiff,et al.  Developing prosthetics to treat cognitive disabilities resulting from acquired brain injuries , 2002, Neurological research.

[16]  S Laureys,et al.  Restoration of thalamocortical connectivity after recovery from persistent vegetative state , 2000, The Lancet.

[17]  J. Giacino,et al.  The vegetative and minimally conscious states: current knowledge and remaining questions. , 2005, The Journal of head trauma rehabilitation.

[18]  J. Giacino,et al.  The minimally conscious state: Definition and diagnostic criteria , 2002, Neurology.

[19]  W. Sato,et al.  Use of the bispectral index during the early postresuscitative phase after out-of-hospital cardiac arrest , 2005, Journal of Anesthesia.

[20]  M. Boly,et al.  Residual cognitive function in comatose, vegetative and minimally conscious states , 2005, Current opinion in neurology.

[21]  Matthew H. Davis,et al.  Using a hierarchical approach to investigate residual auditory cognition in persistent vegetative state. , 2005, Progress in brain research.

[22]  Matthew H. Davis,et al.  Detecting Awareness in the Vegetative State , 2006, Science.

[23]  J. Fins,et al.  Constructing an ethical stereotaxy for severe brain injury: balancing risks, benefits and access , 2003, Nature Reviews Neuroscience.

[24]  A. Zeman.  What in the world is consciousness? , 2005, Progress in brain research.

[25]  A. Prevo,et al.  Children and young adults in a prolonged unconscious state due to severe brain injury: Outcome after an early intensive neurorehabilitation programme , 2005, Brain injury.

[26]  Joseph T. Giacino,et al.  Rehabilitative Management of Patients With Disorders of Consciousness: Grand Rounds , 2004, The Journal of head trauma rehabilitation.

[27]  K. Sunnerhagen,et al.  Outcome after severe brain damage, what makes the difference? , 2005, Brain injury.

[28]  N. Birbaumer,et al.  Information processing in severe disorders of consciousness: Vegetative state and minimally conscious state , 2005, Clinical Neurophysiology.

[29]  N. Schiff.  Modeling the minimally conscious state: measurements of brain function and therapeutic possibilities. , 2005, Progress in brain research.

[30]  F. Plum,et al.  Persistent vegetative state after brain damage. A syndrome in search of a name. , 1972, Lancet.

[31]  J. Guérit.  Neurophysiological patterns of vegetative and minimally conscious states , 2005, Neuropsychological rehabilitation.

[32]  B. Boeve,et al.  Paroxysmal sympathetic storms ("diencephalic seizures") after severe diffuse axonal head injury. , 1998, Mayo Clinic proceedings.

[33]  C. Fischer,et al.  Improved prediction of awakening or nonawakening from severe anoxic coma using tree-based classification analysis* , 2006, Critical care medicine.

[34]  J. Giacino,et al.  The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. , 2004, Archives of physical medicine and rehabilitation.

[35]  M. Coleman,et al.  Gender influence on the progression of HTLV-I associated myelopathy/tropical spastic paraparesis , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[36]  J. Giacino.  The minimally conscious state: defining the borders of consciousness. , 2005, Progress in brain research.

[37]  I. Rampil.  A Primer for EEG Signal Processing in Anesthesia , 1998, Anesthesiology.

[38]  K. Andrews.  International Working Party on the Management of the Vegetative State: summary report. , 1996, Brain injury.

[39]  A. Liberati,et al.  Sensory stimulation for brain injured individuals in coma or vegetative state. , 2002, The Cochrane database of systematic reviews.

[40]  S Laureys,et al.  Cerebral metabolism during vegetative state and after recovery to consciousness , 1999, Journal of neurology, neurosurgery, and psychiatry.

[41]  R. Tate,et al.  The minimally conscious state and recovery potential: a follow-up study 2 to 5 years after traumatic brain injury. , 2005, Archives of physical medicine and rehabilitation.

[42]  N. Childs,et al.  Accuracy of diagnosis of persistent vegetative state , 1993, Neurology.

[43]  M. Boly,et al.  Tracking the recovery of consciousness from coma. , 2006, The Journal of clinical investigation.

[44]  B. Kotchoubey,et al.  Event-related potential measures of consciousness: two equations with three unknowns. , 2005, Progress in brain research.

[45]  J. Stein,et al.  Clinical characteristics and rehabilitation outcomes of patients with posterior cerebral artery stroke. , 2005, Archives of physical medicine and rehabilitation.

[46]  R. Munday,et al.  The sensory modality assessment and rehabilitation technique (SMART): a valid and reliable assessment for vegetative state and minimally conscious state patients , 2004, Brain injury.

[47]  F. Manes,et al.  Assessing level of consciousness and cognitive changes from vegetative state to full recovery , 2005, Neuropsychological rehabilitation.

[48]  Manuel Schabus,et al.  Brain response to one's own name in vegetative state, minimally conscious state, and locked-in syndrome. , 2006, Archives of neurology.

[49]  D. Tresch,et al.  Clinical characteristics of patients in the persistent vegetative state. , 1991, Archives of internal medicine.

[50]  Dominique Morlet,et al.  Late auditory and event-related potentials can be useful to predict good functional outcome after coma. , 2005, Archives of physical medicine and rehabilitation.

[51]  Steve Majerus,et al.  Behavioral evaluation of consciousness in severe brain damage. , 2005, Progress in brain research.

[52]  N. Mann,et al.  Rehabilitation for traumatic brain injury. , 1998, Evidence report/technology assessment.

[53]  David Bates,et al.  The vegetative state: guidance on diagnosis and management. , 2003, Clinical medicine.

[54]  Multi-Society Task Force on Pvs.  Medical aspects of the persistent vegetative state (2). , 1994, The New England journal of medicine.

[55]  Caroline Schnakers,et al.  Bispectral analysis of electroencephalogram signals during recovery from coma: Preliminary findings , 2005, Neuropsychological rehabilitation.

[56]  Thilo Hinterberger,et al.  A device for the detection of cognitive brain functions in completely paralyzed or unresponsive patients , 2005, IEEE Transactions on Biomedical Engineering.

[57]  M J Campbell,et al.  The Wessex Head Injury Matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury , 2000, Clinical rehabilitation.

[58]  F Plum,et al.  fMRI reveals large-scale network activation in minimally conscious patients , 2005, Neurology.

[59]  Bruce D. McCandliss,et al.  Possible axonal regrowth in late recovery from the minimally conscious state. , 2006, The Journal of clinical investigation.