Care and Neurorehabilitation in the Disorder of Consciousness: A Model in Progress

Abstract

The operational model and strategies developed at the Institute S. Anna-RAN to be applied in the care and neurorehabilitation of subjects with disorders of consciousness (DOC) are described. The institute units are sequentially organized to guarantee appropriate care and provide rehabilitation programs adapted to the patients' clinical condition and individual's needs at each phase of evolution during treatment in a fast turnover rate. Patients eligible of home care are monitored remotely. Transferring advanced technology to a stage of regular operation is the main mission. Responsiveness and the time windows characterized by better residual responsiveness are identified and the spontaneous/induced changes in the autonomic system functional state and biological parameters are monitored both in dedicated sessions and by means of an ambient intelligence platform acquiring large databases from traditional and innovative sensors and interfaced with knowledge management and knowledge discovery systems. Diagnosis of vegetative state/unresponsive wakefulness syndrome or minimal conscious state and early prognosis are in accordance with the current criteria. Over one thousand patients with DOC have been admitted and treated in the years 1998–2013. The model application has progressively shortened the time of hospitalization and reduced costs at unchanged quality of services.

Assessment and Intervention with Patients with Severe Disorders of Consciousness

“…The aforementioned learning test strategies and the complementary motor behavior evaluation tool recently described by Pignat et al (2016) could be interpreted as examples of those supplements/corrections (Di Perri et al 2016;Lancioni et al 2014a;Monti 2012). Second, repeating the assessment over time and using combinations of behavioral and electrophysiological or neuroimaging procedures for such an assessment would constitute important cautionary conditions to curb the risks connected with individual fluctuations and reduce misdiagnosis Dolce et al 2015;Gilutz et al 2015).…”

Outcomes of Neurorehabilitation Amongst Patients with Prolonged Disorders of Consciousness

“…However, this study was conducted amongst patients with acute onset of brain injury. (7) Limited and sparse data exist on the effects of sensory stimulation on patients with disorders of consciousness for a prolonged duration.…”

Toward Improving Diagnostic Strategies in Chronic Disorders of Consciousness: An Overview on the (Re-)Emergent Role of Neurophysiology

“…Table 1 shows the different assessments we reviewed with their main outcomes concerning significant MCS/UWS differentiation at group and individual level (i.e., disclosing patients with fLIS among those with UWS and MCS vs. UWS). Whether the clinical assessment remains fundamental and irreplaceable, the combinations of behavioral and electrophysiological/neuroimaging procedures represents an important, cautionary condition to reduce misdiagnosis [153][154][155][156][157][158][159]. Further electrophysiological studies are however required to confirm the values of basic and advanced neurophysiologic paradigms in DoC diagnosis, given that the moderate evidence concerning the possibility distinguishing MCS from UWS is in favor of a spared EEG reactivity, the presence of LEPs components, EPs features, and the PCI threshold [160].…”