Longitudinal Outcome of Patients with Disordered Consciousness in the NIDRR TBI Model Systems Programs

Nakase‐Richardson, Risa; Whyte, John; Giacino, Joseph T.; Pavawalla, Shital P.; Barnett, Scott D.; Yablon, Stuart A.; Sherer, Mark; Kalmar, Kathleen; Hammond, Flora M.; Greenwald, Brian D.; Horn, Lawrence J.; Seel, Ron; McCarthy, Marissa; Tran, Johanna; Walker, William C.

doi:10.1089/neu.2011.1829

Cited by 205 publications

(156 citation statements)

References 27 publications

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“…Diagnosis drives the approach to treatment, and is strongly associated with functional outcome. 7,8 Augmentative communication training, for example, should be deferred until the patient transitions to MCS and demonstrates evidence of language comprehension. The clinical examination should be designed to identify the key distinguishing features ( Table 1), so that the prognosis can be established and appropriate therapeutic interventions initiated as early as possible.…”

Section: Disorders Of Consciousnessmentioning

confidence: 99%

“…Prognoses often lack nuance, and are invariably viewed as poor. Despite observations that 68% of patients with traumatic brain injury on inpatient rehabilitation services regained consciousness and, of those, close to 20% regained functional independence, 8 families of patients in the acute care setting are routinely counselled to make decisions to withhold or withdraw life-sustaining therapies, pursue palliative care recommendations or consent to organ donation before a patient's prognosis-or even diagnosis-is clear (J. J. Fins, unpublished work). [171][172][173][174][175] Access to rehabilitation Patients who have neither died from their injuries nor succumbed to pressures to withhold or withdraw care face substantial challenges on discharge from hospital.…”

Section: Ethical and Policy Considerationsmentioning

confidence: 99%

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Disorders of consciousness after acquired brain injury: the state of the science

et al. 2014

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| The concept of consciousness continues to defy definition and elude the grasp of philosophical and scientific efforts to formulate a testable construct that maps to human experience. Severe acquired brain injury results in the dissolution of consciousness, providing a natural model from which key insights about consciousness may be drawn. In the clinical setting, neurologists and neurorehabilitation specialists are called on to discern the level of consciousness in patients who are unable to communicate through word or gesture, and to project outcomes and recommend approaches to treatment. Standards of care are not available to guide clinical decision-making for this population, often leading to inconsistent, inaccurate and inappropriate care. In this Review, we describe the state of the science with regard to clinical management of patients with prolonged disorders of consciousness. We review consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures. We conclude with a provocative discussion of bioethical and medicolegal issues that are unique to this population and have a profound impact on care, as well as raising questions of broad societal interest.

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Section: Disorders Of Consciousnessmentioning

confidence: 99%

Section: Ethical and Policy Considerationsmentioning

confidence: 99%

Disorders of consciousness after acquired brain injury: the state of the science

et al. 2014

Self Cite

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“…Conséquemment, Giacino et al [58] ont suggéré une révision des données relatives au pronostic de récupération chez ces patients. Les résultats d'études récentes, prenant en compte la distinction entre EV/ENR et ECM, ont notamment révélé qu'une minorité de patients ayant été diagnostiqués en EV/ENR ou en ECM à 1 an démontre une amélioration continue jusqu'à 5 ans après l'accident [59,60]. Par ailleurs, les patients souffrant d'un ECM d'origine traumatique pré-sentent un pronostic de récupération plus favorable et montrent une moindre incapacité fonctionnelle comparativement aux patients en EV/ENR et aux patients en ECM d'origine non traumatique [61].…”

Section: Pronosticunclassified

Diagnostic, pronostic et traitements des troubles de la conscience

Cassol

Aubinet

Thibaut

et al. 2018

NPG Neurologie - Psychiatrie - Gériatrie

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ARTICLE IN PRESSSummary Advances in medicine and intensive care have led to an increase in the number of patients surviving a severe brain injury. Although some patients recover quickly, others remain in a state of altered consciousness. These patients can progress from a coma to a vegetative state or unresponsive wakefulness syndrome (VS/UWS) and later to a minimally conscious state (MCS). In this review, we first describe the different behavioral and neuroimaging methods used in the diagnosis of patients in an altered state of consciousness. We then describe the factors that can influence the prognosis and recovery of these patients, as well as the treatment and therapeutic management that can be proposed in order to improve their state of consciousness. Finally, we conclude this review by highlighting ethical considerations and end-of-life issues.

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“…123 Recovery from MCS has been commonly documented within 6 months of TBI or stroke 76,87 and even more than 1 year following injury. 36,109 These challenges in interpreting the efficacy of DBS in treating consciousness disorders may be overcome through the use of double-blind and/or placebo-controlled prospective studies.…”

Section: Dbs In the Mcsmentioning

confidence: 99%

Neurostimulation for traumatic brain injury

Shin

Dixon²,

Okonkwo³

et al. 2014

JNS

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Traumatic brain injury (TBI) remains a significant public health problem and is a leading cause of death and disability in many countries. Durable treatments for neurological function deficits following TBI have been elusive, as there are currently no FDA-approved therapeutic modalities for mitigating the consequences of TBI. Neurostimulation strategies using various forms of electrical stimulation have recently been applied to treat functional deficits in animal models and clinical stroke trials. The results from these studies suggest that neurostimulation may augment improvements in both motor and cognitive deficits after brain injury. Several studies have taken this approach in animal models of TBI, showing both behavioral enhancement and biological evidence of recovery. There have been only a few studies using deep brain stimulation (DBS) in human TBI patients, and future studies are warranted to validate the feasibility of this technique in the clinical treatment of TBI. In this review, the authors summarize insights from studies employing neurostimulation techniques in the setting of brain injury. Moreover, they relate these findings to the future prospect of using DBS to ameliorate motor and cognitive deficits following TBI.

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Longitudinal Outcome of Patients with Disordered Consciousness in the NIDRR TBI Model Systems Programs

Cited by 205 publications

References 27 publications

Disorders of consciousness after acquired brain injury: the state of the science

Disorders of consciousness after acquired brain injury: the state of the science

Diagnostic, pronostic et traitements des troubles de la conscience

Neurostimulation for traumatic brain injury

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