Promoting the use of personally relevant stimuli for investigating patients with disorders of consciousness

Abstract

Sensory stimuli are used to evaluate and to restore cognitive functions and consciousness in patients with a disorder of consciousness (DOC) following a severe brain injury. Although sophisticated protocols can help assessing higher order cognitive functions and awareness, one major drawback is their lack of sensitivity. The aim of the present review is to show that stimulus selection is crucial for an accurate evaluation of the state of patients with disorders of consciousness as it determines the levels of processing that the patient can have with stimulation from his/her environment. The probability to observe a behavioral response or a cerebral response is increased when her/his personal history and/or her/his personal preferences are taken into account. We show that personally relevant stimuli (i.e., with emotional, autobiographical, or self-related characteristics) are associated with clearer signs of perception than are irrelevant stimuli in patients with DOC. Among personally relevant stimuli, music appears to be a promising clinical tool as it boosts perception and cognition in patients with DOC and could also serve as a prognostic tool. We suggest that the effect of music on cerebral processes in patients might reflect the music’s capacity to act both on the external and internal neural networks supporting consciousness.

Cortical Response to the Natural Speech Envelope Correlates with Neuroimaging Evidence of Cognition in Severe Brain Injury

“…There are several limitations to the NSE method and its translation to clinical practice. In our study, we utilized personalized narratives that were recorded by the patient's family members; prior studies have demonstrated that personal and meaningful stimuli elicit more robust and reliable auditory responses in brain-injured patients [45]. However, acquiring personalized narratives imposes an additional time constraint relative to the use of standardized stimuli.…”

Dog-Assisted Therapy in Neurorehabilitation of Children with Severe Neurological Impairment: An Explorative Study

“…34 This might be a mechanism underlying the here documented effects of DAT, since studies have illustrated that personally and emotionally relevant stimuli induce higher-level activation in DOC patients with disorders of consciousness. 35,36 The high motivation to interact with an animal might also be based on the fact that caregiving is a core need of humans and forms a central part within attachment theory. 37 Caring for an animal is highly emotionally relevant for many people, since this need has been biologically relevant throughout human evolution.…”

Consciousness and Moral Status

“…It turns out that researchers have provisionally attempted to assess residual emotional function in some patients. But no systematic attempt to assess levels of emotional functioning has been conducted (see Perrin, Castro, Tillmann, and Luauté 2015 ). As a result, although it is known that patients with traumatic brain injuries retain some capacity for functional response to emotional and self-relevant stimuli, the level or complexity of their emotional lives is not well understood.…”