Toward a coherent structuration of disorders of consciousness expertise at a country scale: A proposal for France

Naccache, Lionel; Luauté, Jacques; Silva, S.; Sitt, Jacobo; Rohaut, Benjamin

doi:10.1016/j.neurol.2021.12.004

Cited by 11 publications

(10 citation statements)

References 109 publications

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“… Elaborating a strategy for improving a multimodal diagnostic approach, particularly the use of neurotechnology (e.g., elaborating clear and consistent recommendations about when to use it, and introducing standards for the interpretation of emerging results) [ 28 , 29 ]. A promising model to further explore is, for instance, a structured approach to DoCs at the national level [ 30 ], possibly complementing it with relevant international collaborations. Developing a more robust, evidence-based recommendation on the frequency of the assessment of consciousness to better standardize clinical practice, for instance through the use of a simplified behavioral assessment [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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International survey on the implementation of the European and American guidelines on disorders of consciousness

Farisco,

Formisano,

Gosseries

et al. 2023

J Neurol

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Diagnostic, prognostic, and therapeutic procedures for patients with prolonged disorders of consciousness (pDoCs) vary significantly across countries and clinical settings, likely due to organizational factors (e.g., research vs. non-academic hospitals), expertise and availability of resources (e.g., financial and human). Two international guidelines, one from the European Academy of Neurology (EAN) and one from the American Academy of Neurology (AAN) in collaboration with the American Congress of Rehabilitation Medicine (ACRM) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), were developed to facilitate consistent practice among professionals working with this challenging patient population. While the recommendations of both guidelines agree in principle, it remains an open issue how to implement them into clinical practice in the care pathway for patients with pDoCs. We conducted an online survey to explore health professional clinical practices related to the management of patients with pDoCs, and compare said practices with selected recommendations from both the guidelines. The survey revealed that while some recommendations are being followed, others are not and/or may require more honing/specificity to enhance their clinical utility. Particular attention should be given to the implementation of a multimodal assessment of residual consciousness, to the detection and treatment of pain, and to the impact of restrictions imposed by COVID-19 pandemics on the involvement of patients’ families/representatives.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

International survey on the implementation of the European and American guidelines on disorders of consciousness

Farisco,

Formisano,

Gosseries

et al. 2023

J Neurol

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“…Exclusion criteria will be: presence of pacemaker or metallic cerebral implant, craniolacunia, ventricular peritoneal shunt, age <18 years, auditory injury as evaluated by anamnesis, history of neurological and psychiatric disease, previous stroke, use of alcohol or drugs, premorbid dementia. As recommended, a period of observation will be conducted for one week [46] twice a day by four independent examiners (physician, neuropsychologist, speech therapist and physiotherapist).…”

Section: Participantsmentioning

confidence: 99%

Musical and electrical stimulation as intervention in disorder of consciousness (DOC) patients: A randomised cross-over trial

Spaccavento,

Carraturo,

Brattico

et al. 2024

PLoS ONE

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Background Disorders of consciousness (DOC), i.e., unresponsive wakefulness syndrome (UWS) or vegetative state (VS) and minimally conscious state (MCS), are conditions that can arise from severe brain injury, inducing widespread functional changes. Given the damaging implications resulting from these conditions, there is an increasing need for rehabilitation treatments aimed at enhancing the level of consciousness, the quality of life, and creating new recovery perspectives for the patients. Music may represent an additional rehabilitative tool in contexts where cognition and language are severely compromised, such as among DOC patients. A further type of rehabilitation strategies for DOC patients consists of Non-Invasive Brain Stimulation techniques (NIBS), including transcranial electrical stimulation (tES), affecting neural excitability and promoting brain plasticity. Objective We here propose a novel rehabilitation protocol for DOC patients that combines music-based intervention and NIBS in neurological patients. The main objectives are (i) to assess the residual neuroplastic processes in DOC patients exposed to music, (ii) to determine the putative neural modulation and the clinical outcome in DOC patients of non-pharmacological strategies, i.e., tES(control condition), and music stimulation, and (iii) to evaluate the putative positive impact of this intervention on caregiver’s burden and psychological distress. Methods This is a randomised cross-over trial in which a total of 30 participants will be randomly allocated to one of three different combinations of conditions: (i) Music only, (ii) tES only (control condition), (iii) Music + tES. The music intervention will consist of listening to an individually tailored playlist including familiar and self-relevant music together with fixed songs; concerning NIBS, tES will be applied for 20 minutes every day, 5 times a week, for two weeks. After these stimulations two weeks of placebo treatments will follow, with sham stimulation combined with noise for other two weeks. The primary outcomes will be clinical, i.e., based on the differences in the scores obtained on the neuropsychological tests, such as Coma Recovery Scale-Revised, and neurophysiological measures as EEG, collected pre-intervention, post-intervention and post-placebo. Discussion This study proposes a novel rehabilitation protocol for patients with DOC including a combined intervention of music and NIBS. Considering the need for rigorous longitudinal randomised controlled trials for people with severe brain injury disease, the results of this study will be highly informative for highlighting and implementing the putative beneficial role of music and NIBS in rehabilitation treatments. Trial registration ClinicalTrials.gov identifier: NCT05706831, registered on January 30, 2023.

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“…[15]). Such impairments are summed up under the generic expression of "Disorders of Consciousness" (DoC) used in clinical practice to characterise patients who have regained the wakefulnesssleep cycle from a period of being comatose but have lost the ability to demonstrate overt behaviours and who are usually in one of the following states [16,17]: (i) vegetative state (VS) [18] recently dubbed unresponsive wakefulness syndrome (UWS) [19] and defined as a "clinical condition of complete unawareness of the self and the environment" (p. 1499 in Ref. [20]), (ii) minimally conscious state (MCS) [21] (now includes MCS-and MCS+ [22]), which is "a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated" (p. 350-351 in Ref.…”

Section: Introductionmentioning

confidence: 99%

Contemplating on the Nature of Selfhood in DoC Patients: Neurophenomenological Perspective

Fingelkurts¹,

Fingelkurts²

2023

J. Integr. Neurosci.

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Medical well-regarded policy recommendations for patients with disorders of consciousness (DoC) are almost exclusively relied on behavioural examination and evaluation of higher-order cognition, and largely disregard the patients' self. This is so because practically establishing the presence of self-awareness or Selfhood is even more challenging than evaluating the presence of consciousness. At the same time, establishing the potential (actual physical possibility) of Selfhood in DoC patients is crucialy important from clinical, ethical, and moral standpoints because Selfhood is the most central and private evidence of being an independent and free agent that unites intention, embodiment, executive functions, attention, general intelligence, emotions and other components within the intra-subjective frame (first-person givenness). The importance of Selfhood is supported further by the observation that rebooting of self-awareness is the first step to recovery after brain damage. It seems that complex experiential Selfhood can be plausibly conceptualized within the Operational Architectonics (OA) of brain-mind functioning and reliably measured by quantitative electroencephalogram (qEEG) operational synchrony.Keywords: disorders of consciousness (DoC); selfhood; self-consciousness; quantitative electroencephalogram (qEEG); first-person givenness; operational synchrony; brain; vegetative state (VS); minimally conscious state (MCS); unresponsive wakefulness syndrome (UWS)

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Toward a coherent structuration of disorders of consciousness expertise at a country scale: A proposal for France

Cited by 11 publications

References 109 publications

International survey on the implementation of the European and American guidelines on disorders of consciousness

International survey on the implementation of the European and American guidelines on disorders of consciousness

Musical and electrical stimulation as intervention in disorder of consciousness (DOC) patients: A randomised cross-over trial

Contemplating on the Nature of Selfhood in DoC Patients: Neurophenomenological Perspective

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