Neuropsychological rehabilitation
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Neuropsychol Rehabil · Jul 2005
ReviewPsychological needs of patients in low awareness states, their families, and health professionals.
Patients who have emerged from low awareness states may present with psychological needs that can be addressed via adapted formal clinical psychological interventions, or by behavioural techniques. Families of these patients may experience similar psychological reactions to relatives of any patients with severe brain injury, but there are also additional factors that are unique to patients in low awareness states. ⋯ The needs of clinicians working with these clients are also discussed. It is important that services attending to the needs of clients in low awareness states also have adequate support for both relatives and clinicians.
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Neuropsychol Rehabil · Jul 2005
Bispectral analysis of electroencephalogram signals during recovery from coma: preliminary findings.
The aim of this study was to investigate the accuracy of bispectral index (BIS), spectral edge frequency (SEF 95%), total power (TOTPOW) and frontal spontaneous electromyography (F-EMG) in monitoring consciousness in severely brain damaged patients. In 29 patients a total of 106 sedation-free and good quality EEG epochs were correlated with the level of consciousness as assessed by means of the Glasgow Liège Scale (GLS) and the Wessex Head Injury Matrix (WHIM). ⋯ An empirically defined BIS cut-off value of 50 differentiated unconscious patients (coma or vegetative state) from conscious patients (minimally conscious state or emergence from minimally conscious state) with a sensitivity of 75% and specificity of 75%. These preliminary findings are encouraging in the search for electrophysiological correlates of consciousness in severe acute brain damage.
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Twenty-one cases of a vegetative state (VS) caused by various kinds of brain damage were evaluated neurologically and electrophysiologically three months after brain injury. These cases were treated by deep brain stimulation (DBS) therapy, and followed up for over 10 years. The mesencephalic reticular formation was selected as a target in two cases, and the thalamic centre median-parafascicular (CM-pf) complex was selected as a target in the other 19 cases. ⋯ DBS therapy may be useful for allowing patients to emerge from a VS, if the candidates are selected according to appropriate neurophysiological criteria. A special neurorehabilitation system may be necessary for emergence from the bedridden state in the treatment of VS patients. Further, DBS therapy is expected to provide a useful method in minimally conscious state (MCS) patients to achieve consistent discernible behavioural evidence of consciousness, and emergence from the bedridden state.
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Neuropsychol Rehabil · Jul 2005
Electrical treatment of reduced consciousness: experience with coma and Alzheimer's disease.
The right median nerve can be stimulated electrically to help arouse the central nervous system for persons with reduced levels of consciousness. The mechanisms of central action include increased cerebral blood flow and raised levels of dopamine. There is 11 years of experience in the USA of using nerve stimulation for acute coma after traumatic brain injury. ⋯ Improvements in short-term memory and speech fluency have also been noted. Regardless of the aetiology of the coma or reduced level of awareness, electrical stimulation may serve as a catalyst to enhance central nervous system functions. It remains for the standard treatments and modalities to retrain the injured brain emerging from reduced levels of consciousness.
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Neuropsychol Rehabil · Jul 2005
Evoked potentials for the prediction of vegetative state in the acute stage of coma.
For comatose patients in intensive care units, it is important to anticipate their functional outcome as soon and as reliably as possible. Among clinical variables the Glasgow Coma Score (GCS) and the patient's pupil reactivity are the strongest predictive variables. Evoked potentials help to assess objectively brain function. ⋯ In anoxic coma the abolition of somatosensory evoked potentials (SEPs) is related to a poor outcome, defined as death or survival in a vegetative state, with a 100% specificity. Following traumatic brain injury, the predictive value for unfavourable outcome is 98.5% when there are no focal injuries likely to abolish SEP cortical components. In contrast, the presence of event-related evoked potentials, and particularly mismatched negativity (MMN), is a strong predictor of awakening and precludes comatose patients from moving to a permanent vegetative state (PVS).