NeuroRehabilitation
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The term persistent vegetative state (PVS) refers to the only circumstance in which an apparent dissociation of both components of consciousness is found, characterized by preservation of wakefulness with an apparent loss of awareness. Several authors have recently demonstrated by functional neuroimaging studies that a small subset of unresponsive "vegetative" patients may show unambiguous signs of consciousness and command following that is inaccessible to clinical examination at the bedside. The term "estado vegetativo" used in Spanish to describe the PVS syndrome by physicians came from the English-Spanish translation. ⋯ The European Task Force on Disorders of Consciousness has recently proposed a new term, unresponsive wakefulness syndrome (UWS), to assist society in avoiding the depreciatory term vegetative state. Our group has embraced the use of the new term UWS and might suggest that we change our concept and use of the term MCS to minimally responsive wakefulness state (MRWS), or minimally aware wakefulness state (MAWS). Medical terms must be current and avoid any pejorative description of patients, which will promote our abilities to serve humankind and challenge neuroscientists to offer society new and realistic hopes for neurorehabilitation.
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NeuroRehabilitation · Jan 2012
Detection of hemorrhagic and axonal pathology in mild traumatic brain injury using advanced MRI: implications for neurorehabilitation.
There is a need to more accurately diagnose milder traumatic brain injuries with increasing awareness of the high prevalence in both military and civilian populations. Magnetic resonance imaging methods may be capable of detecting a number of the pathoanatomical and pathophysiological consequences of focal and diffuse traumatic brain injury. Susceptibility-weighted imaging (SWI) detects heme iron and reveals even small venous microhemorrhages occurring in diffuse vascular injury. Diffusion tensor imaging (DTI) reveals axonal injury by detecting alterations in water flow in and around injured axons. The overarching hypothesis of this paper is that newer, advanced MR imaging generates sensitive biomarkers of regional brain injury which allows for correlation with clinical signs and symptoms. ⋯ Animal data gave important tissue correlations with imaging results. SWI and DTI are commercially available sequences that can improve the diagnostic and prognostic ability of the trauma clinician. These biomarkers of regional brain injury which are present in imaging shortly after acute injury and persist indefinitely can inform clinicians and researchers about not only injury severity but also which neurobehavioral systems were injured. Analogous to stroke rehabilitation, having an understanding of the distribution of brain injury should ultimately allow for development of more effective rehabilitation strategies and more efficient clinical interventional trials.
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NeuroRehabilitation · Jan 2011
Review Historical ArticleDisorders of consciousness: what's in a name?
Following a coma, some patients may "awaken" without voluntary interaction or communication with the environment. More than 40 years ago this condition was coined coma vigil or apallic syndrome and later became worldwide known as "persistent vegetative state". About 10 years ago it became clear that some of these patients who failed to recover verbal or non-verbal communication did show some degree of consciousness--a condition called "minimally conscious state". ⋯ These neuroimaging studies have also demonstrated that a small subset of unresponsive "vegetative" patients may show unambiguous signs of consciousness and command following inaccessible to bedside clinical examination. These findings, together with negative associations intrinsic to the term "vegetative state" as well as the diagnostic errors and their potential effect on the treatment and care for these patients gave rise to the recent proposal for an alternative neutral and more descriptive name: unresponsive wakefulness syndrome. We here give an overview of PET and (functional) MRI studies performed in these challenging patients and stress the need for a separate ICD-9-CM diagnosis code and MEDLINE MeSH entry for "minimally conscious state" as the lack of clear distinction between vegetative state/unresponsive wakefulness syndrome and minimally conscious state may encumber scientific studies in the field of disorders of consciousness.
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NeuroRehabilitation · Jan 2011
ReviewDo racial and ethnic minority patients fare worse after SCI?: a critical review of the literature.
A number of researchers have identified differences in SCI outcomes between racial and ethnic groups, but findings have never been synthesized to give clinicians and researchers a coherent picture of the problem. The goals of the current project were to (1) conduct a critical literature review of studies specifically investigating racial and ethnic disparities in spinal cord injury care, services, and outcomes; (2) explore possible causative factors that may explain these disparities; (3) propose strategies that may reduce disparities and improve access, service, and outcomes for minority patients with SCI; and (4) generate ideas for future research in this area. ⋯ Results indicated that after an SCI, racial and ethnic minority groups have shorter hospital lengths of stay, higher rehospitalizations rates, higher levels of depression, more days in poor health, greater degrees of unemployment, more difficulties with mobility, lower self-reported subjective well-being and quality of life and life satisfaction, and greater risk of marital breakup. A variety of causative factors, intervention strategies, and directions for future research are presented.
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Neuroimaging at all stages of a traumatic brain injury (TBI) provides information about gross brain pathology. In this review, post-mortem TBI cases are matched to neuroimaging findings from TBI survivors to demonstrate the close correlation between observable pathology with in vivo neuroimaging to the underlying neuropathology. ⋯ The role of hippocampal atrophy and thalamic injury along with the vulnerability of the corpus callosum in TBI are also reviewed. The aim of this review is to provide pathological confirmation of observable neuroimaging abnormalities that relate directly to trauma-induced effects of the injury.