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Monti MM, Beekman R, Spivak NM, Thibaut A, Schnakers C, Whyte J, Molteni E. Common Data Element for Disorders of Consciousness: Recommendations from the Working Group on Therapeutic Interventions. Neurocrit Care 2024; 40:51-57. [PMID: 38030874 DOI: 10.1007/s12028-023-01873-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Over the past 30 years, there have been significant advances in the understanding of the mechanisms associated with loss and recovery of consciousness following severe brain injury. This work has provided a strong grounding for the development of novel restorative therapeutic interventions. Although all interventions are aimed at modulating and thereby restoring brain function, the landscape of existing interventions encompasses a very wide scope of techniques and protocols. Despite vigorous research efforts, few approaches have been assessed with rigorous, high-quality randomized controlled trials. As a growing number of exploratory interventions emerge, it is paramount to develop standardized approaches to reporting results. The successful evaluation of novel interventions depends on implementation of shared nomenclature and infrastructure. To address this gap, the Neurocritical Care Society's Curing Coma Campaign convened nine working groups and charged them with developing common data elements (CDEs). Here, we report the work of the Therapeutic Interventions Working Group. METHODS The working group reviewed existing CDEs relevant to therapeutic interventions within the National Institutes of Health National Institute of Neurological Disorders and Stroke database and reviewed the literature for assessing key areas of research in the intervention space. CDEs were then proposed, iteratively discussed and reviewed, classified, and organized in a case report form (CRF). RESULTS We developed a unified CRF, including CDEs and key design elements (i.e., methodological or protocol parameters), divided into five sections: (1) patient information, (2) general study information, (3) behavioral interventions, (4) pharmacological interventions, and (5) device interventions. CONCLUSIONS The newly created CRF enhances systematization of future work by proposing a portfolio of measures that should be collected in the development and implementation of studies assessing novel interventions intended to increase the level of consciousness or rate of recovery of consciousness in patients with disorders of consciousness.
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Affiliation(s)
- Martin M Monti
- Department of Psychology, University of California Los Angeles, 6522 Pritzker Hall, Los Angeles, CA, USA.
| | - Rachel Beekman
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Norman M Spivak
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | | | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | - Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
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Claassen J, Kondziella D, Alkhachroum A, Diringer M, Edlow BL, Fins JJ, Gosseries O, Hannawi Y, Rohaut B, Schnakers C, Stevens RD, Thibaut A, Monti M. Cognitive Motor Dissociation: Gap Analysis and Future Directions. Neurocrit Care 2024; 40:81-98. [PMID: 37349602 DOI: 10.1007/s12028-023-01769-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Patients with disorders of consciousness who are behaviorally unresponsive may demonstrate volitional brain responses to motor imagery or motor commands detectable on functional magnetic resonance imaging or electroencephalography. This state of cognitive motor dissociation (CMD) may have prognostic significance. METHODS The Neurocritical Care Society's Curing Coma Campaign identified an international group of experts who convened in a series of monthly online meetings between September 2021 and April 2023 to examine the science of CMD and identify key knowledge gaps and unmet needs. RESULTS The group identified major knowledge gaps in CMD research: (1) lack of information about patient experiences and caregiver accounts of CMD, (2) limited epidemiological data on CMD, (3) uncertainty about underlying mechanisms of CMD, (4) methodological variability that limits testing of CMD as a biomarker for prognostication and treatment trials, (5) educational gaps for health care personnel about the incidence and potential prognostic relevance of CMD, and (6) challenges related to identification of patients with CMD who may be able to communicate using brain-computer interfaces. CONCLUSIONS To improve the management of patients with disorders of consciousness, research efforts should address these mechanistic, epidemiological, bioengineering, and educational gaps to enable large-scale implementation of CMD assessment in clinical practice.
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Affiliation(s)
- Jan Claassen
- Department of Neurology, Neurological Institute, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Michael Diringer
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - Brian L Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joseph J Fins
- Division of Medical Ethics, Department of Medicine, Weill Cornell Medical College, NewYork Presbyterian Hospital, New York, NY, 10032, USA
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Yousef Hannawi
- Division of Cerebrovascular Diseases and Neurocritical Care, Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Benjamin Rohaut
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP) - Pitié Salpêtrière, Paris, France
| | | | - Robert D Stevens
- Department of Anesthesiology and Critical Care Medicine, Neurology, and Radiology, School of Medicine, Secondary Appointment in Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Martin Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
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Schnakers C, Zasler ND. Disorders of consciousness: A field in flux. NeuroRehabilitation 2024; 54:1. [PMID: 38217623 DOI: 10.3233/nre-246000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Affiliation(s)
- Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Nathan D Zasler
- Concussion Care Centre of Virginia, Ltd., Richmond, VA, USA
- Tree of Life Services, Inc., Richmond, VA, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA, USA
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Schnakers C. Assessing consciousness and cognition in disorders of consciousness. NeuroRehabilitation 2024; 54:11-21. [PMID: 38251070 DOI: 10.3233/nre-230140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Detecting willful cognition in these patients is known to be challenging due to the patients' motor disabilities and high vigilance fluctuations but also due to the lack of expertise and use of adequate tools to assess these patients in specific settings. This review will discuss the main disorders of consciousness after severe brain injury, how to assess consciousness and cognition in these patients, as well as the challenges and tools available to overcome these challenges and reach an accurate diagnosis.
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Affiliation(s)
- Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, 255 E. Bonita Avenue, Pomona, CA 91769, USA. Tel.: +1 909 596 7733 (ext. 3038); E-mail:
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Farisco M, Formisano R, Gosseries O, Kato Y, Koboyashi S, Laureys S, Lejeune N, Martial C, Matar A, Morrisey AM, Schnakers C, Yakufujiang M, Yamaki T, Veeramuthu V, Zandalasini M, Zasler N, Magliacano A, Estraneo A. International survey on the implementation of the European and American guidelines on disorders of consciousness. J Neurol 2024; 271:395-407. [PMID: 37740739 PMCID: PMC10770208 DOI: 10.1007/s00415-023-11956-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/25/2023]
Abstract
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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Affiliation(s)
- Michele Farisco
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden.
- Biogem, Biology and Molecular Genetics Research Institute, Ariano Irpino, AV, Italy.
| | | | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Shigeki Koboyashi
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- CERVO Brain Research Center, University of Laval, Québec, QC, Canada
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- CHN William Lennox, Ottignies-Louvain-La Neuve, Belgium
- Institute of NeuroScienceUCLouvain, Ottignies-Louvain-La Neuve, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Amal Matar
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Ann-Marie Morrisey
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Maidinamu Yakufujiang
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | - Tomohiro Yamaki
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | | | - Matteo Zandalasini
- Unità Spinale, Neuroriabilitazione E Medicina Riabilitativa Intensiva, Dipartimento Di Medicina Riabilitativa, Azienda USL Di Piacenza, Piacenza, Italy
| | - Nathan Zasler
- Concussion Care Centre of Virginia, LTD, Henrico, VA, 23233, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Alfonso Magliacano
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence and Sant'Angelo dei Lombardi, AV, Italy
| | - Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence and Sant'Angelo dei Lombardi, AV, Italy
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Farisco M, Formisano R, Gosseries O, Kato Y, Koboyashi S, Laureys S, Lejeune N, Martial C, Matar A, Morrisey AM, Schnakers C, Yakufujiang M, Yamaki T, Veeramuthu V, Zandalasini M, Zasler N, Magliacano A, Estraneo A. Correction to: International survey on the implementation of the European and American guidelines on disorders of consciousness. J Neurol 2024; 271:408-409. [PMID: 37991607 PMCID: PMC10769971 DOI: 10.1007/s00415-023-12083-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Michele Farisco
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden.
- Biogem, Biology and Molecular Genetics Research Institute, Ariano Irpino, AV, Italy.
| | | | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Shigeki Koboyashi
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- CERVO Brain Research Center, University of Laval, Québec, QC, Canada
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- CHN William Lennox, Ottignies-Louvain-La Neuve, Belgium
- Institute of NeuroScienceUCLouvain, Ottignies-Louvain-La Neuve, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Amal Matar
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Ann-Marie Morrisey
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Maidinamu Yakufujiang
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | - Tomohiro Yamaki
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | | | - Matteo Zandalasini
- Unità Spinale, Neuroriabilitazione E Medicina Riabilitativa Intensiva, Dipartimento Di Medicina Riabilitativa, Azienda USL Di Piacenza, Piacenza, Italy
| | - Nathan Zasler
- Concussion Care Centre of Virginia, LTD, Henrico, VA, 23233, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | | | - Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
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Yakhkind A, Niznick N, Bodien YG, Hammond FM, Katz D, Luaute J, McNett M, Naccache L, O'Brien K, Schnakers C, Sharshar T, Slomine BS, Giacino JT. Correction: Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Behavioral Phenotyping. Neurocrit Care 2023:10.1007/s12028-023-01874-3. [PMID: 37923969 DOI: 10.1007/s12028-023-01874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Affiliation(s)
- Aleksandra Yakhkind
- Department of Neurology, Tufts University School of Medicine, Boston, MA, USA
| | - Naomi Niznick
- Department of Medicine (Critical Care), The Ottawa Hospital, Ottawa, Canada
| | - Yelena G Bodien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Douglas Katz
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, and Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Jacques Luaute
- Department of Neuro-Rehabilitation, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Molly McNett
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Lionel Naccache
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Katherine O'Brien
- TIRR Disorders of Consciousness Program, TIRR Memorial Hermann Hospital, H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Tarek Sharshar
- Neurosciences, Pole Neuro, Sainte-Anne Hospital, Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Université Paris Cité, Paris, France
| | - Beth S Slomine
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA.
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
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Yakhkind A, Niznick N, Bodien YG, Hammond FM, Katz D, Luaute J, McNett M, Naccache L, O'Brien K, Schnakers C, Sharshar T, Slomine BS, Giacino JT. Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Behavioral Phenotyping. Neurocrit Care 2023:10.1007/s12028-023-01844-9. [PMID: 37726548 DOI: 10.1007/s12028-023-01844-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The recent publication of practice guidelines for management of patients with disorders of consciousness (DoC) in the United States and Europe was a major step forward in improving the accuracy and consistency of terminology, diagnostic criteria, and prognostication in this population. There remains a pressing need for a more precise brain injury classification system that combines clinical semiology with neuroimaging, electrophysiologic, and other biomarker data. To address this need, the National Institute of Neurological Disorders and Stroke launched the Common Data Elements (CDEs) initiative to facilitate systematic collection of high-quality research data in studies involving patients with neurological disease. The Neurocritical Care Society's Curing Coma Campaign expanded this effort in 2018 to develop CDEs for DoC. Herein, we present CDE recommendations for behavioral phenotyping of patients with DoC. METHODS The Behavioral Phenotyping Workgroup used a preestablished, five-step process to identify and select candidate CDEs that included review of existing National Institute of Neurological Disorders and Stroke CDEs, nomination and systematic vetting of new CDEs, CDE classification, iterative review, and approval of panel recommendations and development of corresponding case review forms. RESULTS We identified a slate of existing and newly proposed basic, supplemental, and exploratory CDEs that can be used for behavioral phenotyping of adult and pediatric patients with DoC. CONCLUSIONS The proposed behavioral phenotyping CDEs will assist with international harmonization of DoC studies and allow for more precise characterization of study cohorts, favorably impacting observational studies and clinical trials aimed at improving outcome in this population.
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Affiliation(s)
- Aleksandra Yakhkind
- Department of Neurology, Tufts University School of Medicine, Boston, MA, USA
| | - Naomi Niznick
- Department of Medicine (Critical Care), The Ottawa Hospital, Ottawa, Canada
| | - Yelena G Bodien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Douglas Katz
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, and Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Jacques Luaute
- Department of Neuro-Rehabilitation, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Molly McNett
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Lionel Naccache
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Katherine O'Brien
- TIRR Disorders of Consciousness Program, TIRR Memorial Hermann Hospital, H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Tarek Sharshar
- Neurosciences, Pole Neuro, Sainte-Anne Hospital, Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Université Paris Cité, Paris, France
| | - Beth S Slomine
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA.
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
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Winters B, Serpas D, Fullmer N, Hughes K, Kincaid J, Rosario ER, Schnakers C. Sleep Quality Should Be Assessed in Inpatient Rehabilitation Settings: A Preliminary Study. Brain Sci 2023; 13:brainsci13050718. [PMID: 37239190 DOI: 10.3390/brainsci13050718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES In this preliminary, longitudinal study, our objective was to assess changes in sleep quality during an inpatient stay in a rehabilitation setting in the United States and to relate changes to patients' demographic and clinical characteristics (i.e., age, gender, BMI, ethnicity, reason for hospitalization, pre-hospital living setting, prior diagnosis of sleep disorders, and mental health status). METHODS A total of 35 patients participated in this preliminary study (age = 61 ± 16 years old, 50% <65; BMI = 30 ± 7 kg/m2; 51% female; 51% Caucasian). The average length of hospitalization was 18 ± 8 days. Reasons for hospitalization included orthopedic-related issues (28%), spinal cord injury (28%), stroke (20%), and other (23%). In this sample, 23% had prior sleep disorders (mostly sleep apnea), and 60% came from an acute care unit. Patients' sleep quality was assessed using the Pittsburgh sleep quality index (PSQI) at admission and before discharge. Demographic and medical data were collected. Patients' mental health status was also assessed at the same intervals. Nighttime sound levels and the average number of sleep disturbances were also collected throughout the study (6 months). RESULTS Our data revealed that most patients had poor sleep (PSQI > 5) at admission (86%) and discharge (80%). Using a repeated ANOVA, a significant interaction was obtained between sleep quality and the presence of a diagnosed sleep disorder [F (1, 33) = 12.861, p = 0.001, η2p = 0.280]. The sleep quality of patients with sleep disorders improved over their stay, while the sleep of patients without such disorders did not. The mean nighttime sound collection level averages and peaks were 62.3 ± 5.1 dB and 86.1 ± 4.9 dB, respectively, and the average number of sleep disturbances was 2.6 ± 1.1. CONCLUSION The improved sleep observed in patients with vs. without sleep disorders might be related to the care received for treating such disorders over the stay. Our findings call for the better detection and management of poor sleep in acute inpatient rehabilitation settings. Furthermore, if our findings are replicated in the future, studies on the implementation of quiet times for medical staff, patients, and family should be performed to improve sleep quality in the inpatient rehabilitation setting.
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Affiliation(s)
- Benjamin Winters
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - Dylan Serpas
- Department of Psychology, University of South Florida, Tampa, FL 33620, USA
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
| | - Niko Fullmer
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
| | - Katie Hughes
- Department of Nursing, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
| | - Jennifer Kincaid
- Respiratory Care Services, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
| | - Emily R Rosario
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
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Magee WL, Narayanan A, O'Connor R, Haughey F, Wegener E, Chu BHL, Delargy M, Gray D, Seu AD, Siegert RJ, Tyas RJ, Yelden KC, Schnakers C. VALIDATION OF THE MUSIC THERAPY ASSESSMENT TOOL FOR AWARENESS IN DISORDERS OF CONSCIOUSNESS WITH THE COMA RECOVERY SCALE-REVISED. Arch Phys Med Rehabil 2023:S0003-9993(23)00175-2. [PMID: 37086939 DOI: 10.1016/j.apmr.2023.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVE To examine (1) the concurrent validity of the Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) with the criterion standard Coma Recovery Scale Revised (CRS-R) for outcomes of awareness in patients with prolonged disorders of consciousness (PDoC); (2) the relationship between MATADOC items and CRS-R function subscales (FS) in similar domains; and (3) determine if items/FS measure different constructs. DESIGN A prospective multicentric blinded study with repeated concurrent measures. SETTING 3 inpatient rehabilitation units. PARTICIPANTS Convenience sample of 74 adults with PDoC. MAIN OUTCOME MEASURE(S) The MATADOC protocol elicits behavioral responsiveness using live music in five tasks. A total score ranges 0-10 scoring behaviors across 14-items. The CRS-R uses a language-based protocol and scores observed responses ranging 0-23 in six FS. Both measures were delivered at 4 concurrent timepoints over two weeks. RESULTS Fair (k=0.238, p=.006) ranging to moderate (k=0.419, p<.001) significant agreement was found between CRS-R and MATADOC diagnostic outcomes. Fair-borderline moderate significant agreement was found for overall diagnostic outcomes across all diagnostic categories (k=0.397, p=.001). There was moderate significant agreement between measures for motor scores (.551≤k.571, p<.001) and visual outcomes (.192≤k.415, .001≤p<.005) but no agreement for item/FS outcomes assessing auditory responsiveness. Exploratory factor analysis of all items showed two factors, suggesting that MATADOC and CRS-R measure the same underlying latent variable (awareness) in different ways and could complement each other for diagnosis and intervention purposes. This was supported by scale analysis which showed increased reliability when the two scales are used together rather than separately. CONCLUSIONS Unlike the CRS-R, the music-based MATADOC scores auditory localization for complexity of response and categorizes these behaviors as conscious rather than reflexive. The MATADOC may supplement the CRS-R, having a particular role in interdisciplinary programming for providing a more robust assessment of auditory responsiveness due to using non-verbal musical stimuli.
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Affiliation(s)
- Wendy L Magee
- Temple University, Boyer College of Music and Dance, Music Education and Therapy.
| | - Ajit Narayanan
- Auckland University of Technology, School of Engineering, Computer and Mathematical Sciences, Department of Computer Science
| | - Rebecca O'Connor
- National Rehabilitation Hospital, Dublin, Ireland; Creative Arts Therapy Department, Music Therapy Department, University of Limerick, Ireland
| | - Fiona Haughey
- National Rehabilitation Hospital, Occupational Therapy Department, Dublin
| | - Erin Wegener
- Spectrum Health, Neuro Rehabilitation Services, Rehab and Nursing Center- Kalamazoo Ave, Music Therapy
| | - Bernice H L Chu
- Royal Hospital for Neuro-disability, Music Therapy Department
| | - Mark Delargy
- National Rehabilitation Hospital, Dublin, RCSI Dublin 2021
| | - Dee Gray
- National Rehabilitation Hospital, Creative Arts Therapy Department, Dublin
| | - Alika D Seu
- Spectrum Health, Neuro Rehabilitation Services, Rehab and Nursing Center- Kalamazoo Ave, Music Therapy
| | - Richard J Siegert
- Auckland University of Technology, School of Clinical Sciences, Department of Psychology and Neuroscience
| | - Rosanne J Tyas
- Royal Hospital for Neuro-disability, Music Therapy Department
| | - Kudret C Yelden
- Research Department, Royal Hospital for Neuro-disability, Neurological Rehabilitation, King's College Hospital NHS Trust
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11
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Magliacano A, Liuzzi P, Formisano R, Grippo A, Angelakis E, Thibaut A, Gosseries O, Lamberti G, Noé E, Bagnato S, Edlow BL, Lejeune N, Veeramuthu V, Trojano L, Zasler N, Schnakers C, Bartolo M, Mannini A, Estraneo A. Predicting Long-Term Recovery of Consciousness in Prolonged Disorders of Consciousness Based on Coma Recovery Scale-Revised Subscores: Validation of a Machine Learning-Based Prognostic Index. Brain Sci 2022; 13:51. [PMID: 36672033 PMCID: PMC9856168 DOI: 10.3390/brainsci13010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022] Open
Abstract
Prognosis of prolonged Disorders of Consciousness (pDoC) is influenced by patients' clinical diagnosis and Coma Recovery Scale-Revised (CRS-R) total score. We compared the prognostic accuracy of a novel Consciousness Domain Index (CDI) with that of clinical diagnosis and CRS-R total score, for recovery of full consciousness at 6-, 12-, and 24-months post-injury. The CDI was obtained by a combination of the six CRS-R subscales via an unsupervised machine learning technique. We retrospectively analyzed data on 143 patients with pDoC (75 in Minimally Conscious State; 102 males; median age = 53 years; IQR = 35; time post-injury = 1-3 months) due to different etiologies enrolled in an International Brain Injury Association Disorders of Consciousness Special Interest Group (IBIA DoC-SIG) multicenter longitudinal study. Univariate and multivariate analyses were utilized to assess the association between outcomes and the CDI, compared to clinical diagnosis and CRS-R. The CDI, the clinical diagnosis, and the CRS-R total score were significantly associated with a good outcome at 6, 12 and 24 months. The CDI showed the highest univariate prediction accuracy and sensitivity, and regression models including the CDI provided the highest values of explained variance. A combined scoring system of the CRS-R subscales by unsupervised machine learning may improve clinical ability to predict recovery of consciousness in patients with pDoC.
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Affiliation(s)
- Alfonso Magliacano
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Firenze, Italy
- Polo Specialistico Riabilitativo, Fondazione Don Carlo Gnocchi, 83054 Sant’Angelo dei Lombardi, Italy
| | - Piergiuseppe Liuzzi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Firenze, Italy
- Scuola Superiore Sant’Anna, Istituto di BioRobotica, 56025 Pontedera, Italy
| | | | | | - Efthymios Angelakis
- Neurosurgery Department, University of Athens Medical School, 11527 Athens, Greece
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness-University and University Hospital of Liège-Liège-Belgium, 4000 Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness-University and University Hospital of Liège-Liège-Belgium, 4000 Liège, Belgium
| | - Gianfranco Lamberti
- Neurorehabilitation and Vegetative State Unit E. Viglietta, 12100 Cuneo, Italy
| | - Enrique Noé
- IRENEA-Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, 46011 Valencia, Spain
| | - Sergio Bagnato
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Vigneswaran Veeramuthu
- Division of Clinical Neuropsychology, Thomson Hospital Kota Damansara, Petaling Jaya 47810, Malaysia
| | - Luigi Trojano
- Department of Psychology, University of Campania L. Vanvitelli, 81100 Caserta, Italy
| | - Nathan Zasler
- Concussion Care Centre of Virginia, Ltd., Richmond, VA 23233, USA
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
| | | | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Firenze, Italy
| | - Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Firenze, Italy
- Polo Specialistico Riabilitativo, Fondazione Don Carlo Gnocchi, 83054 Sant’Angelo dei Lombardi, Italy
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12
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Magee W, Narayanan A, Seu A, Bernice C, Delargy M, Gray D, O'Connor R, Siegert R, Schnakers C, Tyas R, Wegener E, Yelden K. Validation of Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) with CRS-R. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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13
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Schnakers C, Bauer C, Formisano R, Noé E, Llorens R, Lejeune N, Farisco M, Teixeira L, Morrissey AM, De Marco S, Veeramuthu V, Ilina K, Edlow BL, Gosseries O, Zandalasini M, De Bellis F, Thibaut A, Estraneo A. What names for covert awareness? A systematic review. Front Hum Neurosci 2022; 16:971315. [PMID: 35992948 PMCID: PMC9389234 DOI: 10.3389/fnhum.2022.971315] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/15/2022] [Indexed: 12/14/2022] Open
Abstract
Background With the emergence of Brain Computer Interfaces (BCI), clinicians have been facing a new group of patients with severe acquired brain injury who are unable to show any behavioral sign of consciousness but respond to active neuroimaging or electrophysiological paradigms. However, even though well documented, there is still no consensus regarding the nomenclature for this clinical entity. Objectives This systematic review aims to 1) identify the terms used to indicate the presence of this entity through the years, and 2) promote an informed discussion regarding the rationale for these names and the best candidates to name this fascinating disorder. Methods The Disorders of Consciousness Special Interest Group (DoC SIG) of the International Brain Injury Association (IBIA) launched a search on Pubmed and Google scholar following PRISMA guidelines to collect peer-reviewed articles and reviews on human adults (>18 years) published in English between 2006 and 2021. Results The search launched in January 2021 identified 4,089 potentially relevant titles. After screening, 1,126 abstracts were found relevant. Finally, 161 manuscripts were included in our analyses. Only 58% of the manuscripts used a specific name to discuss this clinical entity, among which 32% used several names interchangeably throughout the text. We found 25 different names given to this entity. The five following names were the ones the most frequently used: covert awareness, cognitive motor dissociation, functional locked-in, non-behavioral MCS (MCS*) and higher-order cortex motor dissociation. Conclusion Since 2006, there has been no agreement regarding the taxonomy to use for unresponsive patients who are able to respond to active neuroimaging or electrophysiological paradigms. Developing a standard taxonomy is an important goal for future research studies and clinical translation. We recommend a Delphi study in order to build such a consensus.
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Affiliation(s)
- Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, United States
- *Correspondence: Caroline Schnakers
| | - Chase Bauer
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, CA, United States
| | | | - Enrique Noé
- Vithas Neuro Rehab Human Brain, Fundación Hospitales Vithas, Valencia, Spain
| | - Roberto Llorens
- Vithas Neuro Rehab Human Brain, Fundación Hospitales Vithas, Valencia, Spain
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Nicolas Lejeune
- Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
- GIGA-Consciousness, Coma Science Group, University of Liège, Liege, Belgium
| | - Michele Farisco
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
- Science and Society Unit, Biogem, Biology and Molecular Genetics Research Institute, Ariano Irpino, Italy
| | - Liliana Teixeira
- Center for Innovative Care and Health Technology, School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
| | - Ann-Marie Morrissey
- Ageing Research Centre, School of Allied Health, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sabrina De Marco
- Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba, Argentina
| | | | - Kseniya Ilina
- Research Center of Neurology, Moscow, Russia
- Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Brian L. Edlow
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Olivia Gosseries
- GIGA-Consciousness, Coma Science Group, University of Liège, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Matteo Zandalasini
- Unità Spinale, Neuroriabilitazione e Medicina Riabilitativa Intensiva, Dipartimento di Medicina Riabilitativa, Azienda USL di Piacenza, Piacenza, Italy
| | | | - Aurore Thibaut
- GIGA-Consciousness, Coma Science Group, University of Liège, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Neurology Unit, SM della Pietà General Hospital, Nola, Italy
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14
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Aubinet C, Schnakers C, Majerus S. Language Assessment in Patients with Disorders of Consciousness. Semin Neurol 2022; 42:273-282. [PMID: 36100226 DOI: 10.1055/s-0042-1755561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The assessment of residual language abilities in patients with disorders of consciousness (DoC) after severe brain injury is particularly challenging due to their limited behavioral repertoire. Moreover, associated language impairment such as receptive aphasia may lead to an underestimation of actual consciousness levels. In this review, we examine past research on the assessment of residual language processing in DoC patients, and we discuss currently available tools for identifying language-specific abilities and their prognostic value. We first highlight the need for validated and sensitive bedside behavioral assessment tools for residual language abilities in DoC patients. As regards neuroimaging and electrophysiological methods, the tasks involving higher level linguistic commands appear to be the most informative about level of consciousness and have the best prognostic value. Neuroimaging methods should be combined with the most appropriate behavioral tools in multimodal assessment protocols to assess receptive language abilities in DoC patients in the most complete and sensitive manner.
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Affiliation(s)
- Charlène Aubinet
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium.,Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California
| | - Steve Majerus
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
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15
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Cain JA, Spivak NM, Coetzee JP, Crone JS, Johnson MA, Lutkenhoff ES, Real C, Buitrago-Blanco M, Vespa PM, Schnakers C, Monti MM. Ultrasonic Deep Brain Neuromodulation in Acute Disorders of Consciousness: A Proof-of-Concept. Brain Sci 2022; 12:brainsci12040428. [PMID: 35447960 PMCID: PMC9032970 DOI: 10.3390/brainsci12040428] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 02/04/2023] Open
Abstract
The promotion of recovery in patients who have entered a disorder of consciousness (DOC; e.g., coma or vegetative states) following severe brain injury remains an enduring medical challenge despite an ever-growing scientific understanding of these conditions. Indeed, recent work has consistently implicated altered cortical modulation by deep brain structures (e.g., the thalamus and the basal ganglia) following brain damage in the arising of, and recovery from, DOCs. The (re)emergence of low-intensity focused ultrasound (LIFU) neuromodulation may provide a means to selectively modulate the activity of deep brain structures noninvasively for the study and treatment of DOCs. This technique is unique in its combination of relatively high spatial precision and noninvasive implementation. Given the consistent implication of the thalamus in DOCs and prior results inducing behavioral recovery through invasive thalamic stimulation, here we applied ultrasound to the central thalamus in 11 acute DOC patients, measured behavioral responsiveness before and after sonication, and applied functional MRI during sonication. With respect to behavioral responsiveness, we observed significant recovery in the week following thalamic LIFU compared with baseline. With respect to functional imaging, we found decreased BOLD signals in the frontal cortex and basal ganglia during LIFU compared with baseline. In addition, we also found a relationship between altered connectivity of the sonicated thalamus and the degree of recovery observed post-LIFU.
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Affiliation(s)
- Josh A. Cain
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA; (J.P.C.); (J.S.C.); (M.A.J.); (E.S.L.)
- Correspondence: (J.A.C.); (M.M.M.)
| | - Norman M. Spivak
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA; (N.M.S.); (C.R.); (M.B.-B.); (P.M.V.)
- UCLA-Caltech Medical Scientist Training Program, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - John P. Coetzee
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA; (J.P.C.); (J.S.C.); (M.A.J.); (E.S.L.)
- Department of Psychiatry, Stanford School of Medicine, Palo Alto, CA 94304, USA
- Palo Alto VA Medical Center, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Julia S. Crone
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA; (J.P.C.); (J.S.C.); (M.A.J.); (E.S.L.)
| | - Micah A. Johnson
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA; (J.P.C.); (J.S.C.); (M.A.J.); (E.S.L.)
| | - Evan S. Lutkenhoff
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA; (J.P.C.); (J.S.C.); (M.A.J.); (E.S.L.)
| | - Courtney Real
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA; (N.M.S.); (C.R.); (M.B.-B.); (P.M.V.)
| | - Manuel Buitrago-Blanco
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA; (N.M.S.); (C.R.); (M.B.-B.); (P.M.V.)
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Paul M. Vespa
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA; (N.M.S.); (C.R.); (M.B.-B.); (P.M.V.)
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA;
| | - Martin M. Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA; (J.P.C.); (J.S.C.); (M.A.J.); (E.S.L.)
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA; (N.M.S.); (C.R.); (M.B.-B.); (P.M.V.)
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA
- Correspondence: (J.A.C.); (M.M.M.)
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16
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Monti MM, Schnakers C. Flowchart for Implementing Advanced Imaging and Electrophysiology in Patients With Disorders of Consciousness: To fMRI or Not to fMRI? Neurology 2022; 98:452-459. [PMID: 35058337 DOI: 10.1212/wnl.0000000000200038] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The American Academy of Neurology and the European Academy of Neurology have recognized, for the first time, the value of advanced neuroimaging and electrophysiology techniques (AIEs) in the context of diagnosing patients with a disorder of consciousness (DOC). This recognition is part of an important agenda of promoting evidence-based competency in the management of patients with DOC. Nonetheless, considering that these techniques (and the required knowledge) are seldom available outside of advanced medical centers, it is important to provide physicians with a framework for balancing risks and benefits and deciding, on a single patient basis, whether AIEs are suitable. This issue is all the more urgent considering that family members are increasingly aware of the use of AIEs in patients with DOC, pressure for these assessments is likely to increase in the context of ethical and clinical imperatives to meet standards of care, and pathways for reimbursement for such assessments in DOC are yet to be established. The new guidelines, however, provide no guiding principle for physicians to decide when such assessments are appropriate, a limitation that impedes their wide adoption. We address this important gap by proposing an easy to use algorithmic flowchart that is based on the new guidelines and can be used to determine the appropriateness of AIEs for any given patient with DOC and ensure that evidence-based best practices are being followed. We also provide a brief context for understanding the main categories of AIEs available to clinicians, their advantages, and their limitations.
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Affiliation(s)
- Martin Max Monti
- From the Department of Psychology (M.M.M.) and Department of Neurosurgery, Brain Injury Research Center (C.S.), University of California Los Angeles; and Research Institute (C.S.), Casa Colina Hospitals and Centers for Healthcare, Pomona, CA.
| | - Caroline Schnakers
- From the Department of Psychology (M.M.M.) and Department of Neurosurgery, Brain Injury Research Center (C.S.), University of California Los Angeles; and Research Institute (C.S.), Casa Colina Hospitals and Centers for Healthcare, Pomona, CA
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17
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Schnakers C, Liu K, Rosario E. Sociodemographic, geographic and clinical factors associated with functional outcome and discharge location in US inpatient rehabilitation settings. Brain Inj 2022; 36:251-257. [PMID: 35099339 DOI: 10.1080/02699052.2022.2033838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To assess the impact of sociodemographic factors, clinical factors and regional differences on both patients' functional outcome and discharge location in U.S. inpatient rehabilitation settings. METHODS Using eRehabData, 536,453 admissions was used for functional outcome analyses (based on FIM gain) while 259,308 admissions was used for the discharge location analyses. Regression models were used to look at both outcomes. RESULTS Having private insurance and being young and male was associated with the higher FIM gains while being African American, widowed, and living in the Midwest was associated with the lower FIM gains. Furthermore, having private insurance, being young, male, married and African American or Hispanic was associated with the lower odds of being discharged to a skilled nursing facility while living in the Midwest was associated with the greatest odds of being discharged to a skilled nursing facility. Clinical factors such as days from onset and length of stay also had a significant effect on both outcomes. CONCLUSION Our findings suggest that, in the U.S., one of the challenges to successful recovery in the inpatient rehabilitation setting includes insurance status (Medicare/Medicaid), race (African American) but also regional differences (Midwest) and length of stay.
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Affiliation(s)
- Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA
| | - Kayuet Liu
- Department of Sociology, University of California Los Angeles, Los Angeles, California, USA
| | - Emily Rosario
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA
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18
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Wilde EA, Wanner I, Kenney K, Gill J, Stone JR, Disner S, Schnakers C, Meyer R, Prager EM, Haas M, Jeromin A. A Framework to Advance Biomarker Development in the Diagnosis, Outcome Prediction, and Treatment of Traumatic Brain Injury. J Neurotrauma 2022; 39:436-457. [PMID: 35057637 PMCID: PMC8978568 DOI: 10.1089/neu.2021.0099] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Elisabeth A. Wilde
- University of Utah, Neurology, 383 Colorow, Salt Lake City, Utah, United States, 84108
- VA Salt Lake City Health Care System, 20122, 500 Foothill Dr., Salt Lake City, Utah, United States, 84148-0002
| | - Ina Wanner
- UCLA, Semel Institute, NRB 260J, 635 Charles E. Young Drive South, Los Angeles, United States, 90095-7332, ,
| | - Kimbra Kenney
- Uniformed Services University of the Health Sciences, Neurology, Center for Neuroscience and Regenerative Medicine, 4301 Jones Bridge Road, Bethesda, Maryland, United States, 20814
| | - Jessica Gill
- National Institutes of Health, National Institute of Nursing Research, 1 cloister, Bethesda, Maryland, United States, 20892
| | - James R. Stone
- University of Virginia, Radiology and Medical Imaging, Box 801339, 480 Ray C. Hunt Dr. Rm. 185, Charlottesville, Virginia, United States, 22903, ,
| | - Seth Disner
- Minneapolis VA Health Care System, 20040, Minneapolis, Minnesota, United States
- University of Minnesota Medical School Twin Cities, 12269, 10Department of Psychiatry and Behavioral Sciences, Minneapolis, Minnesota, United States
| | - Caroline Schnakers
- Casa Colina Hospital and Centers for Healthcare, 6643, Pomona, California, United States
- Ronald Reagan UCLA Medical Center, 21767, Los Angeles, California, United States
| | - Restina Meyer
- Cohen Veterans Bioscience, 476204, New York, New York, United States
| | - Eric M Prager
- Cohen Veterans Bioscience, 476204, External Affairs, 535 8th Ave, New York, New York, United States, 10018
| | - Magali Haas
- Cohen Veterans Bioscience, 476204, 535 8th Avenue, 12th Floor, New York City, New York, United States, 10018,
| | - Andreas Jeromin
- Cohen Veterans Bioscience, 476204, Translational Sciences, Cambridge, Massachusetts, United States
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19
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Estraneo A, Magliacano A, Fiorenza S, Formisano R, Grippo A, Angelakis E, Cassol H, Thibaut A, Gosseries O, Lamberti G, Noé E, Bagnato S, Edlow BL, Chatelle C, Lejeune N, Veeramuthu V, Bartolo M, Mattia D, Toppi J, Zasler N, Schnakers C, Trojano L. Risk factors for 2-year mortality in patients with prolonged disorders of consciousness: An international multicentre study. Eur J Neurol 2021; 29:390-399. [PMID: 34657359 DOI: 10.1111/ene.15143] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Patients with prolonged disorders of consciousness (pDoC) have a high mortality rate due to medical complications. Because an accurate prognosis is essential for decision-making on patients' management, we analysed data from an international multicentre prospective cohort study to evaluate 2-year mortality rate and bedside predictors of mortality. METHODS We enrolled adult patients in prolonged vegetative state/unresponsive wakefulness syndrome (VS/UWS) or minimally conscious state (MCS) after traumatic and nontraumatic brain injury within 3 months postinjury. At enrolment, we collected demographic (age, sex), anamnestic (aetiology, time postinjury), clinical (Coma Recovery Scale-Revised [CRS-R], Disability Rating Scale, Nociception Coma Scale-Revised), and neurophysiologic (electroencephalogram [EEG], somatosensory evoked and event-related potentials) data. Patients were followed up to gather data on mortality up to 24 months postinjury. RESULTS Among 143 traumatic (n = 55) and nontraumatic (n = 88) patients (VS/UWS, n = 68, 19 females; MCS, n = 75, 22 females), 41 (28.7%) died within 24 months postinjury. Mortality rate was higher in VS/UWS (42.6%) than in MCS (16%; p < 0.001). Multivariate regression in VS/UWS showed that significant predictors of mortality were older age and lower CRS-R total score, whereas in MCS female sex and absence of alpha rhythm on EEG at study entry were significant predictors. CONCLUSIONS This study demonstrated that a feasible multimodal assessment in the postacute phase can help clinicians to identify patients with pDoC at higher risk of mortality within 24 months after brain injury. This evidence can help clinicians and patients' families to navigate the complex clinical decision-making process and promote an international standardization of prognostic procedures for patients with pDoC.
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Affiliation(s)
- Anna Estraneo
- Don Carlo Gnocchi Foundation, Scientific Institute for Research and Health Care, Florence, Italy.,Neurology Unit, Santa Maria della Pietà General Hospital, Nola, Italy
| | - Alfonso Magliacano
- Don Carlo Gnocchi Foundation, Scientific Institute for Research and Health Care, Florence, Italy.,Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Salvatore Fiorenza
- Maugeri Clinical Scientific Institutes, Scientific Institute for Research and Health Care, Laboratory for the Multimodal Evaluation of Disorders of Consciousness, Telese Terme, Italy
| | - Rita Formisano
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Antonello Grippo
- Don Carlo Gnocchi Foundation, Scientific Institute for Research and Health Care, Florence, Italy
| | - Efthymios Angelakis
- Neurosurgery Department, University of Athens Medical School, Athens, Greece
| | - Helena Cassol
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | | | - Enrique Noé
- NEURORHB-Neurorehabilitation Service of Vithas Hospitals, Valencia, Spain
| | - Sergio Bagnato
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Camille Chatelle
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nicolas Lejeune
- Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
| | | | | | - Donatella Mattia
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Jlenia Toppi
- Department of Computer, Control, and Management Engineering, Sapienza University of Rome, Rome, Italy
| | - Nathan Zasler
- Concussion Care Centre of Virginia, Richmond, Virginia, USA
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA
| | - Luigi Trojano
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
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Schnakers C, Zheng ZS, Millan H, Lee S, Howard M, Rosario E. Changes in Electrical Brain Activity Due to tDCS in Post-Stroke Chronic Aphasia: a Double-Blind Randomized Controlled Study. Arch Phys Med Rehabil 2021. [DOI: 10.1016/j.apmr.2021.07.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Estraneo A, Magliacano A, Fiorenza S, Formisano R, Grippo A, Angelakis E, Cassol H, Thibaut A, Gosseries O, Lamberti G, Noé E, Bagnato S, Edlow B, Lejeune N, Veeramuthu V, Bartolo M, De Bellis F, Catino F, Mattia D, Toppi J, Zasler N, Schnakers C, Trojano L. International prospective study on long-term clinical evolution of patients with severe brain injury and disorders of consciousness. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Winters B, Fullmer N, Rosario E, Schnakers C. Sleep Quality in an Acute Inpatient Rehabilitation Setting: The Importance of Prior Sleep Disorders. Arch Phys Med Rehabil 2021. [DOI: 10.1016/j.apmr.2021.07.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Stern JM, Spivak NM, Becerra SA, Kuhn TP, Korb AS, Kronemyer D, Khanlou N, Reyes SD, Monti MM, Schnakers C, Walshaw P, Keselman I, Cohen MS, Yong W, Fried I, Jordan SE, Schafer ME, Engel J, Bystritsky A. Safety of focused ultrasound neuromodulation in humans with temporal lobe epilepsy. Brain Stimul 2021; 14:1022-1031. [PMID: 34198105 DOI: 10.1016/j.brs.2021.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Transcranial Focused Ultrasound (tFUS) is a promising new potential neuromodulation tool. However, the safety of tFUS neuromodulation has not yet been assessed adequately. Patients with refractory temporal lobe epilepsy electing to undergo an anterior temporal lobe resection present a unique opportunity to evaluate the safety and efficacy of tFUS neuromodulation. Histological changes in tissue after tFUS can be examined after surgical resection, while further potential safety concerns can be assessed using neuropsychological testing. METHODS Neuropsychological functions were assessed in eight patients before and after focused ultrasound sonication of the temporal lobe at intensities up to 5760 mW/cm2. Using the BrainSonix Pulsar 1002, tFUS was delivered under MR guidance, using the Siemens Magnetom 3T Prisma scanner. Neuropsychological changes were assessed using various batteries. Histological changes were assessed using hematoxylin and eosin staining, among others. RESULTS With respect to safety, the histological analysis did not reveal any detectable damage to the tissue, except for one subject for whom the histology findings were inconclusive. In addition, neuropsychological testing did not show any statistically significant changes in any test, except for a slight decrease in performance on one of the tests after tFUS. SIGNIFICANCE This study supports the hypothesis that low-intensity Transcranial Focused Ultrasound (tFUS) used for neuromodulation of brain circuits at intensities up to 5760 mW/cm2 may be safe for use in human research. However, due to methodological limitations in this study and inconclusive findings, more work is warranted to establish the safety. Future directions include greater number of sonications as well as longer exposure at higher intensity levels to further assess the safety of tFUS for modulation of neuronal circuits.
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Affiliation(s)
- John M Stern
- Department of Neurology, UCLA School of Medicine, USA
| | - Norman M Spivak
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; Department of Neurosurgery, UCLA School of Medicine, USA
| | - Sergio A Becerra
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA
| | - Taylor P Kuhn
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA
| | - Alexander S Korb
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; BrainSonix Inc., Los Angeles, CA, USA
| | - David Kronemyer
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA
| | - Négar Khanlou
- Department of Pathology and Laboratory Medicine, UCLA School of Medicine, USA
| | - Samuel D Reyes
- Department of Neurosurgery, UCLA School of Medicine, USA
| | - Martin M Monti
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; Department of Neurosurgery, UCLA School of Medicine, USA; Department of Psychology, UCLA College of Letters and Science, USA; Brain Research Institute, UCLA, USA
| | | | - Patricia Walshaw
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA
| | - Inna Keselman
- Department of Neurology, UCLA School of Medicine, USA
| | - Mark S Cohen
- Department of Neurology, UCLA School of Medicine, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; Department of Psychology, UCLA College of Letters and Science, USA; Department of Radiology, UCLA School of Medicine, USA; Department of Biomedical Physics, UCLA School of Medicine, USA; Department of Bioengineering, UCLA School of Engineering, USA; California Nanosystems Institute, UCLA, USA; Brain Research Institute, UCLA, USA
| | - William Yong
- Department of Pathology and Laboratory Medicine, UCLA School of Medicine, USA
| | - Itzhak Fried
- Department of Neurosurgery, UCLA School of Medicine, USA; Brain Research Institute, UCLA, USA
| | - Sheldon E Jordan
- Neurology Management Associates- Los Angeles, Santa Monica, CA, USA
| | - Mark E Schafer
- BrainSonix Inc., Los Angeles, CA, USA; School of Biomedical Engineering, Drexel University, Philadelphia, PA, USA
| | - Jerome Engel
- Department of Neurology, UCLA School of Medicine, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; Department of Neurobiology, UCLA School of Medicine, USA; Brain Research Institute, UCLA, USA
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; BrainSonix Inc., Los Angeles, CA, USA.
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Schnakers C, Zheng ZS, Millan H, Lee S, Howard M, Rosario E. Abstract P200: Transcranial Direct Current Stimulation in Post-Stroke Chronic Aphasia: A Double Blind Randomized Controlled Study. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
There is growing evidence even amongst those with chronic aphasia that transcranial direct current stimulation (tDCS) combined with behavioral speech therapy could boost language. However, current findings do not allow making strong recommendations for using tDCS in order to improve language in post-stroke aphasia. The efficacy of tDCS therefore still needs to be established using double-blind controlled randomized trials in large samples.
Intervention:
In this ongoing double-blind randomized placebo controlled trial study, participants were randomly assigned either to the tDCS group or to the sham group. Both groups had five consecutive days of 20 minutes session, using a FDA approved tDCS device (soterixmedical.com). Behavioral and neuroimaging data were performed the week before/after tDCS/sham intervention and again 3 months following treatment.
Participants:
42 post-stroke patients with chronic aphasia (32 males; age: 61±11y; 0.9-18years post-injury; 32 ischemic stroke; 19 non-fluent aphasia). Eighteen patients were in the tDCS group.
Main Outcome Measures:
The Western Aphasia Battery-Revised (WAB-R), Communication Outcomes after Stroke, patient and family report (COAST). MRI Diffusion Tensor Imaging data (64 dir) were also collected.
Statistical Analyses:
Anova with repeated measures was used on the behavioral outcome measures with aphasia severity, age and time since injury as covariates in SPSS. The average fractional anisotropy (FA) and mean diffusivity (MD) were extracted per ROI from each participant and timepoint.
Main Results:
a) Behavioral. Groups differed, pre/post intervention, on the WAB-R total score, for the Auditory-Verbal Comprehension and Repetition subscores; b) Neuroimaging. Change in Spontaneous Speech and Auditory Verbal Comprehension negatively correlated with change in mean MD and FA, respectively, in Superior Cerebellar Peduncle for tDCS, but not sham.
Conclusion:
Our preliminary findings show a higher improvement in language functions (for both receptive and expressive language skills) in response to treatment (vs. sham). Neuroplasticity was observed in superior cerebellar peduncle in response to tDCS mediated language improvement.
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Affiliation(s)
| | | | - Henry Millan
- Casa Colina Hosp and Cntrs For Healthcare, Pomona, CA
| | - Sharon Lee
- Casa Colina Hosp and Cntrs For Healthcare, Pomona, CA
| | | | - Emily Rosario
- Casa Colina Hosp and Cntrs For Healthcare, Pomona, CA
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25
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Schnakers C, Divine J, Johnson MA, Lutkenhoff E, Monti MM, Keil KM, Guthrie J, Pouratian N, Patterson D, Jensen G, Morales VC, Weaver KF, Rosario ER. Longitudinal changes in blood-based biomarkers in chronic moderate to severe traumatic brain injury: preliminary findings. Brain Inj 2021; 35:285-291. [PMID: 33461331 DOI: 10.1080/02699052.2020.1858345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: This longitudinal study aims at 1) providing preliminary evidence of changes in blood-based biomarkers across time in chronic TBI and 2) relating these changes to outcome measures and cerebral structure and activity.Methods: Eight patients with moderate-to-severe TBI (7 males, 35 ± 7.6 years old, 5 severe TBI, 17.52 ± 3.84 months post-injury) were evaluated at monthly intervals across 6 time-points using: a) Blood-based biomarkers (GFAP, NSE, S100A12, SDBP145, UCH-L1, T-tau, P-tau, P-tau/T-tau ratio); b) Magnetic Resonance Imaging to evaluate changes in brain structure; c) Resting-state electroencephalograms to evaluate changes in brain function; and d) Outcome measures to assess cognition, emotion, and functional recovery (MOCA, RBANS, BDI-II, and DRS).Results: Changes in P-tau levels were found across time [p = .007]. P-tau was positively related to functional [p < .001] and cognitive [p = .006] outcomes, and negatively related to the severity of depression, 6 months later [R = -0.901; p =.006]. P-tau and P-tau/T-tau ratio were also positively correlated to shape change in subcortical areas such as brainstem [T(7) = 4.71, p = .008] and putamen [T(7) = 3.25, p = .012].Conclusions: Our study provides preliminary findings that suggest a positive relationship between P-tau and the recovery of patients with chronic TBI.
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Affiliation(s)
- Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA
| | - James Divine
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA
| | - Micah A Johnson
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Evan Lutkenhoff
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Katrina M Keil
- Transition Living Center, Casa Colina Hospital and Centers for Healthcare, California, Pomona, USA
| | - John Guthrie
- Transition Living Center, Casa Colina Hospital and Centers for Healthcare, California, Pomona, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of California Los Angeles, California, Los Angeles, USA
| | - David Patterson
- Transition Living Center, Casa Colina Hospital and Centers for Healthcare, California, Pomona, USA
| | - Gary Jensen
- Diagnostics Imaging Center, University of California Los Angeles, California, Los Angeles, USA
| | - Vanessa C Morales
- Grant Evaluation & Statistical Support, Loyola Marymount University, California, Los Angeles, USA
| | - Kathleen F Weaver
- Professional Development and Online Learning, Loyola Marymount University, California, Los Angeles, USA
| | - Emily R Rosario
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA
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26
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Cain JA, Spivak NM, Coetzee JP, Crone JS, Johnson MA, Lutkenhoff ES, Real C, Buitrago-Blanco M, Vespa PM, Schnakers C, Monti MM. Ultrasonic thalamic stimulation in chronic disorders of consciousness. Brain Stimul 2021; 14:301-303. [PMID: 33465497 DOI: 10.1016/j.brs.2021.01.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Joshua A Cain
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA.
| | - Norman M Spivak
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, CA, 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - John P Coetzee
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA; Department of Psychiatry, Stanford School of Medicine, Palo Alto, CA, 94304, USA; VA Palo Alto, Palo Alto, CA, 94304, USA
| | - Julia S Crone
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Micah A Johnson
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Evan S Lutkenhoff
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Courtney Real
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, CA, 90095, USA
| | - Manuel Buitrago-Blanco
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, CA, 90095, USA; Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Paul M Vespa
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, CA, 90095, USA; Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, 91767, USA
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA; Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, CA, 90095, USA; Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, 90095, USA.
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27
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Comanducci A, Boly M, Claassen J, De Lucia M, Gibson RM, Juan E, Laureys S, Naccache L, Owen AM, Rosanova M, Rossetti AO, Schnakers C, Sitt JD, Schiff ND, Massimini M. Clinical and advanced neurophysiology in the prognostic and diagnostic evaluation of disorders of consciousness: review of an IFCN-endorsed expert group. Clin Neurophysiol 2020; 131:2736-2765. [PMID: 32917521 DOI: 10.1016/j.clinph.2020.07.015] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 07/06/2020] [Accepted: 07/26/2020] [Indexed: 12/13/2022]
Abstract
The analysis of spontaneous EEG activity and evoked potentialsis a cornerstone of the instrumental evaluation of patients with disorders of consciousness (DoC). Thepast few years have witnessed an unprecedented surge in EEG-related research applied to the prediction and detection of recovery of consciousness after severe brain injury,opening up the prospect that new concepts and tools may be available at the bedside. This paper provides a comprehensive, critical overview of bothconsolidated and investigational electrophysiological techniquesfor the prognostic and diagnostic assessment of DoC.We describe conventional clinical EEG approaches, then focus on evoked and event-related potentials, and finally we analyze the potential of novel research findings. In doing so, we (i) draw a distinction between acute, prolonged and chronic phases of DoC, (ii) attempt to relate both clinical and research findings to the underlying neuronal processes and (iii) discuss technical and conceptual caveats.The primary aim of this narrative review is to bridge the gap between standard and emerging electrophysiological measures for the detection and prediction of recovery of consciousness. The ultimate scope is to provide a reference and common ground for academic researchers active in the field of neurophysiology and clinicians engaged in intensive care unit and rehabilitation.
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Affiliation(s)
- A Comanducci
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - M Boly
- Department of Neurology and Department of Psychiatry, University of Wisconsin, Madison, USA; Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin-Madison, Madison, USA
| | - J Claassen
- Department of Neurology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - M De Lucia
- Laboratoire de Recherche en Neuroimagerie, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - R M Gibson
- The Brain and Mind Institute and the Department of Physiology and Pharmacology, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, Ontario, Canada
| | - E Juan
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin-Madison, Madison, USA; Amsterdam Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - S Laureys
- Coma Science Group, Centre du Cerveau, GIGA-Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; Fondazione Europea per la Ricerca Biomedica Onlus, Milan 20063, Italy
| | - L Naccache
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France; Sorbonne Université, UPMC Université Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - A M Owen
- The Brain and Mind Institute and the Department of Physiology and Pharmacology, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, Ontario, Canada
| | - M Rosanova
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; Fondazione Europea per la Ricerca Biomedica Onlus, Milan 20063, Italy
| | - A O Rossetti
- Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - J D Sitt
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - N D Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - M Massimini
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
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Abstract
INTRODUCTION New guidelines regarding the diagnosis of disorders of consciousness (DOC) (such as vegetative state and minimally conscious state) have recently been published by the American Academy of Neurology and the European Academy of Neurology. This follows an impressive number of prospective studies performed on DOC and recent multi-centric studies with larger sample size, which have gathered precious information on the recovery of cohort of patients through years and which now call for a better management of patients with DOC. AREAS COVERED This review will discuss recent updates on the clinical entities of DOC, the challenges for an accurate diagnosis and the last developments in diagnostic tools. EXPERT OPINION The authors will also discuss the impact of the new guidelines on their way of diagnosing patients and how diagnosis will most likely change in a near future.
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Affiliation(s)
- Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare , Pomona, CA, USA
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29
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Estraneo A, Fiorenza S, Magliacano A, Formisano R, Mattia D, Grippo A, Romoli AM, Angelakis E, Cassol H, Thibaut A, Gosseries O, Lamberti G, Noé E, Bagnato S, Edlow BL, Chatelle C, Lejeune N, Veeramuthu V, Bartolo M, Toppi J, Zasler N, Schnakers C, Trojano L. Multicenter prospective study on predictors of short-term outcome in disorders of consciousness. Neurology 2020; 95:e1488-e1499. [PMID: 32661102 PMCID: PMC7713739 DOI: 10.1212/wnl.0000000000010254] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/20/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE This international multicenter, prospective, observational study aimed at identifying predictors of short-term clinical outcome in patients with prolonged disorders of consciousness (DoC) due to acquired severe brain injury. METHODS Patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) or in minimally conscious state (MCS) were enrolled within 3 months from their brain injury in 12 specialized medical institutions. Demographic, anamnestic, clinical, and neurophysiologic data were collected at study entry. Patients were then followed up for assessing the primary outcome, that is, clinical diagnosis according to standardized criteria at 6 months postinjury. RESULTS We enrolled 147 patients (44 women; mean age 49.4 [95% confidence interval 46.1-52.6] years; VS/UWS 71, MCS 76; traumatic 55, vascular 56, anoxic 36; mean time postinjury 59.6 [55.4-63.6] days). The 6-month follow-up was complete for 143 patients (VS/UWS 70; MCS 73). With respect to study entry, the clinical diagnosis improved in 72 patients (VS/UWS 27; MCS 45). Younger age, shorter time postinjury, higher Coma Recovery Scale-Revised total score, and presence of EEG reactivity to eye opening at study entry predicted better outcome, whereas etiology, clinical diagnosis, Disability Rating Scale score, EEG background activity, acoustic reactivity, and P300 on event-related potentials were not associated with outcome. CONCLUSIONS Multimodal assessment could identify patients with higher likelihood of clinical improvement in order to help clinicians, families, and funding sources with various aspects of decision-making. This multicenter, international study aims to stimulate further research that drives international consensus regarding standardization of prognostic procedures for patients with DoC.
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Affiliation(s)
- Anna Estraneo
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA.
| | - Salvatore Fiorenza
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Alfonso Magliacano
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Rita Formisano
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Donatella Mattia
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Antonello Grippo
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Anna Maria Romoli
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Efthymios Angelakis
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Helena Cassol
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Aurore Thibaut
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Olivia Gosseries
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Gianfranco Lamberti
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Enrique Noé
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Sergio Bagnato
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Brian L Edlow
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Camille Chatelle
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Nicolas Lejeune
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Vigneswaran Veeramuthu
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Michelangelo Bartolo
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Jlenia Toppi
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Nathan Zasler
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Caroline Schnakers
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Luigi Trojano
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
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Bonin EA, Lejeune N, Thibaut A, Cassol H, Antonopoulos G, Wannez S, Martial C, Schnakers C, Laureys S, Chatelle C. Nociception Coma Scale-Revised Allows to Identify Patients With Preserved Neural Basis for Pain Experience. The Journal of Pain 2020; 21:742-750. [DOI: 10.1016/j.jpain.2019.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 09/05/2019] [Accepted: 11/11/2019] [Indexed: 01/18/2023]
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Cortese D, Riganello F, Arcuri F, Lucca L, Tonin P, Schnakers C, Laureys S. The Trace Conditional Learning of the Noxious Stimulus in UWS Patients and Its Prognostic Value in a GSR and HRV Entropy Study. Front Hum Neurosci 2020; 14:97. [PMID: 32327985 PMCID: PMC7161674 DOI: 10.3389/fnhum.2020.00097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/02/2020] [Indexed: 01/18/2023] Open
Abstract
The assessment of the consciousness level of Unresponsive Wakefulness Syndrome (UWS) patients often depends on a subjective interpretation of the observed spontaneous and volitional behavior. To date, the misdiagnosis level is around 30%. The aim of this study was to observe the behavior of UWS patients, during the administration of noxious stimulation by a Trace Conditioning protocol, assessed by the Galvanic Skin Response (GSR) and Heart Rate Variability (HRV) entropy. We recruited 13 Healthy Control (HC) and 30 UWS patients at 31 ± 9 days from the acute event evaluated by Coma Recovery Scale–Revised (CRS-R) and Nociception Coma Scale (NCS). Two different stimuli [musical stimulus (MUS) and nociceptive stimulus (NOC)], preceded, respectively by two different tones, were administered following the sequences (A) MUS1 – NOC1 – MUS2 – MUS3 – NOC2 – MUS4 – NOC3 – NOC*, and (B) MUS1*, NOC1*, NOC2*, MUS2*, NOC3*, MUS3*, NOC4*, MUS4*. All the (*) indicate the only tones administration. CRS-R and NCS assessments were repeated for three consecutive weeks. MUS4, NOC3, and NOC* were compared for GSR wave peak magnitude, time to reach the peak, and time of wave's decay by Wilcoxon's test to assess the Conditioned Response (CR). The Sample Entropy (SampEn) was recorded in baseline and both sequences. Machine Learning approach was used to identify a rule to discriminate the CR. The GSR magnitude of CR was higher comparing music stimulus (p < 0.0001) and CR extinction (p < 0.002) in nine patients and in HC. Patients with CR showed a higher SampEn in sequence A compared to patients without CR. Within the third and fourth weeks from protocol administration, eight of the nine patients (88.9%) evolved into MCS. The Machine-learning showed a high performance to differentiate presence/absence of CR (≥95%). The possibility to observe the CR to the noxious stimulus, by means of the GSR and SampEn, can represent a potential method to reduce the misdiagnosis in UWS patients.
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Affiliation(s)
- Daniela Cortese
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy
| | - Francesco Riganello
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy.,Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Francesco Arcuri
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy
| | - Lucia Lucca
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy
| | - Paolo Tonin
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy
| | - Caroline Schnakers
- Neurosurgery Department, University of California, Los Angeles, Los Angeles, CA, United States.,Research Institute, Casa Colina Hospital and Centers of Healthcare, Pomona, CA, United States
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
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Wang F, Hu N, Hu X, Jing S, Heine L, Thibaut A, Huang W, Yan Y, Wang J, Schnakers C, Laureys S, Di H. Detecting Brain Activity Following a Verbal Command in Patients With Disorders of Consciousness. Front Neurosci 2019; 13:976. [PMID: 31572121 PMCID: PMC6753948 DOI: 10.3389/fnins.2019.00976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/30/2019] [Indexed: 11/20/2022] Open
Abstract
Background The accurate assessment of patients with disorders of consciousness (DOC) is a challenge to most experienced clinicians. As a potential clinical tool, functional magnetic resonance imaging (fMRI) could detect residual awareness without the need for the patients’ actual motor responses. Methods We adopted a simple active fMRI motor paradigm (hand raising) to detect residual awareness in these patients. Twenty-nine patients were recruited. They met the diagnosis of minimally conscious state (MCS) (male = 6, female = 2; n = 8), vegetative state/unresponsive wakefulness syndrome (VS/UWS) (male = 17, female = 4; n = 21). Results We analyzed the command-following responses for robust evidence of statistically reliable markers of motor execution, similar to those found in 15 healthy controls. Of the 29 patients, four (two MCS, two VS/UWS) could adjust their brain activity to the “hand-raising” command, and they showed activation in motor-related regions (which could not be discovered in the own-name task). Conclusion Longitudinal behavioral assessments showed that, of these four patients, two in a VS/UWS recovered to MCS and one from MCS recovered to MCS+ (i.e., showed command following). In patients with no response to hand raising task, six VS/UWS and three MCS ones showed recovery in follow-up procedure. The simple active fMRI “hand-raising” task can elicit brain activation in patients with DOC, similar to those observed in healthy volunteers. Activity of the motor-related network may be taken as an indicator of high-level cognition that cannot be discerned through conventional behavioral assessment.
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Affiliation(s)
- Fuyan Wang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.,Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Nantu Hu
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Xiaohua Hu
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.,Department of Rehabilitation, Hangzhou Wujing Hospital, Hangzhou, China
| | - Shan Jing
- Department of Rehabilitation, Hangzhou Wujing Hospital, Hangzhou, China
| | - Lizette Heine
- INSERM, U1028, CNRS, UMR5292, Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center, Lyon, France.,Coma Science Group, GIGA-Research, CHU University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Research, CHU University Hospital of Liège, Liège, Belgium
| | - Wangshan Huang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Yifan Yan
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Jing Wang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Caroline Schnakers
- Coma Science Group, GIGA-Research, CHU University Hospital of Liège, Liège, Belgium.,Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Steven Laureys
- Coma Science Group, GIGA-Research, CHU University Hospital of Liège, Liège, Belgium
| | - Haibo Di
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
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Formisano R, Giustini M, Aloisi M, Contrada M, Schnakers C, Zasler N, Estraneo A. An International survey on diagnostic and prognostic protocols in patients with disorder of consciousness. Brain Inj 2019; 33:974-984. [DOI: 10.1080/02699052.2019.1622785] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | - Marianna Contrada
- IRCCS Santa Lucia Foundation, Rome, Italy
- Behavioral Neuroscience, Sapienza University of Rome, Rome Italy
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers of Healthcare, Pomona, CA, USA; Psychiatry Department, University of California, Los Angeles, CA, USA
| | - Nathan Zasler
- Department of Physical Medicine and Rehabilitation, Concussion Care Centre of Virginia, Ltd, Tree of Life Services, Inc, Richmond, Virginia, USA
| | - Anna Estraneo
- Emergency Neurology Department, Santa Maria della Pietà General Hospital, Nola NA, Italy
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Schnakers C, Lutkenhoff ES, Bio BJ, McArthur DL, Vespa PM, Monti MM. Acute EEG spectra characteristics predict thalamic atrophy after severe TBI. J Neurol Neurosurg Psychiatry 2019; 90:617-619. [PMID: 29954872 PMCID: PMC6310668 DOI: 10.1136/jnnp-2017-317829] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/13/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA
| | - Evan S Lutkenhoff
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Branden J Bio
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA.,Department of Psychology, Princeton University, Princeton, New Jersey, USA
| | - David L McArthur
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Paul M Vespa
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA.,Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Martin M Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA .,Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
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Gosseries O, Schnakers C, Laureys S. Editorial: Between Theory and Clinic: The Contribution of Neuroimaging in the Field of Consciousness Disorders. Front Neurol 2019; 10:165. [PMID: 30890996 PMCID: PMC6413699 DOI: 10.3389/fneur.2019.00165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 02/07/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Olivia Gosseries
- Coma Science Group, University Hospital of Liege, Liege, Belgium.,GIGA-Consciousness, University of Liege, Liege, Belgium
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, United States
| | - Steven Laureys
- Coma Science Group, University Hospital of Liege, Liege, Belgium.,GIGA-Consciousness, University of Liege, Liege, Belgium
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Molteni E, Slomine BS, Castelli E, Zasler N, Schnakers C, Estraneo A. International survey on diagnostic and prognostic procedures in pediatric disorders of consciousness. Brain Inj 2019; 33:517-528. [PMID: 30663416 DOI: 10.1080/02699052.2019.1565899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS 1. to investigate diagnostic and prognostic procedures routinely used by international professionals to assess children with disorders of consciousness (DoC); 2. to explore use and availability of internal and national guidelines for pediatric DoC; 3. to identify international differences in diagnostic/prognostic protocols. METHODS The International Brain Injury Association DoC Special Interest Group emailed a survey link to 43,469 professionals. The survey included questions on diagnostic/prognostic procedures and guidelines for children with DoC. RESULTS Data on 82 respondents [(50% physicians) primarily from Europe (43.9%)and North America (37.8%)] were analyzed. Common diagnostic tools included the Glasgow Coma Scale for clinical assessment (94%), the Coma Recovery Scale-Revised for outcome measurement (57%), and cerebral MRI (94%). Clinical features used most frequently to inform prognosis varied with patient age. Few respondents used national (28%) admission protocols for children with DoC, and most were unaware of published national guidelines for diagnostic (72%) and prognostic (85%) procedures. Compared to North American respondents, more European respondents were physicians and used neurophysiological data for prognosis. CONCLUSIONS This international survey provides useful information about diagnostic and prognostic procedures currently used for children with DoC and highlights the need for guidelines to promote best practices for diagnosis/prognosis in pediatric DoC.
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Affiliation(s)
- Erika Molteni
- a Acquired Brain Injury Unit, IRCCS E. Medea , Scientific Institute , Lecco , Italy.,b School of Biomedical Engineering and Imaging Sciences , King's College London , UK
| | - Beth S Slomine
- c Department of Neuropsychology , Kennedy Krieger Institute, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Enrico Castelli
- d Paediatric Neurorehabilitation Units, Neuroscience and Neurorehabilitation Department , Bambino Gesù Children's Hospital , Rome , Italy
| | - Nathan Zasler
- e Concussion Care Centre of Virginia, Ltd., Tree of Life Services, Inc., Department of Physical Medicine and Rehabilitation , Virginia Commonwealth University , Richmond , Virginia , USA.,f Department of Physical Medicine and Rehabilitation , University of Virginia , Charlottesville , Virginia , USA
| | - Caroline Schnakers
- g Research Institute , Casa Colina Hospital and Centers for Healthcare , Pomona , CA , USA
| | - Anna Estraneo
- h DOC Research Laboratory and Neurorehabilitation Unit for DOC patients , Maugeri Clinical Scientific Institutes, IRCCS , Telese Terme , Italy
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Zhang Y, Wang J, Schnakers C, He M, Luo H, Cheng L, Wang F, Nie Y, Huang W, Hu X, Laureys S, Di H. Validation of the Chinese version of the Coma Recovery Scale-Revised (CRS-R). Brain Inj 2019; 33:529-533. [PMID: 30663434 DOI: 10.1080/02699052.2019.1566832] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PRIMARY OBJECTIVE This study aims to validate the Chinese version of the Coma Recovery Scale-Revised (CRS-R). METHODS One hundred sixty-nine patients were assessed with both the CRS-R and the Glasgow Coma Scale (GCS), diagnosed as being in unresponsive wakefulness syndrome (UWS, formerly known as vegetative state), minimally conscious state (MCS), or emergence from MCS (EMCS). A subgroup of 50 patients has been assessed twice by the same rater, within 24 h. Patient outcome was documented six months after assessment. RESULTS The internal consistency for the CRS-R total score was excellent (Cronbach's α = 0.84). Good test-retest reliability was obtained for CRS-R total score and subscale scores (intra-class correlation coefficient [ICC] = 0.87 and ICC = 0.66-0.84, respectively). Inter-rater reliability was high (ICC = 0.719; p < 0.01). Concurrent validity was good between CRS-R total scale and GCS total scale. Diagnostic validity was excellent compared with GCS (emerged from UWS: 24%; emerged from MCS: 28%). When considering patient outcome, diagnostic validity was good. In addition, false-positive rates have been detected for both diagnoses. CONCLUSION The Chinese version of the CRS-R is a reliable and sensitive tool and can discriminate patients in UWS, MCS, and EMCS successfully.
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Affiliation(s)
- Ying Zhang
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China.,b The Affiliated Hospital of Hangzhou Normal University , Hangzhou Normal University , Hangzhou , Zhejiang , China
| | - Jing Wang
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China
| | - Caroline Schnakers
- c Research Institute , Casa Colina Hospital and Centers for Healthcare , Pomona , CA , USA.,d Department of Psychiatry , University of California , Los Angeles , CA , USA
| | - Minhui He
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China.,b The Affiliated Hospital of Hangzhou Normal University , Hangzhou Normal University , Hangzhou , Zhejiang , China
| | - Hong Luo
- b The Affiliated Hospital of Hangzhou Normal University , Hangzhou Normal University , Hangzhou , Zhejiang , China
| | - Lijuan Cheng
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China.,e Hangzhou Normal University Qianjiang College , Hangzhou , Zhejiang , China
| | - Fuyan Wang
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China.,b The Affiliated Hospital of Hangzhou Normal University , Hangzhou Normal University , Hangzhou , Zhejiang , China
| | - Yunzhi Nie
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China.,f Ningbo NO.7 Hospital , Ningbo , Zhejiang , China
| | - Wangshan Huang
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China
| | - Xiaohua Hu
- g Department of Rehabilitation , Hangzhou Wujing Hospital , Hangzhou , China
| | - Steven Laureys
- h GIGA, GIGA-Consciousness, Coma Science Group, University & Neurology Department , Hospital of Liege , Liege , Belgium
| | - Haibo Di
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China
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Riganello F, Chatelle C, Schnakers C, Laureys S. Heart Rate Variability as an Indicator of Nociceptive Pain in Disorders of Consciousness? J Pain Symptom Manage 2019; 57:47-56. [PMID: 30267843 DOI: 10.1016/j.jpainsymman.2018.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 01/18/2023]
Abstract
CONTEXT Heart rate variability is thought to reflect the affective and physiological aspects of pain and is emerging as a possible descriptor of the functional brain organization contributing to homeostasis. OBJECTIVES To investigate whether the short-term Complexity Index (CIs), a measure of heart rate variability complexity is useful to discriminate responses to potentially noxious and nonnoxious stimulation in patients with different levels of consciousness. METHODS Twenty-two patients (11 minimally conscious state [MCS], 11 vegetative state/unresponsive wakefulness syndrome [VS/UWS]) and 14 healthy controls (HC) were enrolled. We recorded the electrocardiographic response and calculated the CIs before (baseline), during, and after nonnoxious and noxious stimulation. Mann-Whitney and Wilcoxon's tests were used to investigate differences in CIs according to the level of consciousness (i.e., HC vs. patients and VS/UWS vs. MCS) and the three conditions (i.e., baseline, nonnoxious, noxious). The correlation between the three conditions and the Coma Recovery Scale-Revised was investigated by Spearman's correlations. RESULTS We observed higher CIs values in HC as compared with patients during the baseline (P < 0.034) and after the noxious stimulation (P < 0.0001). We also found higher values in MCS versus VS/UWS patients after the noxious condition (P < 0.001) and lower values in the noxious versus nonnoxious condition solely for the VS/UWS group (P < 0.007). A correlation was found between CIs in noxious condition and Coma Recovery Scale-Revised scores. CONCLUSION Our results suggest a less complex autonomic response to noxious stimuli in VS/UWS patients. Such method may help to better understand sympathovagal response to potentially painful stimulation in brain-injured patients.
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Affiliation(s)
- Francesco Riganello
- GIGA Consciousness, Coma Science Group, Liège, Belgium; Research in Advanced Neurorehabilitation (RAN), S.Anna Institute, Crotone, Italy.
| | - Camille Chatelle
- GIGA Consciousness, Coma Science Group, Liège, Belgium; Laboratory for NeuroImaging of Coma and Consciousness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Caroline Schnakers
- Neurosurgery Department, University of California, Los Angeles, California, USA; Research Institute, Casa Colina Hospital and Centers of Healthcare, Pomona, California, USA
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Schnakers C, Rosario E, Weaver K, Morales V. Blood-based Biomarkers of Late Recovery in Traumatic Brain Injury. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schnakers C, Rosario E, Jensen G, Divine J, Johnson M. In Search of Biomarkers For Late Recovery of TBI Patients: A Multimodal Approach. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cheng L, Cortese D, Monti MM, Wang F, Riganello F, Arcuri F, Di H, Schnakers C. Do Sensory Stimulation Programs Have an Impact on Consciousness Recovery? Front Neurol 2018; 9:826. [PMID: 30333789 PMCID: PMC6176776 DOI: 10.3389/fneur.2018.00826] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/13/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives: Considering sensory stimulation programs (SSP) as a treatment for disorders of consciousness is still debated today. Previous studies investigating its efficacy were affected by various biases among which small sample size and spontaneous recovery. In this study, treatment-related changes were assessed using time-series design in patients with disorders of consciousness (i.e., vegetative state-VS and minimally conscious state-MCS). Methods: A withdrawal design (ABAB) was used. During B phases, patients underwent a SSP (3 days a week, including auditory, visual, tactile, olfactory, and gustatory stimulation). The program was not applied during A phases. To assess behavioral changes, the Coma Recovery Scale-Revised (CRS-R) was administered by an independent rater on a weekly basis, across all phases. Each phase lasted 4 weeks. In a subset of patients, resting state functional magnetic resonance imaging (fMRI) data were collected at the end of each phase. Results: Twenty nine patients (48 ± 19 years old; 15 traumatic; 21 > a year post-injury; 11 VS and 18 MCS) were included in our study. Higher CRS-R total scores (medium effect size) as well as higher arousal and oromotor subscores were observed in the B phases (treatment) as compared to A phases (no treatment), in the MCS group but not in the VS group. In the three patients who underwent fMRI analyses, a modulation of metabolic activity related to treatment was observed in middle frontal gyrus, superior temporal gyrus as well as ventro-anterior thalamic nucleus. Conclusion: Our results suggest that SSP may not be sufficient to restore consciousness. SSP might nevertheless lead to improved behavioral responsiveness in MCS patients. Our results show higher CRS-R total scores when treatment is applied, and more exactly, increased arousal and oromotor functions.
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Affiliation(s)
- Lijuan Cheng
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Daniela Cortese
- Research in Advanced Neurorehabilitation, S. Anna Institute, Crotone, Italy
| | - Martin M. Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Fuyan Wang
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | | | - Francesco Arcuri
- Research in Advanced Neurorehabilitation, S. Anna Institute, Crotone, Italy
| | - Haibo Di
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, United States
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Skenderian D, Cisneros EP, Schnakers C. Cultural Factors Limiting Assessment/ Treatment of PTSD of an Afghan-American Translator. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schnakers C, Korb A, Bystritsky A, Vespa P, Monti M. Low Intensity Focused Ultrasound as a Treatment for Disorders of Consciousness: Preliminary Data. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schnakers C, Liu K, Rosario ER. Which Factors Predict the Best Patients’ Outcome in United States Rehabilitation Setting? Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schnakers C, Divine J, Johnson M, Patterson D, Jensen G, Rosario ER. Biomarkers for Late Recovery of Patients With Traumatic Brain Injury: A Multimodal Approach. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hauger SL, Schanke AK, Andersson S, Chatelle C, Schnakers C, Løvstad M. The Clinical Diagnostic Utility of Electrophysiological Techniques in Assessment of Patients With Disorders of Consciousness Following Acquired Brain Injury: A Systematic Review. J Head Trauma Rehabil 2018; 32:185-196. [PMID: 27831962 DOI: 10.1097/htr.0000000000000267] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the diagnostic utility of electrophysiological recordings during active cognitive tasks in detecting residual cognitive capacities in patients with disorders of consciousness (DoC) after severe acquired brain injury. DESIGN Systematic review of empirical research in MEDLINE, Embase, PsycINFO, and Cochrane from January 2002 to March 2016. MAIN MEASURES Data extracted included sample size, type of electrophysiological technique and task design, rate of cognitive responders, false negatives and positives, and excluded subjects from the study analysis. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used for quality appraisal of the retrieved literature. RESULTS Twenty-four studies examining electrophysiological signs of command-following in patients with DoC were identified. Sensitivity rates in healthy controls demonstrated variable accuracy across the studies, ranging from 71% to 100%. In patients with DoC, specificity and sensitivity rates varied in the included studies, ranging from 0% to 100%. Pronounced heterogeneity was found between studies regarding methodological approaches, task design, and procedures of analysis, rendering comparison between studies challenging. CONCLUSION We are still far from establishing precise recommendations for standardized electrophysiological diagnostic procedures in DoC, but electrophysiological methods may add supplemental diagnostic information of covert cognition in some patients with DoC.
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Affiliation(s)
- S L Hauger
- Department of Research, Sunnaas Rehabilitation Hospital, Norway (Mrs Hauger and Drs Løvstad and Schanke); Department of Psychology, University of Oslo, Oslo, Norway (Drs Andersson, Løvstad, and Schanke); Laboratory for NeuroImaging of Coma and Consciousness, Massachusetts General Hospital, Boston, and Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, University Hospital of Lausanne, Switzerland (Dr Chatelle); and Department of Neurosurgery, University of California, Los Angeles (Dr Schnakers)
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Hauger SL, Olafsen K, Schnakers C, Andelic N, Nilsen KB, Helseth E, Funderud I, Andersson S, Schanke AK, Løvstad M. Cognitive Event-Related Potentials during the Sub-Acute Phase of Severe Traumatic Brain Injury and Their Relationship to Outcome. J Neurotrauma 2017; 34:3124-3133. [PMID: 28594285 DOI: 10.1089/neu.2017.5062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Predicting outcome in the early phase after severe traumatic brain injury (sTBI) is a major clinical challenge, particularly identifying patients with potential for good cognitive outcome. The current single-center prospective study aimed to explore presence and normalization of electroencephalography (EEG)-based event-related potentials (ERPs) in the early phase followings TBI, and their relationship to functional and cognitive outcome 6 months post-injury. Fourteen adult patients (eight males) with sTBI were recruited from the neurointensive care unit (mean age = 38.2 years [standard deviation (SD) = 14.7]; mean lowest Glasgow Coma Scale (GCS) score within first 24 h = 5.4, SD = 1.87). EEG recordings were conducted biweekly at three time-points applying an ERP paradigm encompassing a passive condition involving hearing their own name randomly interspersed between an unfamiliar name (UN), and an active condition with instruction to count their own name. Functional and cognitive outcome 6 months post-injury was measured with Glasgow Outcome Scale-Extended (GOSE) and neuropsychological tests of attention and memory. Ten patients demonstrated a significantly enhanced cognitive P3 in the active counting task compared with passive listening across recordings, and six presented with normalization of P3 in the counting task. Moreover, P3 amplitude to the counting task at the third time-point was positively correlated with both functional outcome (GOSE) and cognition (verbal learning, attentional set-shifting, and switching) 6 months post-injury. ERP can index cognitive capacities in the early phase following sTBI, and the cognitive P3 component in an active design is associated with functional and cognitive outcome, demonstrating that the cognitive P3 may yield valuable information of residual cognition and provide supplementary prognostic information.
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Affiliation(s)
- Solveig L Hauger
- 1 Department of Research, Sunnaas Rehabilitation Hospital , Nesoddtangen, Norway .,2 Department of Psychology, University of Oslo , Norway
| | - Kjell Olafsen
- 3 Department of Neurointensive Treatment, Oslo University Hospital , Norway
| | - Caroline Schnakers
- 4 Neurosurgery Department, University of California , Los Angeles.,5 Research Institute , Casa Colina Hospital and Centers of Healthcare, Pomona, California
| | - Nada Andelic
- 6 Department of Physical Medicine and Rehabilitation, Oslo University Hospital , Norway .,7 Institute of Health and Society, CHARM (Center for Habilitation and Rehabilitation Models and Services), Faculty of Medicine, University of Oslo , Norway
| | - Kristian Bernhard Nilsen
- 8 Department of Neurology, Oslo University Hospital , Norway .,9 Department of Neuroscience, Norwegian University of Science and Technology , Norway
| | - Eirik Helseth
- 10 Department of Neurosurgery, Oslo University Hospital , Norway .,11 Faculty of Medicine, University of Oslo , Norway
| | | | | | - Anne-Kristine Schanke
- 1 Department of Research, Sunnaas Rehabilitation Hospital , Nesoddtangen, Norway .,2 Department of Psychology, University of Oslo , Norway
| | - Marianne Løvstad
- 1 Department of Research, Sunnaas Rehabilitation Hospital , Nesoddtangen, Norway .,2 Department of Psychology, University of Oslo , Norway
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Rosario E, Morales V, Schnakers C, Weaver K. Characterizing Longitudinal Changes in Blood-based Biomarkers Following Traumatic Brain Injury. Arch Phys Med Rehabil 2017. [DOI: 10.1016/j.apmr.2017.08.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Formisano R, Schnakers C, Zasler N, Estraneo A. International Survey on Diagnostic and Prognostic Procedures: A Report From the IBIA DOC SIG. Arch Phys Med Rehabil 2017. [DOI: 10.1016/j.apmr.2017.08.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schnakers C, Rosenberg S, Lam M, Bustamante E, Divine J, Millan H, Rosario E. Augmentative and Alternative Communication Intervention in Patients with Aphasia. Arch Phys Med Rehabil 2017. [DOI: 10.1016/j.apmr.2017.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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