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Pugliese ME, Battaglia R, Ursino M, Lucca LF, Quintieri M, Vatrano M, Tonin P, Cerasa A. Prevalence and Risk Factors of Deep Venous Thrombosis in Intensive Inpatient Neurorehabilitation Unit. Healthcare (Basel) 2024; 12:936. [PMID: 38727493 PMCID: PMC11082945 DOI: 10.3390/healthcare12090936] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Venous thromboembolism (VTE) (deep vein thrombosis and its complication, pulmonary embolism) is a major cause of morbidity and mortality in hospitalized patients and about 7% of these cases are due to immobility secondary to a neurological impairment. Acquired brain injury (ABI) has also been recognized as one of the main risk factors for VTE. Numerous epidemiological studies have been conducted to assess the risk factors for VTE in institutionalized polytrauma patients, although there is a lack of information about neurorehabilitation wards. Since VTE is often undiagnosed, this prospective study aimed to determine the prevalence and clinical characteristics of lower-limb deep venous thrombosis (DVT) in ABI patients at neurorehabilitation admission. METHODS ABI patients were screened for DVT on admission to the intensive rehabilitation unit (IRU) with compression ultrasonography and basal D-dimer assay and were daily clinically monitored until discharge. A total of 127 consecutive ABI patients (mean age: 60.1 ± 17.6 years; 63% male; time from event: 30.9 ± 22.1 days; rehabilitation time in IRU: 84.6 ± 58.4 days) were enrolled. RESULTS On admission to the IRU, the DVT prevalence was about 8.6%. The mean D-dimer level in patients with DVT was significantly higher than in patients without DVT (6 ± 0.9 vs. 1.97 ± 1.61, p-value = 0.0001). ABI patients with DVT did not show any significant clinical characteristics with respect to ABI without DVT, although a prevalence of hemorrhagic strokes and patients originating from the Intensive Care Unit and Neurosurgery ward was revealed. During the rehabilitation period, patients with DVT showed a significant difference in pharmacological DVT prophylaxis (high prevalence of nadroparin with 27.3% vs. 1.7%, p-value = 0.04) and a prevalence of transfers in critical awards (36% versus 9.5% of patients without DVT, p-value = 0.05). The mortality rate was similar in the two groups. CONCLUSIONS Our research offers a more comprehensive view of the clinical development of DVT patients and confirms the prevalence rate of DVT in ABI patients as determined upon IRU admission. According to our findings, screening these individuals regularly at the time of rehabilitation admission may help identify asymptomatic DVT quickly and initiate the proper treatment to avoid potentially fatal consequences. However, to avoid time-consuming general ultrasonography observation, a more precise selection of patients entering the rehabilitation ward is required.
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Affiliation(s)
- Maria Elena Pugliese
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
| | - Riccardo Battaglia
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
| | - Maria Ursino
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
| | - Lucia Francesca Lucca
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
| | - Maria Quintieri
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
| | - Martina Vatrano
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
| | - Paolo Tonin
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
| | - Antonio Cerasa
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Rende, Italy
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Zhou Y, Altonji KA, Kakkanatt A, Greenwald BD. Speech recovery after single-dose zolpidem in two minimally conscious patients with severe traumatic brain injuries: a case report. Brain Inj 2024; 38:337-340. [PMID: 38308526 DOI: 10.1080/02699052.2024.2311342] [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] [Received: 05/23/2023] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND In rare cases, zolpidem administration has been found to paradoxically improve cognition in patients with brain injury in disorders of consciousness. CASE PRESENTATION Two minimally conscious plus (MCS+) patients at baseline, a 24-year-old woman 8 weeks post-traumatic brain injury (TBI) and 23-year-old man 6 weeks post-TBI, demonstrated behavioral improvements after off-label, single-dose administration of 10 mg of zolpidem. DISCUSSION/CONCLUSION The patients demonstrated improved cognition on Coma Recovery Scale-Revised assessment after ingesting zolpidem. In particular, speech was substantially restored as one patient recovered functional communication and both demonstrated intelligible verbalizations for the first-time post-injuries following zolpidem. Overall, evidence is limited regarding the underlying mechanisms of various cognitive improvements in zolpidem response although studies incorporating neuroimaging are promising. The outcomes and similarities between these cases contribute to the current literature and highlight the need for rigorous studies in the future to guide zolpidem trials in patient care for those with DOC.
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Affiliation(s)
- Yi Zhou
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kathryn A Altonji
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Ashley Kakkanatt
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Brian D Greenwald
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Clark T, Lewko A, Calestani M. The circular paradox of including people with severe brain injuries and reduced decisional capacity in research: A feasibility study exploring randomized research, consent-based recruitment biases, and the resultant health inequities. Physiother Theory Pract 2023:1-17. [PMID: 37477593 DOI: 10.1080/09593985.2023.2236194] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
BACKGROUND People with severe brain injuries (PSBI) and reduced capacity to consent (CTC) frequently develop muscle contractures. Standard care includes prolonged stretch (PS) but there is limited condition-specific evidence from randomized controlled trials (RCTs). PURPOSE Identify factors affecting the inclusion of PSBI and reduced CTC in a PS RCT and methodologies more capable of generating condition-specific outcomes. METHODS Mixed-method feasibility studies, including a pilot RCT (PSBI, adults with reduced CTC) comparing PS treatments (serial casting and splinting) and focus groups/interviews with physiotherapists involved in PS treatment. Reflexive thematic analysis developed themes. RESULTS Two PSBI were included in the pilot RCT with no significant safety concerns or adverse effects. Twelve physiotherapists participated in two focus groups and two interviews. Four themes were identified: 1) complexity of contracture management; 2) burden of decision making; 3) lack of evidence and uncertainty; and 4) challenges to RCT acceptability and feasibility. CONCLUSIONS Reduced CTC contributes to the exclusion of PSBI from experimental research, and a circular paradox where poor research inclusion contributes to generalized healthcare and "evidence-biased medicine." Due to the complexity of their condition, simply including PSBI in randomized research is unlikely to create meaningful health outcomes. Improving their care requires a paradigm shift toward pluralistic methods of knowledge generation.
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Affiliation(s)
- Teresa Clark
- Physiotherapy, Royal Hospital for Neurodisability, London, UK
- Faculty of Health, Social Care and Education, Kingston University and St George's, London, UK
| | - Agnieszka Lewko
- Faculty of Health, Social Care and Education, Kingston University and St George's, London, UK
- Research Centre for Healthcare and Communities, Coventry University, Richard Crossman Building, Coventry, UK
| | - Melania Calestani
- Department of Midwifery, School of Education, Midwifery and Social Care, Faculty of Health, Science, Social Care and Education, Kingston University, Kingston Upon Thames, UK
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Rose AE, Cullen B, Crawford S, Evans JJ. A systematic review of mood and depression measures in people with severe cognitive and communication impairments following acquired brain injury. Clin Rehabil 2023; 37:679-700. [PMID: 36380679 PMCID: PMC10041571 DOI: 10.1177/02692155221139023] [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: 11/17/2022]
Abstract
AIM A systematic review to identify which mood and depression measures are valid for use with people with severe cognitive and communication impairments following severe acquired brain injury. METHOD A systematic search of Cochrane, Web of Science, Ovid, and EBSCOhost was performed in March 2020, July 2021, and September 2022. The search focused on self-report and observer-rated assessment tools used to assess mood, depression, and/or distress in those described as having a severe acquired brain injury. Psychometric properties were extracted using the Consensus-based standards for the selection of health measurement instruments (COSMIN) risk of bias checklist. Qualitative synthesis was performed on extracted patient data. RESULTS Nineteen papers detailing the psychometric properties of 25 measures were included, involving 2,914 participants. Nine papers provided details confirming the severity of participants' cognitive and communication impairments. The remaining papers described including severely injured participants but provided limited details so that precise level of severity could not be confirmed. Only one paper showed evidence of adequate psychometric properties and included those with severe cognitive impairments in a study of two observer-rated measures, the Stroke Aphasia Depression Questionnaire (10 items) and the Aphasia Depression Rating Scale. CONCLUSIONS Due to the exclusion of individuals with severe cognitive and communication consequences following brain injury, no studies using self-report measures showed adequate validity evidence to recommend their use in this population. A small study using two observer-rated scales included those with severe cognitive impairments and showed satisfactory evidence that these measures can be validly used with this population.
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Affiliation(s)
- Alexandra E Rose
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Department of Psychology, 59386Royal Hospital for Neuro-disability, London, UK
| | - Breda Cullen
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Sarah Crawford
- Department of Psychology, 59386Royal Hospital for Neuro-disability, London, UK
| | - Jonathan J Evans
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Colombo MA, Comanducci A, Casarotto S, Derchi CC, Annen J, Viganò A, Mazza A, Trimarchi PD, Boly M, Fecchio M, Bodart O, Navarro J, Laureys S, Gosseries O, Massimini M, Sarasso S, Rosanova M. Beyond alpha power: EEG spatial and spectral gradients robustly stratify disorders of consciousness. Cereb Cortex 2023:7091601. [PMID: 36977648 DOI: 10.1093/cercor/bhad031] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 03/30/2023] Open
Abstract
Neurophysiological markers can overcome the limitations of behavioural assessments of Disorders of Consciousness (DoC). EEG alpha power emerged as a promising marker for DoC, although long-standing literature reported alpha power being sustained during anesthetic-induced unconsciousness, and reduced during dreaming and hallucinations. We hypothesized that EEG power suppression caused by severe anoxia could explain this conflict. Accordingly, we split DoC patients (n = 87) in postanoxic and non-postanoxic cohorts. Alpha power was suppressed only in severe postanoxia but failed to discriminate un/consciousness in other aetiologies. Furthermore, it did not generalize to an independent reference dataset (n = 65) of neurotypical, neurological, and anesthesia conditions. We then investigated EEG spatio-spectral gradients, reflecting anteriorization and slowing, as alternative markers. In non-postanoxic DoC, these features, combined in a bivariate model, reliably stratified patients and indexed consciousness, even in unresponsive patients identified as conscious by an independent neural marker (the Perturbational Complexity Index). Crucially, this model optimally generalized to the reference dataset. Overall, alpha power does not index consciousness; rather, its suppression entails diffuse cortical damage, in postanoxic patients. As an alternative, EEG spatio-spectral gradients, reflecting distinct pathophysiological mechanisms, jointly provide a robust, parsimonious, and generalizable marker of consciousness, whose clinical application may guide rehabilitation efforts.
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Affiliation(s)
| | - Angela Comanducci
- IRCCS, Fondazione Don Carlo Gnocchi Onlus, Milan 20148, Italy
- Department of Engineering, Università Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Silvia Casarotto
- Department of Biomedical and Clinical Sciences, University of Milan, Milan 20157, Italy
- IRCCS, Fondazione Don Carlo Gnocchi Onlus, Milan 20148, Italy
| | | | - Jitka Annen
- Coma Science Group, GIGA-Consciousness, University of Liège and Centre du Cerveau2, University Hospital of Liège, Liège 4000, Belgium
| | | | - Alice Mazza
- IRCCS, Fondazione Don Carlo Gnocchi Onlus, Milan 20148, Italy
| | | | - Melanie Boly
- Department of Neurology and Department of Psychiatry, University of Wisconsin, Madison, WI 53705-2281, USA
| | - Matteo Fecchio
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Olivier Bodart
- Coma Science Group, GIGA-Consciousness, University of Liège and Centre du Cerveau2, University Hospital of Liège, Liège 4000, Belgium
| | - Jorge Navarro
- IRCCS, Fondazione Don Carlo Gnocchi Onlus, Milan 20148, Italy
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège and Centre du Cerveau2, University Hospital of Liège, Liège 4000, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège and Centre du Cerveau2, University Hospital of Liège, Liège 4000, Belgium
| | - Marcello Massimini
- Department of Biomedical and Clinical Sciences, University of Milan, Milan 20157, Italy
- IRCCS, Fondazione Don Carlo Gnocchi Onlus, Milan 20148, Italy
| | - Simone Sarasso
- Department of Biomedical and Clinical Sciences, University of Milan, Milan 20157, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences, University of Milan, Milan 20157, Italy
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Shevelev OA, Petrova MV, Mengistu EM, Yuriev MY, Kostenkova IZ, Vesnin SG, Kanarskii MM, Zhdanova MA, Goryanin I. Correction of Local Brain Temperature after Severe Brain Injury Using Hypothermia and Medical Microwave Radiometry (MWR) as Companion Diagnostics. Diagnostics (Basel) 2023; 13:diagnostics13061159. [PMID: 36980467 PMCID: PMC10047658 DOI: 10.3390/diagnostics13061159] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/07/2023] [Accepted: 03/12/2023] [Indexed: 03/30/2023] Open
Abstract
The temperature of the brain can reflect the activity of its different regions, allowing us to evaluate the connections between them. A study involving 111 patients in a vegetative state or minimally conscious state used microwave radiometry to measure their cortical temperature. The patients were divided into a main group receiving a 10-day selective craniocerebral hypothermia (SCCH) procedure, and a control group receiving basic therapy and rehabilitation. The main group showed a significant improvement in consciousness level as measured by CRS-R assessment on day 14 compared to the control group. Temperature heterogeneity increased in patients who received SCCH, while remaining stable in the control group. The use of microwave radiometry to assess rehabilitation effectiveness and the inclusion of SCCH in rehabilitation programs appears to be a promising approach.
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Affiliation(s)
- Oleg A Shevelev
- Federal Research and Clinical Centre for Resuscitation and Rehabilitology, 107031 Moscow, Russia
- Department of Anaesthesiology and Intensive Care, Department of General Pathology and Pathological Physiology, Institute of Medicine, Peoples' Friendship University of Russia, 117198 Moscow, Russia
| | - Marina V Petrova
- Federal Research and Clinical Centre for Resuscitation and Rehabilitology, 107031 Moscow, Russia
- Department of Anaesthesiology and Intensive Care, Department of General Pathology and Pathological Physiology, Institute of Medicine, Peoples' Friendship University of Russia, 117198 Moscow, Russia
| | - Elias M Mengistu
- Federal Research and Clinical Centre for Resuscitation and Rehabilitology, 107031 Moscow, Russia
- Department of Anaesthesiology and Intensive Care, Department of General Pathology and Pathological Physiology, Institute of Medicine, Peoples' Friendship University of Russia, 117198 Moscow, Russia
| | - Mikhail Y Yuriev
- Federal Research and Clinical Centre for Resuscitation and Rehabilitology, 107031 Moscow, Russia
| | - Inna Z Kostenkova
- Federal Research and Clinical Centre for Resuscitation and Rehabilitology, 107031 Moscow, Russia
| | - Sergey G Vesnin
- Medical Microwave Radiometry (MMWR) LTD, Edinburgh EH10 5LZ, UK
| | - Michael M Kanarskii
- Federal Research and Clinical Centre for Resuscitation and Rehabilitology, 107031 Moscow, Russia
| | - Maria A Zhdanova
- Federal Research and Clinical Centre for Resuscitation and Rehabilitology, 107031 Moscow, Russia
| | - Igor Goryanin
- School of Informatics, University of Edinburgh, Edinburgh EH8 9YL, UK
- Biological Systems Unit, Okinawa Institute Science and Technology, Onna 904-0495, Japan
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Lutkenhoff ES, Nigri A, Rossi Sebastiano D, Sattin D, Visani E, Rosazza C, D'Incerti L, Bruzzone MG, Franceschetti S, Leonardi M, Ferraro S, Monti MM. EEG Power spectra and subcortical pathology in chronic disorders of consciousness. Psychol Med 2022; 52:1491-1500. [PMID: 32962777 DOI: 10.1017/s003329172000330x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite a growing understanding of disorders of consciousness following severe brain injury, the association between long-term impairment of consciousness, spontaneous brain oscillations, and underlying subcortical damage, and the ability of such information to aid patient diagnosis, remains incomplete. METHODS Cross-sectional observational sample of 116 patients with a disorder of consciousness secondary to brain injury, collected prospectively at a tertiary center between 2011 and 2013. Multimodal analyses relating clinical measures of impairment, electroencephalographic measures of spontaneous brain activity, and magnetic resonance imaging data of subcortical atrophy were conducted in 2018. RESULTS In the final analyzed sample of 61 patients, systematic associations were found between electroencephalographic power spectra and subcortical damage. Specifically, the ratio of beta-to-delta relative power was negatively associated with greater atrophy in regions of the bilateral thalamus and globus pallidus (both left > right) previously shown to be preferentially atrophied in chronic disorders of consciousness. Power spectrum total density was also negatively associated with widespread atrophy in regions of the left globus pallidus, right caudate, and in the brainstem. Furthermore, we showed that the combination of demographics, encephalographic, and imaging data in an analytic framework can be employed to aid behavioral diagnosis. CONCLUSIONS These results ground, for the first time, electroencephalographic presentation detected with routine clinical techniques in the underlying brain pathology of disorders of consciousness and demonstrate how multimodal combination of clinical, electroencephalographic, and imaging data can be employed in potentially mitigating the high rates of misdiagnosis typical of this patient cohort.
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Affiliation(s)
- Evan S Lutkenhoff
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Brain Injury Research Center (BIRC), Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Anna Nigri
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Davide Rossi Sebastiano
- Department of Neurophysiology, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Davide Sattin
- Neurology, Public Health, Disability Unit and Coma Research Centre, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Elisa Visani
- Department of Neurophysiology, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Cristina Rosazza
- Scientific Direction, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Ludovico D'Incerti
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Maria Grazia Bruzzone
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Silvana Franceschetti
- Department of Neurophysiology, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit and Coma Research Centre, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Stefania Ferraro
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
- School of Life Science and Technology, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China: On the behalf of the Coma Research Center, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Brain Injury Research Center (BIRC), Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Bystrup MR, Aadal L, Pallesen H, Larsen K, Hindhede AL. Who are relatives? Young adults, relatives and professionals' perceptions of relatives during the rehabilitation of young adults with a severe acquired brain injury. Disabil Rehabil 2022; 45:1655-1666. [PMID: 35559686 DOI: 10.1080/09638288.2022.2072959] [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: 11/03/2022]
Abstract
PURPOSE This paper explores the perception of "relatives" during the rehabilitation of young adults with severe acquired brain injury (SABI). METHODS This longitudinal qualitative study followed eight young adults with a SABI from hospital discharge to a year and a half after discharge. The design encompassed professional records, interviews, and surveys, including a name generator list completed by the young adults and focus group interviews with both their families and professionals. We apply a sociological theoretical framework concerning friendship, and we employ social network analysis (SNA) methodology to capture, visualise, and analyse the young adults' significant social relations. RESULTS Social relations engaged as relatives during rehabilitation are to a large extent determined by the perceptions of professionals and the parents of the young adult. These perceptions contain a limited number of social relations, with priority given to biological and juridical ties. This might reflect the reduced social support available for the young adult, who initially had a much larger social network. CONCLUSION The authors suggest a professional rethinking of who "relatives" are as well as considering these social ties as dynamic. Implications for rehabilitationRehabilitation professionals must be aware of and pay attention to differing perceptions that exist as to who qualifies as significant social relations in order to reconsider the practical implementation of relative involvement.The perception of who relatives are during the rehabilitation process should be reconsidered and extended to include who the young adult perceive as significant social relations.Relatives are not a fixed entity and should be considered dynamically throughout the rehabilitation process.Social relations of the young adult must to a larger extent be considered during rehabilitation to prevent social isolation in the long run.
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Affiliation(s)
- Mette Ryssel Bystrup
- Department of Culture and Learning, Aalborg University, Copenhagen SV, Denmark.,Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Lena Aadal
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Hanne Pallesen
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Kristian Larsen
- The University Hospital Centre for Health Research (UCSF) & University of Copenhagen, Copenhagen, Denmark
| | - Anette L Hindhede
- The University Hospital Centre for Health Research (UCSF) & University of Copenhagen, Copenhagen, Denmark
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Winters B, Kuluris B, Pathmanaban R, Vanderwalt H, Thibaut A, Schnakers C. Changes of Spasticity across Time in Prolonged Disorders of Consciousness: A Retrospective Study. Brain Sci 2022; 12:295. [PMID: 35204057 DOI: 10.3390/brainsci12020295] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES In this retrospective study, we investigated how spasticity developed in patients diagnosed with a prolonged DOC over an almost two-year observation period (21 months), and how it related to the patients' age, gender, time since injury, etiology, level of consciousness, and anti-spastic medications. METHODS In total, 19 patients with a severe brain injury and prolonged DOC admitted to a long-term care facility were included in this study (14 male, age: 45.8 ± 15.3 years, 10 traumatic brain injury, 1.01 ± 0.99 years after brain injury, 11 minimally conscious state vs. 8 vegetative state). Each patient was assessed at admission and then quarterly, totaling eight assessments over 21 months. Spasticity was measured with the Modified Ashworth Scale (MAS) for both upper and lower limbs. The Western Neuro Sensory Stimulation Profile (WNSSP) was administered to assess the level of consciousness. Any other medical and demographic information of interest was obtained through medical records. Linear mixed models were used to assess each variable's impact on the change of spasticity over time. RESULTS Significant differences were observed in the evolution of spasticity in patients based on their etiology for the upper limbs [F (7, 107.29) = 2.226; p = 0.038], and on their level of consciousness for the lower limbs [F (7, 107.07) = 3.196; p = 0.004]. CONCLUSION Our preliminary results suggest that spasticity evolves differently according to the type of brain lesion and the level of consciousness. Spasticity in DOCs might therefore be mediated by different mechanisms and might have to be treated differently among patients. Future longitudinal studies should be performed prospectively in a bigger cohort and with data collection beginning earlier after brain injury to confirm our results and better understand the evolution of spasticity in this population.
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Berenati M, Naro A, Calabrò C, Torrisi M, Cardali SM, Calabrò RS. Is Neuromuscular Electrical Stimulation Effective in Treating Severe Dysarthria: Insights from a Case Study. Innov Clin Neurosci 2021; 18:23-25. [PMID: 35096478 PMCID: PMC8794476] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Dysarthria refers to a group of disorders resulting from disturbances in neuromuscular control over the speech mechanisms due to damage of the central nervous system (CNS) or peripheral nervous system (PNS). Rehabilitation outcomes of dysarthria significantly depend on the collaboration skills of the patients. This case study aimed to investigate the potential role of neuromuscular electric stimulation (NMES) in improving severe dysarthria. An 18-year-old man affected by severe dysarthria following postanoxic brain injury underwent two different intensive rehabilitation trainings: conventional rehabilitation alone, followed by NMES training alone. We evaluated patient articulation function before and after each training. The overall NMES program was scheduled in daily sessions of 30 minutes, six days a week, for four consecutive weeks. The patient did not report any side effects either during or following both types of intensive rehabilitation training. However, a clear reduction of dysarthria severity was observed only after the NMES training. CONCLUSION NMES could allow for improved articulator expression and vocal parameters, thus enhancing communication skills, when conventional articulation treatments are not possible or are ineffective.
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Affiliation(s)
- Matteo Berenati
- Mr. Berenati, Ms. C. Calabrò, and Drs. Naro, Torrisi, and R. Calabrò are with IRCCS Centro Neurolesi "Bonino-Pulejo" in Messina, Italy
- Dr. Cardali is with UOC Neurochirurgia, AOU Policlinico G Martino in Messina, Italy
| | - Antonino Naro
- Mr. Berenati, Ms. C. Calabrò, and Drs. Naro, Torrisi, and R. Calabrò are with IRCCS Centro Neurolesi "Bonino-Pulejo" in Messina, Italy
- Dr. Cardali is with UOC Neurochirurgia, AOU Policlinico G Martino in Messina, Italy
| | - Cinzia Calabrò
- Mr. Berenati, Ms. C. Calabrò, and Drs. Naro, Torrisi, and R. Calabrò are with IRCCS Centro Neurolesi "Bonino-Pulejo" in Messina, Italy
- Dr. Cardali is with UOC Neurochirurgia, AOU Policlinico G Martino in Messina, Italy
| | - Michele Torrisi
- Mr. Berenati, Ms. C. Calabrò, and Drs. Naro, Torrisi, and R. Calabrò are with IRCCS Centro Neurolesi "Bonino-Pulejo" in Messina, Italy
- Dr. Cardali is with UOC Neurochirurgia, AOU Policlinico G Martino in Messina, Italy
| | - Salvatore Massimiliano Cardali
- Mr. Berenati, Ms. C. Calabrò, and Drs. Naro, Torrisi, and R. Calabrò are with IRCCS Centro Neurolesi "Bonino-Pulejo" in Messina, Italy
- Dr. Cardali is with UOC Neurochirurgia, AOU Policlinico G Martino in Messina, Italy
| | - Rocco Salvatore Calabrò
- Mr. Berenati, Ms. C. Calabrò, and Drs. Naro, Torrisi, and R. Calabrò are with IRCCS Centro Neurolesi "Bonino-Pulejo" in Messina, Italy
- Dr. Cardali is with UOC Neurochirurgia, AOU Policlinico G Martino in Messina, Italy
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11
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Zhou L, Wang J, Wu Y, Liu ZY, Yu Y, Liu JF, Chen X. Clinical significance of mismatch negativity in predicting the awakening of comatose patients after severe brain injury. J Neurophysiol 2021; 126:140-147. [PMID: 34038175 DOI: 10.1152/jn.00658.2020] [Citation(s) in RCA: 1] [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: 11/22/2022] Open
Abstract
We assessed the clinical significance of mismatch negativity (MMN) in predicting the awakening of comatose patients with severe brain injury. The clinical data of patients with severe brain injury, admitted to the neurosurgical intensive care unit of Xiangya Hospital of Central South University from July 2018 to March 2020, who underwent auditory MMN examinations within 28 days after coma onset, were reviewed. Correlations between clinical factors and prognosis [Glasgow Outcome Scale (GCS) for 3 mo] were analyzed. Fifty-three patients were included; 37 (69.8%) had favorable outcomes. A univariate analysis revealed the Glasgow Coma Scale (GCS) and absolute MMN amplitudes at electrodes Fz and Cz were significantly correlated with prognosis. Only GCS scores and MMN amplitude at Fz were independent predictors in multivariate logistic regression analysis (area under the curve 0.744 vs. 0.753, respectively); both combined, improved accuracy to 84.6%. MMN amplitudes at Fz were dichotomized at a value of 1.08 μV with a sensitivity and specificity of 81.1% and 68.7%, respectively, for predicting comatose patients' awakening. In conclusion, MMN amplitude at Fz is a reliable prognostic indicator for comatose patients with severe brain injury; the prediction value improved when combined with GCS. Thus, an event-related potential component with a clear site and cutoff value may support prognostication in severe brain injury.NEW & NOTEWORTHY Mismatch negativity (MMN) can assess the prognosis of comatose patients after severe brain injury, especially for MMN amplitude. In addition, MMN analysis at electrode Fz best predicts recovery of consciousness in patients with severe brain injury. Importantly, a quantitative approach (cutoff value of 1.08 μV) may improve the use of MMN for prognostication.
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Affiliation(s)
- Liang Zhou
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Jian Wang
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Yun Wu
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Zi-Yuan Liu
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Yang Yu
- College of Intelligence Science and Technology, National University of Defense Technology, Changsha, Hunan Province, China
| | - Jin-Fang Liu
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Xin Chen
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
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12
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Mélotte E, Belorgeot M, Herr R, Simon J, Kaux JF, Laureys S, Sanz LRD, Lagier A, Morsomme D, Pellas F, Gosseries O. The Development and Validation of the SWADOC: A Study Protocol for a Multicenter Prospective Cohort Study. Front Neurol 2021; 12:662634. [PMID: 33995257 PMCID: PMC8116670 DOI: 10.3389/fneur.2021.662634] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/03/2021] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: After a coma, patients with severe brain injury may present disorders of consciousness (DOC). A substantial proportion of these patients also suffer from severe dysphagia. Assessment of and therapy for swallowing disabilities of patients with DOC are essential because dysphagia has major functional consequences and comorbidities. Dysphagia evaluation in patients with DOC is impeded by the lack of adapted tools. The first aim of this study was to create a new tool, the SWallowing Assessment in Disorders Of Consciousness (SWADOC), and propose a validation protocol. The SWADOC was developed to help therapists assess factors related to swallowing in patients with DOC. The second aim was to investigate the relationship between patients' level of consciousness and SWADOC items and scores. Method/Design: In this multicenter prospective cohort, 104 patients with DOC will be tested three times over five consecutive days with the SWADOC. Statistical analyses will focus on the reliability and validity of the SWADOC, especially the intrarater and interrater reliability, internal consistency, measures of dispersion, and concurrent validity with the Facial Oral Tract Therapy Swallowing Assessment of Saliva (FOTT-SAS). The level of consciousness will be assessed with the Simplified Evaluation of CONsciousness Disorders (SECONDs) and the Coma Recovery Scale-Revised (CRS-R). Discussion: The assessment of swallowing abilities among patients with DOC is the first necessary step toward the development of a customized dysphagia care plan. A validated scoring tool will be essential for clinicians to better assess dysphagia in patients with DOC and document the evolution of their disorders. Trial Registration: NCT04706689.
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Affiliation(s)
- Evelyne Mélotte
- Physical and Rehabilitation Medicine Department, University Hospital of Liège, Liège, Belgium.,Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Marion Belorgeot
- Physical and Rehabilitation Medicine Department, University Hospital of Nîmes, Nîmes, France
| | - Roxanne Herr
- Department of Speech and Language Pathology, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Jessica Simon
- Psychology and Neuroscience of Cognition, University of Liège, Liège, Belgium
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Leandro R D Sanz
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Aude Lagier
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liège, Liège, Belgium
| | - Dominique Morsomme
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liège, Liège, Belgium
| | - Frederic Pellas
- Physical and Rehabilitation Medicine Department, University Hospital of Nîmes, Nîmes, France
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium
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13
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Schnakers C, Hirsch M, Noé E, Llorens R, Lejeune N, Veeramuthu V, De Marco S, Demertzi A, Duclos C, Morrissey AM, Chatelle C, Estraneo A. Covert Cognition in Disorders of Consciousness: A Meta-Analysis. Brain Sci 2020; 10:E930. [PMID: 33276451 DOI: 10.3390/brainsci10120930] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 12/20/2022] Open
Abstract
Covert cognition in patients with disorders of consciousness represents a real diagnostic conundrum for clinicians. In this meta-analysis, our main objective was to identify clinical and demographic variables that are more likely to be associated with responding to an active paradigm. Among 2018 citations found on PubMed, 60 observational studies were found relevant. Based on the QUADAS-2, 49 studies were considered. Data from 25 publications were extracted and included in the meta-analysis. Most of these studies used electrophysiology as well as counting tasks or mental imagery. According to our statistical analysis, patients clinically diagnosed as being in a vegetative state and in a minimally conscious state minus (MCS-) show similar likelihood in responding to active paradigm and responders are most likely suffering from a traumatic brain injury. In the future, multi-centric studies should be performed in order to increase sample size, with similar methodologies and include structural and functional neuroimaging in order to identify cerebral markers related to such a challenging diagnosis.
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14
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Abstract
PURPOSE OF REVIEW The purpose of this review is to describe ethical and legal issues that arise in the management of patients with disorders of consciousness ranging from the minimally conscious state to the coma state, as well as brain death. RECENT FINDINGS The recent literature highlights dilemmas created by diagnostic and prognostic uncertainties in patients with disorders of consciousness. The discussion also reveals the challenges experienced by the disability community, which includes individuals with severe brain injury who are classified as having a disorder of consciousness. We review current guidelines for management of patients with disorders of consciousness including discussions around diagnosis, prognosis, consideration of neuropalliation, and decisions around life sustaining medical treatment. SUMMARY In the setting of uncertainty, this review describes the utility of applying a disability rights perspective and shared decision-making process to approach medical decision-making for patients with disorders of consciousness. We outline approaches to identifying surrogate decision makers, standards for decision-making and decision-making processes, specifically addressing the concept of futility as a less useful framework for making decisions. We also highlight special considerations for research, innovative and controversial care, brain death, organ donation, and child abuse and neglect.
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Affiliation(s)
- Lauren Rissman
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Erin Talati Paquette
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
- Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern University Pritzker School of Law (by courtesy), Chicago, IL
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15
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Sörbo A, Eiving I, Theodorsson E, Rydenhag B, Jonsdottir IH. Pre-traumatic conditions can influence cortisol levels before and after a brain injury. Acta Neurol Scand 2020; 141:342-350. [PMID: 31879940 DOI: 10.1111/ane.13212] [Citation(s) in RCA: 3] [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] [Received: 08/23/2019] [Revised: 12/01/2019] [Accepted: 12/21/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Satisfactory anabolic reactions, including the activation of the hypothalamic-pituitary-adrenal (HPA) axis, are essential following severe traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (SAH). Many factors may influence this activation. This study aimed to investigate whether individuals who reported chronic diseases, psychosocial afflictions, or stressful events before a severe brain injury display a different pattern regarding cortisol levels retrospectively and up to three months compared with those who did not report stressful experiences. MATERIALS AND METHODS Fifty-five patients aged 16-68 years who were admitted to the neurointensive care unit (NICU) were included. Hair cortisol measurements offer a unique opportunity to monitor cortisol levels retrospectively and after the trauma. Hair strands were collected as soon as possible after admission to the NICU and every month until three months after the injury/insult. The participants/relatives were asked about stressful events, psychosocial afflictions and recent and chronic diseases. RESULTS The group who reported chronic diseases and/or stressful events before the brain injury had more than twice as high median hair cortisol levels before the brain injury compared with those who did not report stress, but the difference was not statistically significant (P = .12). Those who reported stress before the brain injury had statistically significantly lower hair cortisol values after the brain injury and they remained until three months after the injury. CONCLUSIONS Stressful events and/or chronic disease before brain injury might affect mobilization of adequate stress reactions following the trauma. However, the large variability in cortisol levels in these patients does not allow firm conclusions and more studies are needed.
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Affiliation(s)
- Ann Sörbo
- Department of Neurology and Rehabilitation Södra Älvsborg Hospital Borås Sweden
- Department of Neurology and Rehabilitation Uddevalla Hospital Uddevalla Sweden
- Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Ingrid Eiving
- Neurointensive Care Unit Department of Anesthesiology and Intensive Care Sahlgrenska University Hospital Gothenburg Sweden
| | - Elvar Theodorsson
- Department of Clinical Chemistry and Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Bertil Rydenhag
- Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurosurgery Sahlgrenska University Hospital Gothenburg Sweden
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16
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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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17
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Gesch JM, Low Choy NL, Weeks BK, Nascimento M, Steele M, Kuys SS. Inter- and intra-tester reliability of the acute brain injury physiotherapy assessment (ABIPA) in patients with acquired brain injury. Brain Inj 2017; 31:1799-1806. [PMID: 29115864 DOI: 10.1080/02699052.2017.1346298] [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: 10/18/2022]
Abstract
BACKGROUND The Acute Brain Injury Physiotherapy Assessment (ABIPA) is a new outcome measure with face validity and sensitivity to change in the early stages of neuromotor recovery after acquired brain injury (ABI). Reliability of physiotherapists using the tool has not been established. OBJECTIVE Determine inter- and intra-tester reliability of physiotherapists using the ABIPA. METHODS An observational study using video-recorded assessments of patient performance (n = 7) was undertaken with two cohorts of physiotherapists: those receiving training (n = 23) and those provided with guidelines only (n = 7) to administer the ABIPA. RESULTS Across all physiotherapists (n = 30), inter-tester reliability was excellent (α ≥ 0.9) for total ABIPA score. All individual items, except trunk alignment in supine (α = 0.5), showed excellent or good internal consistency (α ≥ 0.7). For intra-tester reliability, substantial or perfect agreement was achieved for eight items (weighted Kappa Kw ≥ 0.6), moderate agreement for four items (Kw = 0.4-0.6) and three items achieved fair agreement (alignment head supine: Kw = 0.289; alignment trunk supine: Kw = 0.387 and tone left upper limb: Kw = 0.366). CONCLUSION Physiotherapists are highly consistent using the ABIPA but several items may need revision to improve intra-tester reliability.
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Affiliation(s)
- Janelle M Gesch
- a Brain Injury Rehabilitation Unit , Department of Physiotherapy, Princess Alexandra Hospital , Woolloongabba, Brisbane , QLD , Australia.,b Australian Catholic University, (Brisbane Campus) , Brisbane , QLD , Australia
| | - Nancy L Low Choy
- b Australian Catholic University, (Brisbane Campus) , Brisbane , QLD , Australia.,c The Prince Charles Hospital , Brisbane , QLD , Australia
| | - Benjamin K Weeks
- d Menzies Health Institute Queensland, Griffith University , Gold Coast , QLD , Australia
| | - Margarida Nascimento
- a Brain Injury Rehabilitation Unit , Department of Physiotherapy, Princess Alexandra Hospital , Woolloongabba, Brisbane , QLD , Australia
| | - Michael Steele
- d Menzies Health Institute Queensland, Griffith University , Gold Coast , QLD , Australia
| | - Suzanne S Kuys
- b Australian Catholic University, (Brisbane Campus) , Brisbane , QLD , Australia.,c The Prince Charles Hospital , Brisbane , QLD , Australia.,d Menzies Health Institute Queensland, Griffith University , Gold Coast , QLD , Australia
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Abstract
This article addresses questions surrounding the minimally conscious state (MCS) from the perspective of adult clinical ethics. It describes the background of the MCS diagnosis, analyzes phenomenological ambiguities inherent in the nature of MCS, and raises epistemological concerns surrounding its diagnosis. It argues that in many cases, the burdens of prolonging treatment for people who have sustained certain severe brain injuries (SBI) outweigh the benefits, even if they are in or have the prospect of entering into MCS. It also argues that often such long-term measures are problematic from the perspective of patient preferences and stewardship of resources. Consequently, it suggests that the delineation of MCS as a distinct neurological state, along with research that seeks to expand how MCS is diagnosed, poses ethical difficulties for families and providers making decisions for affected patients.
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Abstract
AIM OF THE STUDY Cranioplasty is the surgical repair of skull defects, which commonly is performed after traumatic skull injuries due to tumor removal or decompressive craniectomy. Several studies reported improvement in cognitive functions following cranioplasty in patients with severe brain damage. The reasons why exist such clinical improvement is not completely understood, although the increase in cerebrospinal fluid hydrodynamics with the potential improvement of local and global cerebral hemodynamics, blood flow, and metabolism may play a pivotal role. We investigated whether the cranioplasty improved neurological recovery and the whole array of cognitive functions or just some specific domains. MATERIALS AND METHODS A total of 30 consecutive brain-injured subjects with craniectomy were enrolled and underwent a structured neuropsychological assessment immediately before the cranioplasty, 1 month after the cranioplasty and 1 year after the surgical procedure. RESULTS Our results showed that cranioplasty may facilitate the cognitive recovery, independently from the surgical timing. Particularly, we observed an important cognitive recovery in the period immediately after cranioplasty, while the improvement trend settles after a lapse of time, and the recovery starts to slow down. CONCLUSIONS Cranioplasty seems to significantly improve neuropsychological and motor status in the patients with skull defects, independently from cranioplasty timing and patient's clinical status.
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Affiliation(s)
| | | | | | - Angela Marra
- a IRCCS Centro Neurolesi "Bonino Pulejo" , Messina , Italy
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20
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Baker JL, Ryou JW, Wei XF, Butson CR, Schiff ND, Purpura KP. Robust modulation of arousal regulation, performance, and frontostriatal activity through central thalamic deep brain stimulation in healthy nonhuman primates. J Neurophysiol 2016; 116:2383-2404. [PMID: 27582298 DOI: 10.1152/jn.01129.2015] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 08/08/2016] [Indexed: 11/22/2022] Open
Abstract
The central thalamus (CT) is a key component of the brain-wide network underlying arousal regulation and sensory-motor integration during wakefulness in the mammalian brain. Dysfunction of the CT, typically a result of severe brain injury (SBI), leads to long-lasting impairments in arousal regulation and subsequent deficits in cognition. Central thalamic deep brain stimulation (CT-DBS) is proposed as a therapy to reestablish and maintain arousal regulation to improve cognition in select SBI patients. However, a mechanistic understanding of CT-DBS and an optimal method of implementing this promising therapy are unknown. Here we demonstrate in two healthy nonhuman primates (NHPs), Macaca mulatta, that location-specific CT-DBS improves performance in visuomotor tasks and is associated with physiological effects consistent with enhancement of endogenous arousal. Specifically, CT-DBS within the lateral wing of the central lateral nucleus and the surrounding medial dorsal thalamic tegmental tract (DTTm) produces a rapid and robust modulation of performance and arousal, as measured by neuronal activity in the frontal cortex and striatum. Notably, the most robust and reliable behavioral and physiological responses resulted when we implemented a novel method of CT-DBS that orients and shapes the electric field within the DTTm using spatially separated DBS leads. Collectively, our results demonstrate that selective activation within the DTTm of the CT robustly regulates endogenous arousal and enhances cognitive performance in the intact NHP; these findings provide insights into the mechanism of CT-DBS and further support the development of CT-DBS as a therapy for reestablishing arousal regulation to support cognition in SBI patients.
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Affiliation(s)
- Jonathan L Baker
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York;
| | - Jae-Wook Ryou
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York
| | - Xuefeng F Wei
- College of New Jersey, Department of Biomedical Engineering, Ewing Township, New Jersey; and
| | - Christopher R Butson
- University of Utah, Scientific Computing & Imaging (SCI) Institute, Department of Bioengineering, Salt Lake City, Utah
| | - Nicholas D Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York
| | - Keith P Purpura
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York
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21
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Fotakopoulos G, Tsianaka E, Vagkopoulos K, Fountas KN. According to which factors in severe traumatic brain injury craniectomy could be beneficial. Surg Neurol Int 2016; 7:19. [PMID: 26981320 PMCID: PMC4774169 DOI: 10.4103/2152-7806.176671] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 03/19/2015] [Accepted: 12/31/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To investigate the clinical outcome at 101 patients undergoing decompressive craniectomy (DC) after severe traumatic brain injury (TBI). METHODS Age, Glasgow Coma Scale (GCS) at the time of intubation, and the intraoperative intracranial pressure (ICP) were recorded. Formal DC was performed in all cases and the square surface of bone flap was calculated in cm(2) based on the length and the width from computed tomography scan. RESULTS The difference of good neurological recovery (Glasgow outcome score 4-5), between patients with ICP ≤20 mmHg, GCS ≥5, age ≤60 years, and bone flap ≥130 cm(2) and those with ICP >20 mmHg, GCS <5, age >60 years, and bone flap <130 cm(2), was statistically significant. CONCLUSION Although the application of DC in severe TBI is controversial and the population in this study is small, our study demonstrates the threshold of the specific factors (patient age, ICP and GCS on the day of the surgery and the size of the bone flap) which may help in the decision of performing DC. Furthermore, this study proves that the different combinations and mainly at the same time involvement of all prognostic parameters (age <60, GCS <5, bone flap ≥130 cm(2), and ICP ≤20 at time of DC surgery) allow a better outcome.
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Affiliation(s)
- George Fotakopoulos
- Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Biopolis, 41110 Larissa, Thessaly, Greece,Corresponding author
| | - Eleni Tsianaka
- Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Biopolis, 41110 Larissa, Thessaly, Greece
| | - Konstantinos Vagkopoulos
- Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Biopolis, 41110 Larissa, Thessaly, Greece
| | - Kostas N. Fountas
- Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Biopolis, 41110 Larissa, Thessaly, Greece,Center for Research and Technology of Thessaly, 38500 Larissa, Greece
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Aricò I, Naro A, Pisani LR, Leo A, Muscarà N, De Salvo S, Silvestri R, Bramanti P, Calabrò RS. Could combined sleep and pain evaluation be useful in the diagnosis of disorders of consciousness (DOC)? Preliminary findings. Brain Inj 2015; 30:159-63. [PMID: 26618404 DOI: 10.3109/02699052.2015.1089595] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The diagnosis of Disorders of Consciousness (DOC) is still challenging. Indeed, ~ 40% of patients in vegetative state (VS) are misdiagnosed, suggesting the need of more appropriate diagnostic tools. Emerging data are showing that EEG, including sleep structure evaluation and multimodal evoked potential recording could be helpful in DOC diagnosis. Moreover, pain perception evaluation could further increase diagnosis accuracy in such individuals. METHODS Fourteen individuals with DOC, due to severe brain injury, were enrolled and admitted to the Intensive Neurorehabilitation Unit of the Research Institute. All patients were evaluated by means of the Coma Recovery Scale-Revised, a 24(hh)-polysomnography and a Laser Evoked Potential (LEP) paradigm. RESULTS Clinically-defined patients in Minimally Consciousness State showed a more preserved sleep structure, physiologic hypnic figures and preserved REM/NREM sleep distribution than subjects in VS. LEP showed increased latencies and reduced amplitudes and were also detectable in patients with more structured sleep. CONCLUSIONS The data support previous findings concerning the importance of sleep study in DOC diagnosis, with more specific neurophysiological paradigms. Interestingly, the findings shed some light on the possible correlations among global brain connectivity, sleep structure and pain perception, which are related to the activity of the wide thalamo-cortical and cortico-cortical networks underlying consciousness.
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Affiliation(s)
- Irene Aricò
- a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy
| | - Antonino Naro
- a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy
| | | | - Antonino Leo
- a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy
| | - Nunzio Muscarà
- a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy
| | - Simona De Salvo
- a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy
| | - Rosalia Silvestri
- b Department of Neurosciences , University of Messina , Messina , Italy
| | - Placido Bramanti
- a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy
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Matesz I, Dénes Z, Belinszkaja G, Frey E, Nagy H, Tarjányi S, Zsiray M. [Bronchoscopy-guided decannulation of tracheostomy in patients with brain injury]. Orv Hetil 2014; 155:1108-12. [PMID: 25002314 DOI: 10.1556/oh.2014.29947] [Citation(s) in RCA: 3] [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: 11/19/2022]
Abstract
INTRODUCTION Progress in intensive care management of patients with severe brain injury due to trauma or vascular lesion significantly improved the mortality and increased the number of patients with tracheostomy who undergo treatment in rehabilitation departments. AIM The aim of the authors was to describe the safe tracheostomy decannulation method of patients with brain injury during rehabilitation. METHOD A prospective, descriptive study performed at the rehabilitation departments of the National Institute for Medical Rehabilitation in Budapest, Hungary. RESULTS From January 1 until December 31, 2013, thirty examinations with flexible bronchoscope for tracheostomy decannulation were performed in 20 patients. The patients were admitted to the rehabilitation wards with various brain injuries: 6 patients suffered from trauma, 5 had ischemic stroke, 3 patients had brain stem haemorrhage, 2 patients cerebellar and one patient bifrontal haemorrhage. One patient had menangioma, and one had multiple organ failure and anoxic brain injury caused by pneumonia. The average age of patients was 44 years (range, 18-80 years). During the procedure successful decannulation was performed in 13 patients. Decannulation occurred 62 days after tracheostomy on average. CONCLUSIONS Safe patient care requires that various medical departments keep pace with the development of different specialities. To ensure early rehabilitation of patients with severe brain injury having tracheostomy, safe treatment and, if possible, decannulation should be performed. This procedure requires the involvement of a physician with bronchoscopy skills as well as the development of local protocols.
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Affiliation(s)
- István Matesz
- Országos Orvosi Rehabilitációs Intézet Budapest Szanatórium u. 19. 1528
| | - Zoltán Dénes
- Országos Orvosi Rehabilitációs Intézet Budapest Szanatórium u. 19. 1528
| | | | - Erika Frey
- Országos Orvosi Rehabilitációs Intézet Budapest Szanatórium u. 19. 1528
| | - Helga Nagy
- Országos Orvosi Rehabilitációs Intézet Budapest Szanatórium u. 19. 1528
| | - Szilvia Tarjányi
- Országos Orvosi Rehabilitációs Intézet Budapest Szanatórium u. 19. 1528
| | - Miklós Zsiray
- Országos Korányi Tbc és Pulmonológiai Intézet Budapest
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Corallo F, Marra A, Bramanti P, Calabrò RS. Effect of cranioplasty on functional and neuro - psychological recovery after severe acquired brain injury: fact or fake? Considerations on a single case. Funct Neurol 2014; 29:273-275. [PMID: 25764258 PMCID: PMC4370441] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cranioplasty is performed, using autograft materials, to treat the "trephined syndrome" in patients previously submitted to craniectomy. Indeed, considerable improvements in neuropsychological deficits, control of convulsions and partial prevention of cerebral atrophy are achieved after this surgical procedure. We describe the pre- and post-operative neuropsychological and functional evaluation of a 30-year-old male patient who underwent cranioplasty following previous craniectomy for a subarachnoid hemorrhage due to a spontaneously ruptured aneurysm of the right middle cerebral artery.
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Schiff ND. Central thalamic deep brain stimulation for support of forebrain arousal regulation in the minimally conscious state. Handb Clin Neurol 2013; 116:295-306. [PMID: 24112903 DOI: 10.1016/B978-0-444-53497-2.00024-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This chapter considers the use of central thalamic deep brain stimulation (CT/DBS) to support arousal regulation mechanisms in the minimally conscious state (MCS). CT/DBS for selected patients in a MCS is first placed in the historical context of prior efforts to use thalamic electrical brain stimulation to treat the unconscious clinical conditions of coma and vegetative state. These previous studies and a proof of concept result from a single-subject study of a patient in a MCS are reviewed against the background of new population data providing benchmarks of the natural history of vegetative and MCSs. The conceptual foundations for CT/DBS in selected patients in a MCS are then presented with consideration of both circuit and cellular mechanisms underlying recovery of consciousness identified from empirical studies. Directions for developing future generalizable criteria for CT/DBS that focus on the integrity of necessary brain systems and behavioral profiles in patients in a MCS that may optimally response to support of arousal regulation mechanisms are proposed.
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