New approaches and new therapies

The diagnosis of prolonged disorders of consciousness remains problematic despite the available guidelines; misdiagnosis between the vegetative state(VS)and minimally conscious state (MCS) is estimated to hover around 40%. The clinical assessment of UWS/VS condition is based on clinical consensus and behavioural scales, as the Coma Recovery Scale-Revised (CRS-R). The difficulty in the assessment of the consciousness level of UWS/VS patients depends frequently by a subjective interpretation of the observed spontaneous and volitional behaviour. In absence of speech, the motor response is the unique possible. However, it is not always easily detectable, leading the examiner to a possible misdiagnosis.
The implementation of an Ambient intelligence system with sensor networks for the continuous automatic monitoring of subjects with severe brain damage and disorder of consciousness could provide an accurate system of observation of the patient-ambient interaction, offering a better support to the clinical decision in the rehabilitation phase
The system realized in the S. Anna Institute of Crotone was designed to allow real-time analyses of relevant environmental parameters and the subjects’ vital signs. Main purposes are to identify: 1- partially preserved or recovered circadian/ultradian rhythms; 2) functional changes potentially associated to prognostic indicators; 3) momentary subject/environment interactions or functional changes possibly indicative of residual/recovered responsiveness; 4) predictive models of responsiveness.
Improvement and the advancement of the therapeutic approach in the acute phase on the one hand, but also new methods of rehabilitation of consciousness with sensory regulation and the application of ambient intelligence are all other perspectives that allow one to shed a new light on the future evolution of this devastating disease, not only for the patient but for all family members and the subsequent fallout aspects of social damage.