Publications of Steven LAUREYS
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See detailBijna-dood-ervaringen : Een opkomend Wetenschappelijk Onderzoeksgebied
Martial, Charlotte ULiege; Cassol, Helena ULiege; LAUREYS, Steven ULiege

in The Executive Committee of IANDS The Netherlands (Ed.) Het geheim van Elysion: 45 jaar studie naar nabij-de-dood-ervaringen over bewustzijn in liefde zonder waarheen (in press)

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See detailFrom unconscious to conscious: a spectrum of states
Barra, Alice ULiege; Carrière, Manon ULiege; LAUREYS, Steven ULiege et al

in Overgaard, M; Mogensen, J; Kirkeby-Hinrup, A (Eds.) Beyond the Neural Correlates of Consciousness (in press)

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See detailConsciousness and communication BCIs in severe brain-injured patients
Annen, Jitka ULiege; Laureys, Steven ULiege; Gosseries, Olivia ULiege

in Handbook Brain-Computer Interfacing: Neural Devices for paralysis in neurological practise and beyond (in press)

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See detailPET Imaging in Altered States of Consciousness: Coma, Sleep, and Hypnosis
Bonin, Estelle ULiege; Martens, Géraldine ULiege; Cassol, Helena ULiege et al

in van Waarde, A; Otte, A; de Vries, E.F.J (Eds.) et al PET and SPECT in Neurology (in press)

Positron emission tomography (PET) allows studies of cerebral metabolism and blood flow and has been widely used to investigate physiological mechanisms underlying altered states of consciousness ... [more ▼]

Positron emission tomography (PET) allows studies of cerebral metabolism and blood flow and has been widely used to investigate physiological mechanisms underlying altered states of consciousness. Consciousness is characterized by two components: wakefulness and awareness. In this chapter, we review the current literature on brain metabolism during pathological loss of consciousness (vegetative/unresponsive or minimally conscious states), sleep (in healthy subjects and in patients with insomnia), and under hypnosis. By identifying brain areas specifically involved in conscious processing, these studies have contributed to our understanding of the underlying physiology of consciousness. The precuneal and cingulate cortices, for example, seem to be key areas for maintaining conscious awareness. FDG-PET further allowed the identification of the minimal energetic requirement for conscious awareness in this population, which corresponds to 42% of normal cortical activity. Up to now, it is the most accurate neuroimaging tool regarding the diagnosis of patients with disorders of consciousness. In the future, its use as part of multimodal assessment could improve diagnosis and prognosis in this challenging population. In sleep, a greater activity of the precuneus/posterior cingulate cortex and the fronto-parietal areas during non rapid eye movement sleep also seems to play a role in disorders such as insomnia. Other areas such as the hypothalamus, amygdala, or temporo-occipital cortex seem to play a role in different states such as rapid eye movement sleep and hypnosis. PET studies permit a better comprehension of the neural correlates of consciousness and to identify the implication of specific neural areas and networks in altered states of consciousness in post-comatose patients, sleep and induced hypnosis. [less ▲]

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See detailÉtats de conscience altérée: soins palliatifs et décisions de fin de vie
Lejeune, Nicolas ULiege; van Erp, Willemijn ULiege; Rohaut, Benjamin et al

in Jacquemin, Dominique; De Broucker, Didier (Eds.) Manuel de soins palliatifs (in press)

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See detailSwallowing in individuals with disorders of consciousness: A cohort study
MELOTTE, Evelyne ULiege; MAUDOUX, Audrey ULiege; DELHALLE, Sabrina ULiege et al

in Annals of Physical and Rehabilitation Medicine (in press)

Background. After a period of coma, a proportion of individuals with severe brain injury remain in an altered state of consciousness before regaining partial or complete recovery. Individuals with ... [more ▼]

Background. After a period of coma, a proportion of individuals with severe brain injury remain in an altered state of consciousness before regaining partial or complete recovery. Individuals with disorders of consciousness (DOC) classically receive hydration and nutrition through an enteral feeding tube. However, the real impact of the level of consciousness on an individual’s swallowing ability remains poorly investigated. Objective. We aimed to document the incidence and characteristics of dysphagia in DOC individuals and to evaluate the link between different components of swallowing and the level of consciousness. Methods. We analyzed clinical data on the respiratory status, oral feeding and otolaryngologic examination of swallowing in DOC individuals. Univariate and multivariate logistic regression was used to analyse the association of components of swallowing and participant groups (i.e., unresponsive wakefulness syndrome [UWS] and minimally conscious state [MCS]). Results. We included 92 individuals with DOC (26 UWS and 66 MCS). Overall, 99% of the participants showed deficits in the oral and/or pharyngeal phase of swallowing. As compared with the MCS group, the UWS group more frequently had a tracheostomy (69% vs 24%), with diminished cough reflex (27% vs 54%) and no effective oral phase (0% vs 21%). Conclusion. Almost all DOC participants had severe dysphagia. Some components of swallowing (i.e., tracheostomy, cough reflex and efficacy of the oral phase of swallowing) were related to consciousness. In particular, no UWS participant had an efficient oral phase, which suggests that its presence may be a sign of consciousness. In addition, no UWS participant could be fed entirely orally, whereas no MCS participant orally received ordinary food. Our study also confirms that objective swallowing assessment can be successfully completed in DOC individuals and that specific care is needed to treat severe dysphagia in DOC. [less ▲]

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See detailAttitudes of professional caregivers and family members regarding the use of monitoring devices to improve assessments of pain and discomfort during continuous sedation until death.
Six, Stefaan ULiege; Van Overmeire, Roel; Bilsen, Johan et al

in Journal of Pain and Symptom Management (in press)

Context Assessing consciousness and pain during continuous sedation until death (CSD) by behaviorbased observational scales alone has recently been put into question. Instead, the use of monitoring ... [more ▼]

Context Assessing consciousness and pain during continuous sedation until death (CSD) by behaviorbased observational scales alone has recently been put into question. Instead, the use of monitoring technology has been suggested to make more objective and reliable assessments. Insights into which factors influence attitudes towards using these monitoring devices in a context of CSD is a first step in formulating recommendations to inform future practice. Objectives The aim of this study was to find out what influences professional caregivers’ and family members’ attitudes regarding the use of monitors during CSD. Methods We conducted semi-structured face-to-face interviews with 20 professional caregivers and 15 family members, who cared for a patient or had a family member respectively who took part in a study using monitoring devices. Recruitment took place in an academic hospital, a locoregional hospital and 2 nursing homes, all located in Belgium. Two researchers independently analysed the data, using grounded theory to inductively develop a model that represents the emerging attitude towards use of monitors during CSD. Results Our model shows that the emerging attitudes towards using monitors during CSD is determined by view on CSD, desire for peace of mind, emotional valence attached to using monitors and the realization that the sole use of behavior-based observational measures could be unreliable in a CSD context. We identified several facilitators and barriers to inform future implementation strategies. Conclusion Most participants had no objections and all participants found the use of monitoring devices during CSD feasible and acceptable. We identified a number of facilitators and barriers and suggested that being aware that care can be improved, good communication, shared decision making and continuing professional education can overcome the identified barriers. We suggest future research would focus on developing implementation strategies and guidelines for introducing objective monitoring devices in diverse palliative care settings. Key Message Our study shows attitude towards using monitors during CSD is determined by the view on CSD, desire for peace of mind, emotional valence attached to using monitors and realizing the sole use of behavior-based observational measures could be unreliable. The use of monitoring devices was acceptable to all participants. [less ▲]

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See detailEthics of life-sustaining treatment in locked-in syndrome: A Chinese survey
Yan, Yifan; Demertzi, Athina ULiege; Xia, Yinyan et al

in Annals of Physical and Rehabilitation Medicine (in press)

BACKGROUND: Locked-in syndrome (LIS) characterizes individuals who have experienced pontine lesions, who have limited motor output but with preserved cognitive abilities. Despite their severe physical ... [more ▼]

BACKGROUND: Locked-in syndrome (LIS) characterizes individuals who have experienced pontine lesions, who have limited motor output but with preserved cognitive abilities. Despite their severe physical impairment, individuals with LIS self-profess a higher quality of life than generally expected. Such third-person expectations about LIS are shaped by personal and cultural factors in western countries. OBJECTIVE: We sought to investigate whether such opinions are further influenced by the cultural background in East Asia. We surveyed attitudes about the ethics of life-sustaining treatment in LIS in a cohort of medical and non-medical Chinese participants. RESULTS: The final study sample included 1545 respondents: medical professionals (n=597, 39%), neurologists (n=303, 20%), legal professionals (n=276, 18%) and other professionals (n=369, 24%), including 180 family members of individuals with LIS. Most of the participants (70%), especially neurologists, thought that life-sustaining treatment could not be stopped in individuals with LIS. It might be unnecessary to withdraw life-sustaining treatment, because the condition involved is not terminal and irreversible, and physical treatment can be beneficial for the patient. A significant proportion (59%) of respondents would like to be kept alive if they were in that condition; however, older people thought the opposite. Families experience the stress of caring for individuals with LIS. The mean (SD) quality of life score for relatives was 0.73 (2.889) (on a -5,+5 scale), which was significantly lower than that of non-relatives, 1.75 (1.969) (P<0.001). CONCLUSIONS: Differences in opinions about end of life in LIS are affected by personal characteristics. The current survey did not identify a dissociation between personal preferences and general opinions, potentially because of a social uniformity in China where individualism is less pronounced. Future open-ended surveys could identify specific needs of caregivers so that strategic interventions to reduce ethical debasement are designed. [less ▲]

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See detailNociception Coma Scale Revised allows to identify patients with preserved neural basis for pain experience
Bonin, Estelle ULiege; Lejeune, Nicolas ULiege; Thibaut, Aurore ULiege et al

in Journal of Pain (in press)

The Nociception Coma Scale-Revised (NCS-R) was developed to help assess pain in patients with disorders of consciousness (DOC). Several studies have shown its sensitivity in assessing response to acute ... [more ▼]

The Nociception Coma Scale-Revised (NCS-R) was developed to help assess pain in patients with disorders of consciousness (DOC). Several studies have shown its sensitivity in assessing response to acute noxious stimuli. However, they failed to determine a reliable cut-off score that could be used to infer pain processing in these patients. This retrospective cross-sectional study aimed to determine a NCS-R cut-off score supporting preserved neural basis for pain experience, based on brain metabolism preservation as measured by fluorodeoxyglucose positron emission tomography (FDG-PET). We included patients in unresponsive wakefulness syndrome (UWS) confirmed by the FDG-PET and examined the NCS-R total scores. As the highest score was 4, we defined the cut-off to be 5 and compared the brain metabolism of these patients to matched patients with DOC and a NCS-R cut-off score ≥ 5 (i.e., potential pain), as well as healthy subjects. We found a higher global cerebral metabolism in healthy subjects compared to both patient groups and also in patients with potential pain compared with FDG-PET confirmed UWS. We observed a preserved metabolism in the left insula in patients with potential pain compared with FDG-PET confirmed UWS. [less ▲]

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See detailThe dilemma of hydrocephalus in prolonged disorders of consciousness
Arnts, Hisse; van Erp, Willemijn ULiege; Sanz, Leandro ULiege et al

in Journal of Neurotrauma (2020)

Prolonged disorders of consciousness (DOC) are considered to be amongst the most severe outcomes after acquired brain injury. Medical care for these patients is mainly focused on minimizing complications ... [more ▼]

Prolonged disorders of consciousness (DOC) are considered to be amongst the most severe outcomes after acquired brain injury. Medical care for these patients is mainly focused on minimizing complications, since treatment options for patients with unresponsive wakefulness or minimal consciousness remain scarce. The complication rate in patients with DOC is high, both in the acute hospital setting as in the rehabilitation or long-term care phase. Hydrocephalus is one of these well-known complications and usually develops quickly following acute changes in cerebrospinal fluid (CSF) circulation after different types of brain damage. However, hydrocephalus may also develop with a significant delay, weeks or even months after the initial injury, reducing the potential for natural recovery of consciousness. In this phase, hydrocephalus is likely to be missed in DOC patients, since their limited behavioral responsiveness camouflages the classic signs of increased intracranial pressure or secondary normal-pressure hydrocephalus. Moreover, the development of late-onset hydrocephalus may exceed the period of regular outpatient follow-up. Several controversies remain about the diagnosis of clinical hydrocephalus in patients with ventricular enlargement after severe brain injury. In this article, we discuss both the difficulties in diagnosis and dilemmas in treatment of CSF disorders in patients with prolonged DOC and review evidence from the literature to advance an active surveillance protocol for the detection of this late, but treatable complication. Moreover, we advocate a low threshold for cerebrospinal fluid diversion when hydrocephalus is suspected, even months or years after brain injury. [less ▲]

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See detailNear-Death Experience Memories Include More Episodic Components Than Flashbulb Memories
Cassol, Helena ULiege; Bonin, Estelle ULiege; Bastin, Christine ULiege et al

in Frontiers in Psychology (2020), 11(888),

Memories of near-death experiences (NDEs) are recalled as “realer” than memories of other real or imagined events. Given their rich phenomenology, emotionality and consequentiality, it was hypothesized ... [more ▼]

Memories of near-death experiences (NDEs) are recalled as “realer” than memories of other real or imagined events. Given their rich phenomenology, emotionality and consequentiality, it was hypothesized that they could meet some aspects of the definition of flashbulb memories. We aimed to identify and compare the episodic and non-episodic information provided in verbal recollections of NDE, flashbulb, and control autobiographical memories. The phenomenological characteristics and centrality of the memories were also compared. Twenty-five participants who had lived a NDE in a life-threatening situation were interviewed and completed the Memory Characteristics Questionnaires as well as the Centrality of Event Scale for their NDE, a flashbulb and another autobiographical memory used as control. Overall, transcribed NDE verbal recollections included a higher overall amount of details and more internal/episodic information than control autobiographical and flashbulb memories. Moreover, flashbulb memories were associated to a lower intensity of feelings while remembering and a lower personal importance, and are less reactivated and less susceptible to be remembered from a first person perspective compared to NDE and control autobiographical memories. Finally, NDE memories are the most central memories to experiencers’ identity, followed by control autobiographical and then by flashbulb memories. These findings corroborate previous studies highlighting the impact and uniqueness of NDE memories. [less ▲]

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See detailPrevalence of signs of nociception during physiotherapy in patient with disorders of consciousness.
Bonin, Estelle ULiege; Fossati, Mariachiara; Filippini, Maria Maddalena et al

Conference (2020, March 05)

Patients with disorders of consciousness (DOC) may suffer from neuro-orthopaedics disorders that can lead to potential pain during physiotherapy (PT). These patients are unable to communicate it is ... [more ▼]

Patients with disorders of consciousness (DOC) may suffer from neuro-orthopaedics disorders that can lead to potential pain during physiotherapy (PT). These patients are unable to communicate it is therefore a real challenge for clinicians to assess pain and adapt treatment. This randomized double-blind placebo-controlled study aimed to investigate the prevalence of signs of nociception during PT and their changes in relation to a pain-killer. During baseline (D0), pain responsiveness was assessed using the NCS-R (Nociception Coma Scale-Revised): at rest; during a tactile stimulation (TS); during a nociceptive stimulation (NS); and during PT. Then, patient with signs of potential pain during PT was assessed during a placebo and a pain-killer condition (D1 and D2). Our results show that most DOC patients present signs of potential pain during PT (14/19; 73.4%), and a few of them already received analgesic treatment before the study (5/14, 35.7%). During baseline, we found significant differences between the NCS-R score during PT than the three others stimulation, suggesting that passive mobilizations are potentially painful for DOC patient. These difference remains during placebo and treatment condition expect with the NS. We do not found an effect of pain-killer on the NCS-R score during PT and NS. This could be explained by the fact that the NCS-R failed to detect the effect of pain-killer or that this effect was not strong enough. This study point-out that PT may be painful for DOC patients and appropriate assessment and treatment before and during mobilizations should become a priority in clinical setting. [less ▲]

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See detailNear-death experience as a probe to explore (disconnected) consciousness
Martial, Charlotte ULiege; Cassol, Helena ULiege; Laureys, Steven ULiege et al

in Trends in Cognitive Sciences (2020)

Forty-five years ago, the first evidence of near-death experience (NDE) during comatose state was provided, setting the stage for a new paradigm for studying the neural basis of consciousness in ... [more ▼]

Forty-five years ago, the first evidence of near-death experience (NDE) during comatose state was provided, setting the stage for a new paradigm for studying the neural basis of consciousness in unresponsive states. At present, the state of consciousness associated with NDEs remains an open question. In the common view, consciousness is said to disappear in a coma with the brain shutting down, but it is oversimplified. This article argues that the novel framework distinguishing awareness, wakefulness and connectedness is relevant to comprehend the phenomenon. Classical NDEs correspond to internal awareness experienced in unresponsive conditions, thereby corresponding to an episode of disconnected consciousness. Our proposal suggests new directions for NDE research, and more broadly, consciousness science. [less ▲]

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See detailCharacterization of near-death experiences using text mining analyses: a preliminary study
Charland-Verville, Vanessa ULiege; Ribeiro de Paula, Demetrius; Martial, Charlotte ULiege et al

in PLoS ONE (2020)

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See detailBrain metabolism but not grey matter volume underlies the presence of language function in the minimally conscious state
Aubinet, Charlène ULiege; Cassol, Helena ULiege; Gosseries, Olivia ULiege et al

in Neurorehabilitation and Neural Repair (2020), 34(2), 172-184

Background. The minimally conscious state (MCS) is subcategorized into MCS- and MCS+, depending on the absence or presence of high-level behavioral responses such as command following. Objective. We aim ... [more ▼]

Background. The minimally conscious state (MCS) is subcategorized into MCS- and MCS+, depending on the absence or presence of high-level behavioral responses such as command following. Objective. We aim to investigate the functional and structural neuroanatomy underlying the presence of these responses in MCS- and MCS+ patients. Methods. In this cross-sectional retrospective study, chronic MCS patients were diagnosed using repeated Coma Recovery Scale-Revised assessments. Fluorodeoxyglucose-positron emission tomography data were acquired on 57 patients (16 MCS-; 41 MCS+) and magnetic resonance imaging with voxel-based morphometry analysis was performed on 66 patients (17 MCS-; 49 MCS+). Brain glucose metabolism and grey matter integrity were compared between patient groups and control groups. A metabolic functional connectivity analysis testing the hypothesis of preserved language network in MCS+ compared to MCS- was also done. Results. Patients in MCS+ presented higher metabolism mainly in the left middle temporal cortex, known to be important for semantic processing, compared to the MCS- group. The left angular gyrus was also functionally disconnected from the left prefrontal cortex in MCS- compared to MCS+. No significant differences were found in grey matter volume between patient groups. Conclusions. The clinical sub-categorization of MCS is supported by differences in brain metabolism but not in grey matter structure, suggesting that brain function in the language network is the main support for recovery of command-following, intelligible verbalization and/or intentional communication in the MCS. Better characterizing the neural correlates of residual cognitive abilities of MCS patients contributes to reduce their misdiagnosis and to adapt therapeutic approaches. [less ▲]

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See detailIslands of Awareness or Cortical Complexity?
Cecconi, Benedetta ULiege; LAUREYS, Steven ULiege; Annen, Jitka ULiege

in Trends in Neurosciences (2020)

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See detailBrain-computer interfaces for consciousness assessment and communication in severely brain-injured patients
Annen, Jitka ULiege; Laureys, Steven ULiege; Gosseries, Olivia ULiege

in Millán, José del R.; Ramsey, Nick F. (Eds.) Handbook of Clinical Neurology. Volume 168: Brain-Computer Interfaces (2020)

Patients with disorders of consciousness (DOC) suffer from awareness deficits. Comorbidities such as motor disabilities or visual problems hamper clinical assessments, which can lead to misdiagnosis of ... [more ▼]

Patients with disorders of consciousness (DOC) suffer from awareness deficits. Comorbidities such as motor disabilities or visual problems hamper clinical assessments, which can lead to misdiagnosis of the level of consciousness and render the patient unable to communicate. Objective measures of consciousness can reduce the risk of misdiagnosis and could enable patients to communicate by voluntarily modulating their brain activity. This chapter gives an overview of the literature regarding brain-computer interface (BCI) research in DOC patients. Different auditory, visual, and motor imagery paradigms are discussed, alongside their corresponding advantages and disadvantages. At this point, the use of BCIs for DOC patients in clinical applications is still preliminary. However, perspectives on the improvements in BCIs for DOC patients seem positive, and implementation during rehabilitation shows promise. © 2020 Elsevier B.V. [less ▲]

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See detailCan the Nociception Coma Scale-Revised be used in patients with a tracheostomy?
Lejeune, Nicolas ULiege; Thibaut, Aurore ULiege; Martens, Géraldine ULiege et al

in Archives of Physical Medicine and Rehabilitation (2020)

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See detailCorrection to: Minimally conscious state “plus”: diagnostic criteria and relation to functional recovery (Journal of Neurology, (2020), 267, 5, (1245-1254), 10.1007/s00415-019-09628-y)
Thibaut, Aurore ULiege; Bodien, Y. G.; Laureys, Steven ULiege et al

in Journal of Neurology (2020), 267(5), 1255-1259

Following electronic publication of the above-referenced manuscript, we discovered that one of the three criteria we proposed to establish command-following in the MCS+ syndrome was inadvertently omitted ... [more ▼]

Following electronic publication of the above-referenced manuscript, we discovered that one of the three criteria we proposed to establish command-following in the MCS+ syndrome was inadvertently omitted in some parts of the manuscript. Specifically, "object recognition" was omitted from the criteria used to diagnose MCS+. We operationally define command-following as a Coma Recovery Scale-Revised (CRS-R) Auditory Subscale score of 3 (i.e. reproducible command-following: A3) or 4 (i.e. consistent commandfollowing: A4), or a Visual Subscale score of 5 (i.e. object recognition: V5). However, in Tables 1 and 2 and Figs. 2 and 3, we failed to include object recognition as a criterion for MCS+. In addition, in Fig. 4 (CRS-R Face Sheet), object recognition is not labeled as a criterion for MCS+. Therefore, we would like to highlight the corrected parts of our manuscript to clarify that the criteria for "command-following" include object recognition (V5) as well as reproducible (A3) and consistent (A4) command-following. Please note that these modifications do not change any of the findings of the study. Please find the individual corrections here: In the section “Methods” the paragraph “consistent command following” needs to be replaced by: Command following: At least three clearly-discernible behavioral responses are observed over four consecutive trials on at least one of two commands. Note that this definition also includes object recognition. At the end of the “Procedures” paragraph, the following text needs to be added before Table 1. Note that we did not include “attention” from the Arousal Subscale as a criterion for MCS+ because all responses, regardless of accuracy, are considered when scoring this item. This item can be scored even in the absence of intact language function. For example, a patient with aphasia who does not comprehend language but understands that a response is anticipated may meet the required criteria. At the end of the section “Results” the word “lower” needs to be replaced by “higher”: The MCS- group had significantly higher (i.e., worse) DRS scores than all other groups (all p values < 0.05—supplementary Fig. S3). Please find the corrected Figs. 2, 3 and 4, as well as supplemental Fig. 3, on the following page:(Figure presented.), (Table presented.). © 2020, Springer-Verlag GmbH Germany, part of Springer Nature. [less ▲]

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See detailMinimally conscious state “plus”: diagnostic criteria and relation to functional recovery
Thibaut, Aurore ULiege; Bodien, Y. G.; Laureys, Steven ULiege et al

in Journal of Neurology (2020), 267(5), 1245-1254

Background: We investigated the relationship between three language-dependent behaviors (i.e., command-following, intelligible verbalization, and intentional communication) and the functional status of ... [more ▼]

Background: We investigated the relationship between three language-dependent behaviors (i.e., command-following, intelligible verbalization, and intentional communication) and the functional status of patients with disorders of consciousness (DoC). We hypothesized that patients in minimally conscious state (MCS) who retain behavioral evidence of preserved language function would have similar levels of functional disability, while patients who lack these behaviors would demonstrate significantly greater disability. We reasoned that these results could then be used to establish empirically-based diagnostic criteria for MCS+. Methods: In this retrospective cohort study we included rehabilitation inpatients diagnosed with DoC following severe-acquired brain injury (MCS = 57; vegetative state/unresponsive wakefulness syndrome [VS/UWS] = 63); women: 46; mean age: 47 ± 19 years; traumatic etiology: 68; time post-injury: 40 ± 23 days). We compared the scores of the Disability Rating Scale score (DRS) at time of transition from VS/UWS to MCS or from MCS– to MCS+, and at discharge between groups. Results: Level of disability on the DRS was similar in patients with any combination of the three language-related behaviors. MCS patients with no behavioral evidence of language function (i.e., MCS–) were more functionally impaired than patients with MCS+ at time of transition and at discharge. Conclusions: Command-following, intelligible verbalization, and intentional communication are not associated with different levels of functional disability. Thus, the MCS+ syndrome can be diagnosed based on the presence of any one of these language-related behaviors. Patients in MCS+ may evidence less functional disability compared to those in MCS who fail to demonstrate language function (i.e., MCS–). © 2019, Springer-Verlag GmbH Germany, part of Springer Nature. [less ▲]

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