Coma and Disorders of Consciousness

Foreword
Preface
Contents
Chapter 1: Neural Correlates of Consciousness
	Introduction
	The Neural Correlates of Consciousness
	Neurophysiological Techniques Used in the Study of the NCC
	Physiological States of Consciousness: NCC in Sleep
	Pharmacological States of Consciousness: NCC in Anesthesia
	Pathological States of Consciousness: NCC in Disorders of Consciousness
	Conclusions
	References
Chapter 2: Behavioral Assessment and Diagnosis of Disorders of Consciousness
	Introduction
	Disorders of Consciousness
		Coma
		Vegetative State/Unresponsive Wakefulness Syndrome
		Minimally Conscious State
		Covert Awareness
	Bedside Assessment
		The Coma Recovery Scale-Revised
		Individualized Quantitative Behavioral Assessment (IQBA)
		Pain Assessment
		Language Assessment
		Diagnostic Accuracy
	Conclusion
	References
Chapter 3: Brain–Computer Interfaces and Their Place in the Management of Disorders of Consciousness
	What Are BCIs and How Can Patients with a Disorder of Consciousness Benefit From Them?
	BCIs Help to Refine the Taxonomy of Disorders of Consciousness
	The Applications of BCIs in Research for Patients with a Disorder of Consciousness
		P3
		Motor Imagery
		SSVEP
		Hybrid BCIs
		Body–Computer Interfaces (Biofeedback Machines)
	Recommendations for BCI Use According to Current Guidelines for Clinical Management of Patients with a Disorder of Consciousness
	Future Research and Clinical Directions to Encourage Development and Implementation of BCIs for Patients with a Disorder of Consciousness
	Conclusion
	References
Chapter 4: Prognosis in Disorders of Consciousness
	Introduction
	Evolution
	Prognostic Issues
	Conclusion
	References
Chapter 5: Neuromedical Comorbidities and Their Management in Patients with DoC
	Introduction
	Comorbidities Assessment
	Respiratory Complications and Dysphagia
	Neurosurgical Complications
	Spasticity and Other Motor Disorders
	Heterotopic Ossification and Bed Best Syndrome
	ICU-Acquired Weakness (ICU-AW)/Critical Illness Polyneuropathy (CIP)
	Pain Assessment and Treatment
	Language Disorders
	Epilepsy
	Hypopituitarism
	Paroxysmal Sympathetic Hyperactivity (PSH)
	Metabolic and Gastrointestinal Complications
	Discussion and Conclusions
	Appendix
	References
Chapter 6: Music as Sensory Stimulation and Therapeutic Intervention
	Introduction: Sensory Stimulation in Comatose and DoC Patients
	The Beneficial Effects of Music
	Music in DoC Patients
		Behavioral and Physiological Modulations
		Brain Modulations
	Music Therapy/Intervention
		Music Interventions Using Patient-Preferred Music
		Music Interventions Using Improvised Music
		Combined Approaches
		Music Therapy Within Interdisciplinary Rehabilitation
		Protocols for Music Interventions
		Working with Families
	New Perspectives for Music and Coma
	References
Chapter 7: Pharmacological Treatments
	Introduction
	Potential Pharmacological Agents
		Amantadine
		Apomorphine
		Levodopa
		Methylphenidate
		Bromocriptine
		Modafinil
		Selegiline
		Zolpidem
		Baclofen
	Underlying Pharmacological Mechanisms
	Clinical Considerations
	Off-Label Use of Specific Medication
	Limitations of Current Research
	Future Directions
		Psychedelics
		The Potential of Whole-Brain Computational Modeling
	Conclusion
	References
Chapter 8: Emerging Treatment for Patients with Disorders of Consciousness: The Field of Neuromodulation
	Introduction
	Defining the Neurostimulation Target
	Major Neurostimulatory Techniques Being Tested for DOC Treatment
		Central Techniques
			Deep Brain Stimulation (DBS)
			Transcranial Focused Ultrasound Stimulation (tFUS)
		Bottom-Up Techniques
			Spinal Cord Stimulation (SCS)
			Median Nerve Stimulation (MNS)
			Vagus Nerve Stimulation (VNS)
		Top-Down Techniques
			Transcranial Magnetic Stimulation (TMS)
			Transcranial Electrical Stimulation (tES)
		Conclusion
	Limitations, Future Directions, and Opportunities
	References
Chapter 9: The Ethics in the Management of Patients with Disorders of Consciousness
	Introduction
	A Heuristic Approach for Identifying Emerging Ethical Issues: Fundamental vs. Practical
		Fundamental Ethical Issues Arising from DOCs
			The Inferential Diagnosis of DOCs
			The Ethical Relevance of the Unconscious
		Practical Ethical Issues
			Misdiagnosis
			Nosology
	The Distributed Responsibility Model
		Institutional Issues
		Clinical Issues
		Interpersonal Issues
	Conclusion
	References
Chapter 10: Taking Care of Patients with Disorders of Consciousness: Caregivers’ Burden and Quality of Life
	Introduction
	Who Is the Informal Caregiver of a Patient with DOC?
	Sociodemographic Characteristics of DOC Patients’ Caregivers
	Hours of Care and Support for Caring
	Motivations for Caregiving
	Burden: Definition and Concepts
	Burden and Emotional Distress: The Impact on the Emotional Domain
	Burden as the Impact on Employment, Economic Status, and Leisure Activities of Caregivers
	Burden and Coping Strategies
	Burden as the Impact on Caregivers’ Quality of Life
	Caregivers’ Involvement During Patients’ Assessments
	Caregivers Within the International Guidelines
	Concluding Remarks
	References
Chapter 11: Models and Systems of Care for Patients with Disorders of Consciousness
	Introduction
	Characteristics of Successful Care Systems in Non-neurological Diseases
	Health Service Delivery Gaps and Opportunities
	Existing Models of Systems-Level DoC Care and Research
	The Dutch Model
		History
		Chain of Care Model
		Research Activities Associated with the Chain of Care Model
	Traumatic Brain Injury Model Systems
		TBIMS Infrastructure and Mission
		TBIMS DoC Special Interest Group
		TBIMS DoC-Related Accomplishments
	The Curing Coma Campaign
		Gaps in the Understanding of the Natural History of Coma Recovery
		Impact of the Lack of Data in Hyperacute Management
		COMPOSE Study Addresses the Gap in the Natural History of Coma Recovery
	Moving Toward an Integrated DoC Model System for Clinical Care and Research
		Barrier 1: No Systematic Surveillance Systems to Track and Characterize DoC Admissions
		Barrier 2: Variability in Approaches to Diagnosis, Intervention, and Outcome Assessment in Acute and Chronic Care
		Barrier 3: Limited and Non-Standardized Assessment of Long-Term Recovery
		Barrier 4: Lack of an Infrastructure to Integrate Clinical Data into a Research Database
	A Lesson from the TBI Model Systems
	Conclusion
	References
Chapter 12: Pediatric DOC: Diagnosis, Prognosis, and Treatment
	Introduction
	Diagnosis
		Neurobehavioral Assessment
		Multi-Modal Assessment
			Neural Abnormalities in Pediatric DoC
				Abnormalities at Rest
				Circadian Abnormalities
				Evoked Abnormalities
			Neuroimaging
			Neurophysiology
		Gaps and Future Directions
	Outcome and Prognosis
		Patient Characteristics
		Neuroimaging
		Neurophysiology
		Gaps and Future Directions
	Treatment
		Gaps and Future Directions
	Summary and Conclusions
	References
Chapter 13: Near-Death Experiences: What Do We Know?
	Description of the Phenomenon
	Identifying NDEs
	NDE Characteristics
	NDEs Not “Near Death”
	Negative NDEs
	NDE Experiencers’ Characteristics
	NDEs and Its Consequences
	Limits and Debates in NDE Research
	Explicative Models for NDEs
		Psychological Theories
		Neurobiological Theories
	Conclusion
	References
Chapter 14: Future Perspectives of Clinical Coma Science
	In the Past …
	Recent Findings on Assessment and Treatment
	In the Future …
	References
Index