Patients with disorders of consciousness: vegetative state and minimally conscious state.
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Abstract:
At present, clinical judgment and experience guide diagnostic, prognostic and treatment decisions for individuals with DOC. However, we continue to struggle with diagnostic error, misinterpretation of behavioral findings, inability to predict functional outcome in individual cases, and uncertainty regarding the neural mechanisms of recovery. When combined with behavioral observations, functional neuroimaging strategies have the potential to improve clinical decision-making and patient care. Our prior research on fMRI activation patterns suggests that patients in MCS retain the neural circuits for receptive language and visual processing. We will test a novel fMRI protocol that is designed to reliably detect conscious awareness in patients who may be unable to execute behavioral signs of active cognitive processing, using a hierarchical stimulation paradigm that systematically assesses levels of cognitive processing in the auditory and visual systems. In light of provocative findings suggesting that cognitive processing may be maintained in patients who appear to be unconscious on bedside examination, we will extend our investigation to individuals with VS as well as those in MCS. We also predict that patients capable of activating multiple cortical networks will achieve more favorable cognitive and functional outcomes, a finding with direct implications for rehabilitation treatment planning.
