Citation

Magee WL, Tillmann B, Perrin F, Schnakers C. Front. Psychol. 2016; 7: e1273.

Affiliation

Brain Injury Research Center, Department of Neurosurgery, University of California, Los Angeles Los Angeles, CA, USA.

Copyright

(Copyright © 2016, Frontiers Research Foundation)

DOI

10.3389/fpsyg.2016.01273

PMID

27630591

PMCID

PMC5005341

Abstract

Despite the body of research on disorders of consciousness (DOC) that has emerged since the “persistent vegetative state” was first named (Jennet and Plum, 1972), the provision of optimal care for this complex population continues to challenge health, medical and science professionals. This is in notwithstanding continual developments in definitions to enhance diagnostic criteria, for example the definition of the minimally conscious state by Giacino et al. (2002) and the term “Unresponsive Wakefulness Syndrome” to replace “vegetative state” proposed by Laureys et al. (2010). Of central concern is the recovery of consciousness (Whyte, 2014), an ambiguous concept that encompasses both wakefulness and awareness (Royal College of Physicians, 2013). Consciousness cannot be directly assessed using verbal reports in this non-communicative population (Seel et al., 2010). The ability to demonstrate consciousness is further compromised in these patients who show minimal motor responses (often due to spasticity), are poorly aroused, and may have significant cognitive and sensory impairments.

The prescient issue has been accurate diagnosis in order to plan appropriate treatment and identify potential in people with DOC. The incidence of misdiagnosis remains unacceptably high (Schnakers et al., 2009; van Erp et al., 2015). For some time, the auditory modality has emerged as potentially sensitive for indicating awareness in people diagnosed as being in vegetative state (Gill-Thwaites and Munday, 2004; Owen et al., 2005, 2006). This insight has prompted greater exploration of auditory stimulation within research and practice, particularly given the suspected incidence of visual impairment in DOC contributing to misdiagnosis (Andrews et al., 1996). More particularly, auditory stimulation with an emotional valence, such as a familiar voice or the patient's own name, has been shown as helpful when trying to understand residual brain processing and when uncovering consciousness in patients with severe brain injury (Bekinschtein et al., 2004; Laureys et al., 2004; Schiff et al., 2005; Perrin et al., 2006; Di et al., 2007). As music has a well-known relationship with emotional processing (Frühholz et al., 2014; Omigie, 2016), such stimulation might be crucial when assessing the recovery of consciousness in this challenging population...

Language: en