Analysis of Italian regulations on pathways of care for patients in a vegetative or minimally conscious state.

Different rehabilitation models for persons diagnosed with disorders of consciousness have been proposed in Europe during the last decade. In Italy, the Ministry of Health has defined a national healthcare model, although, to date, there is a lack of information on how this has been implemented at regional level. The INCARICO project collected information on different regional regulations, analysing ethical aspects and mapping care facilities (numbers of beds and medical units) in eleven regional territories. The researchers found a total of 106 laws; differences emerged both between regions and versus the national model, showing that patients with the same diagnosis may follow different pathways of care. An ongoing cultural shift from a treatment-oriented medical approach towards a care-oriented integrated biopsychosocial approach was found in all the welfare and healthcare systems analysed. Future studies are needed to explore the relationship between healthcare systems and the quality of services provided.

Heart rate variability: an index of brain processing in vegetative state? An artificial intelligence, data mining study.

OBJECTIVE: Brain processing at varying levels of functional complexity has been documented in vegetative state. In this study, data mining procedures are applied to identify significant changes in heart rate variability (an emerging objective descriptor of autonomic correlates of brain activation) in response to complex auditory stimuli with emotional value (music). METHODS: The heart rate of subjects in vegetative state from brain damage (n=6) or spontaneous hemorrhage (n=3) and 16 healthy controls was recorded while they passively listened to four pre-selected music samples by different authors (mean recording time: 3m and 36s±24s). The parametric and non-parametric frequency spectra were computed on the heart rate, spectra were compared within/across subjects and music authors, and the spectra descriptors were entered into a 1-R rules data mining procedure (WEKA software Leave One Out and Ten Fold Cross validation). The procedure independently classified the heart rate spectral patterns of both patients and controls and the emotions reported by healthy subjects as "positive" or "negative". RESULTS: In both healthy controls and vegetative state subjects, the power spectra while passively listening to music differed from baseline when compared irrespective of the music authorship and from each other when compared across music samples. Data mining sorted the nu_LF (normalized parameter unit of the spectrum low frequency range) as the significant descriptor of heart rate variability in the conditions of the study. The nu_LF classification of the healthy controls' HRV changes in response to music replicated that based on subjective reports with 75-93.7% accuracy. CONCLUSIONS: Although preliminary, these findings suggest that autonomic changes with possible emotional value can be induced by complex stimuli also in vegetative state, with implications on the residual responsiveness of these subjects. SIGNIFICANCE: Heart rate variability descriptors and data mining methods appear applicable to investigate brain function in the absence of consciousness.

[Visual and computerized analysis of EEG during transcendental meditation and sleep (author's transl)]. / Rechnerunterstützte Analyse des EEG während Transzendentaler Meditation und Schlaf.

Polygraphic records (EEG, EOG, heart rate) were obtained of 5 subjects during and after transcendental meditation (TM) as well as during night sleep. The records were analyzed twice. During TM the amplitude of the alpha-waves was higher as before TM and appeared continuously. Bilateral theta-bursts were also observed. The same EEG changes were seen during relaxation with closed eyes. The discriminance-analysis of 5 frequency-bands of the EEG recorded from C3 showed either no differences in dominant frequency, power and variancy. No differences were observed between the flat EEGs recorded during TM or sleep. The heart rate was significantly slower during meditation or light sleep - when a flat EEG (stage 1) was recorded - as when the recording showed an alpha-rhythm. The vigilosomnograms of all our subjects were normal. The subjects reported that they experienced an increased relaxation, alertness and floating consciousness. They were able to maintain themselves for unusually long time in a state of decreased alertness (stages W1;10).