Examining the Functionality of the MATADOC With the CRS-R: A Pilot Study.

Prolonged disorders of consciousness (PDOC) following acquired brain injury affect a person's awareness of self and the environment. Motor, communication, sensory, and cognitive deficits challenge assessment. Rigorously tested behavioral assessments, sensitive to detecting awareness, are critical for discerning a prognosis for recovery and access to treatment. The Coma Recovery Scale-Revised (CRS-R) is considered the gold standard in PDOC diagnostic assessments. This study explored preliminary concurrent validity of the Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) with the CRS-R. The MATADOC and CRS-R were administered concurrently to 8 participants utilizing a repeated measures design. Correlations for diagnosis and item functionality were explored between and within the 2 measures. There was an adequate level of agreement between the 2 measures for overall diagnosis. Significant positive correlations were found between measures for all domains utilizing the MATADOC repeated administrations design. Within-measure relationships were significant for each of the auditory and communication domains with diagnosis for both measures, and additionally for each of the visual and arousal domains with diagnosis on the MATADOC. Both measures yielded significant inter-item relationships for auditory-visual domains, communication-visual domains, arousal-auditory domains, and arousal-visual domains. The MATADOC yielded an additional significant correlation for the auditory-communication domains. The findings have positive implications for the MATADOC as a diagnostic measure and companion assessment in cases of questionable diagnosis. Research with a larger sample is warranted. Generally, higher arousal scores on the MATADOC support music as effective in eliciting arousal, giving patients the opportunity to perform at their optimal level of function.

Event-related EEG power modulations and phase connectivity indicate the focus of attention in an auditory own name paradigm.

Estimating cognitive abilities in patients suffering from Disorders of Consciousness remains challenging. One cognitive task to address this issue is the so-called own name paradigm, in which subjects are presented with first names including the own name. In the active condition, a specific target name has to be silently counted. We recorded EEG during this task in 24 healthy controls, 8 patients suffering from Unresponsive Wakefulness Syndrome (UWS) and 7 minimally conscious (MCS) patients. EEG was analysed with respect to amplitude as well as phase modulations and connectivity. Results showed that general reactivity in the delta, theta and alpha frequency (event-related de-synchronisation, ERS/ERD, and phase locking between trials and electrodes) toward auditory stimulation was higher in controls than in patients. In controls, delta ERS and lower alpha ERD indexed the focus of attention in both conditions, late theta ERS only in the active condition. Additionally, phase locking between trials and delta phase connectivity was highest for own names in the passive and targets in the active condition. In patients, clear stimulus-specific differences could not be detected. However, MCS patients could reliably be differentiated from UWS patients based on their general event-related delta and theta increase independent of the type of stimulus. In conclusion, the EEG signature of the active own name paradigm revealed instruction-following in healthy participants. On the other hand, DOC patients did not show clear stimulus-specific processing. General reactivity toward any auditory input, however, allowed for a reliable differentiation between MCS and UWS patients.

Moving Toward Conscious Pain Processing Detection in Chronic Disorders of Consciousness: Anterior Cingulate Cortex Neuromodulation.

UNLABELLED: It has been assumed that patients with chronic disorders of consciousness (DOC) do not feel pain, but it is possible that some of them just cannot report it. Modulation of γ-band oscillatory activity (γBO) in centroparietal areas (considered as a marker of either subjective pain perception processes or pain-related motor behavior preparation) by part of the anterior cingulate cortex (ACC) has been proposed to be suggestive of conscious pain perception and could therefore be used to assess the maintenance of some level of conscious pain perception in patients with DOC. Hence, we used a repetitive transcranial magnetic stimulation (rTMS) approach in an attempt to trigger frontoparietal output. We enrolled 10 healthy participants (HC), 10 patients in a minimally conscious state (MCS), and 10 with unresponsive wakefulness syndrome (UWS), who underwent a 1-Hz rTMS protocol over ACC. Before and after the neurostimulation paradigm, we measured the pain-rating assessment (pVAS), γBO, latency, and the amplitude of cortical nociceptive potentials evoked by transcutaneous electric sinusoidal stimuli (EEP). In all the HC and MCS and in 2 of the UWS subjects, rTMS increased γBO and reduced the EEP amplitude, whereas pVAS scoring improved in the HC. Our findings provide some evidence about conscious pain processing even in patients with severe DOC and show that rTMS over ACC may be a useful approach to better investigate the level of conscious impairment. PERSPECTIVE: Patients with DOC may not be able to respond to pain stimuli, although they may feel it. The possibility of detecting residual pain perceptions by means of a noninvasive neuromodulation paradigm, studying the correlation between the ACC and centroparietal γBO, may help clinicians to better assess pain in such individuals.

Thalamocortical Sensorimotor Circuit Damage Associated with Disorders of Consciousness for Diffuse Axonal Injury Patients.

The relationship of structural and functional brain damage and disorders of consciousness (DOC) for diffuse axonal injury (DAI) is still not fully explored. We employed diffusion tensor imaging (DTI) and resting-state fMRI (RS-fMRI) to examine the changes of resting activations and white matter (WM) integrity for DAI with DOC. WM damages were observed in the body and genu of the corpus callosum, right external capsule (EC) and superior corona radiate (SCR), left superior cerebellar peduncle (SCP) and posterior thalamic radiation (PTR). The RS-fMRI revealed augmented amplitude of low-frequency fluctuation (ALFF) in the anterior cingulate cortex, hippocampus, insula, amygdala and putamen, and reduced ALFF in the precuneus, thalamus, pre-central and post-central gyri. Correlation analysis identified positive associations between the Glasgow Coma Scale (GCS) and activation of the precuneus and between GCS and DTI measurements in the left PTR and SCP, but a negative correlation was found between GCS and activation of the thalamus. Cross modality association analyses indicated that activations of the amygdala and postcentral gyrus were correlated with DTI measurements of the right EC and left PTR respectively. These results implicate that the WM damages in thalamocortical sensorimotor circuit and aberrant brain activity responding to self-awareness and sensation are critical factors to DOC, which expand the current understanding of the neural mechanisms underlying DAI.

Music therapy assessment tool for awareness in disorders of consciousness (MATADOC): standardisation of the principal subscale to assess awareness in patients with disorders of consciousness.

Establishing valid and reliable measures for use with patients with disorders of consciousness (DOC) following profound brain injury is challenging due to a number of factors including the complex presentation of such patients and assessor variability. The auditory modality has been demonstrated to have greater sensitivity for detecting awareness in DOC patients. However, there are no measures developed to assess auditory responsiveness specifically. The objective of this study was to examine the psychometric properties of the principal subscale of a music therapy assessment tool (MATADOC) developed for use with adult DOC patients. The subscale assesses behavioural domains essential for diagnosis of awareness. Twenty-one adult patients were recruited from a specialist rehabilitation unit. In a prospective study with repeated measures, internal consistency, inter-rater and test-retest reliability and dimensionality were examined. The five-item scale showed satisfactory internal reliability (α = .76) and a strong first principal component. Corrected item-total correlations were all > .45. Inter-rater intra-class correlations (ICCs) ranged from 0.65-1.00 and intra-rater ICCs from 0.77-0.90. Rasch analysis confirmed these impressions of a reliable, unidimensional and homogenous scale. Diagnostic outcomes had 100% agreement with a validated external reference standard. The results indicate that the MATADOC principal subscale provides a new behavioural measure that can contribute to interdisciplinary assessment of awareness with DOC patients.

Personality profiles of patients with dissociative trance disorder in Singapore.

This report studies the personality of individuals who suffer from dissociative trance disorder and examines whether the personality profiles could predict the individual's frequency of trance states. A total of 58 cases were given the Eysenck Personality Questionnaire (EPQ) and their personal information harvested from the case notes and through subsequent interviews. The subjects were also reassessed 1 year later to obtain their frequency of trance states. For both sexes, there were lower extraversion scores and higher psychoticism, neuroticism, and lie scores in the sample compared to the Singapore norms. Of the 47 subjects traced, total episodes of trances that occurred over the 1-year period was positively correlated with neuroticism and negatively with extraversion scores. The high lie scores in individuals with dissociative trance disorder could be a reflection of their concern of how others perceive them. The motivation could be that of restoration of self-esteem or "face." The profiles in the EPQ could be used to predict the individual's frequency of trance states. Subjects with personality traits like nervousness, excitability, and emotional instability were more likely to have a higher frequency of trance states.

Conciencia humana y ritmos de vigilia-sueño: revisión y consideraciones neuropsicológicas 1, 2, 3, 4 / Human consciousness and sleep/waking rhythms: a review and some neuropsychological considerations

En este artículo se revisa, basándose en datos de la literatura y en estudios personales, la importancia de los ritmos vigilia-sueño para entender la conciencia humana. A menudo se considera que la conciencia se reduce marcadamente o desaparece en el sueño. Sin embargo, hay numerosas pruebas de que durante el sueño se da una intensa experiencia subjetiva, gran parte de la cual no se recuerda más tarde. Esto implica que la "corriente de la conciencia" de William James persiste a lo largo del sueño al igual que en vigilia, pero que problemas de recuerdo interfieren con lo que llega a relatarse. Los sujetos dormidos manifiestan un conocimiento consciente selectivo de los estímulos externos: los estímulos significativos llevan, por lo general, al despertar mientras que los estímulos relativamente no significativos, por lo menos a veces, se incorporan a la actividad mental que está ocurriendo en sueño REM o No REM. La ideación durante el sueño se caracteriza por un alto grado de autonomía y escaso control voluntario. En el sueño pueden darse ideas creativas y solucionarse problemas complejos, ya sea en los ensueños o en una actividad mental similar a los pensamientos. Los parámetros de la conciencia de vigilia muestran fluctuaciones rítmicas, posiblemente relacionadas con el sueño, de frecuencia tanto circadiana (ciclo vigilia-sueño de 24 hrs.) como ultradiana (ciclo de sueño No REM/REM de 90-120 min.). Por otra parte, la conciencia de vigilia está marcadamente influida por la calidad de la estabilidad temporal del sueño precedente. Se ha demostrado que una cantidad considerable de los denominados "estados alterados de conciencia" consisten, básica o exclusivamente, en una disfunción de los mecanismos de vigilia-sueño. Las lesiones cerebrales pueden producir un deterioro selectivo de ciertos aspectos de la actividad mental durante el sueño. Se concluye que para un mayor conocimiento de la conciencia humana es de gran importancia, y de hecho imprescindible, promover el análisis de la conciencia subjetiva en el sueño oen estados de sueño parcial (AU)