Abstract
Media reports on the case of Rom Houben have constituted a new reminder of the risks of misdiagnosis with cases with apparent vegetative state, particularly when following the clinical consensus of the care team as diagnostic criterion. Systematic use of behavioral and non-behavioral assessment strategies (e.g., behavioral scales, event-related potentials, and neuro-imaging) may help reduce the aforementioned risks. A new learning assessment strategy could also be considered part of the assessment to extend the evaluation process. Signs of learning might be viewed as forms of concrete knowledge representing a basic level of non-reflective consciousness.
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References
Andrews K, Murphy L, Munday R, Littlewood C (1996) Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. Br Med J 313:13–16
Babiloni C, Sarà M, Vecchio F, Pistoia F, Sebastiano F, Onorati P et al (2009) Cortical sources of resting-state alpha rhythms are abnormal in persistent vegetative state patients. Clin Neurophysiol 120:719–729
Bekinschtein T, Shalom DE, Forcato C, Herrera M, Coleman MR, Facundo FM et al (2009) Classical conditioning in the vegetative and minimally conscious state. Nat Neurosci. doi:10.1038/nn.2391
Bernat JL (2009) Chronic consciousness disorders. Annu Rev Med 60:381–392
Boly M, Tshibanda L, Vanhaudenhuyse A, Noirhomme Q, Schnakers C, Ledoux D et al (2009) Functional connectivity in the default network during resting state is preserved in a vegetative but not in a brain dead patient. Hum Brain Mapp 30:2393–2400
Bosco A, Lancioni GE, Olivetti Belardinelli M, Singh NN, O’Reilly MF, Sigafoos J (2009) Learning as a possible sign of non-reflective consciousness in persons with a diagnosis of vegetative state and pervasive motor impairment. Cogn Process 10:355–359
Cauda F, Sacco K, D’Agata F, Duca S, Cocito D, Geminiani G, Migliorati F, Isoardo G (2009) Low-frequency BOLD fluctuations demonstrate altered thalamocortical connectivity in diabetic neuropathic pain. BMC Neurosci 26:138
Childs NL, Mercer WN, Childs HW (1993) Accuracy of diagnosis of persistent vegetative state. Neurology 43:1465–1467
Dehaene S, Changeux J-P, Naccache L, Sackur J, Sergent C (2006) Conscious, preconscious, and subliminal processing: a testable taxonomy. Trends Cogn Sci 10:204–211
Geers S, Boon P (2009) The (permanent) vegetative state. not an obvious diagnosis. [De (permanente) vegetatieve status. geen evidente diagnose]. Tijdschr Geneeskd 65:219–225
Kotchoubey B (2007) Event-related potentials predict the outcome of the vegetative state. Clin Neurophysiol 118:477–479
Lancioni GE, Singh NN, O’Reilly MF, Sigafoos J, Didden R, Oliva D, Calzolari C, Montironi G (2007) A learning setup for a post-coma adolescent with profound multiple disabilities involving small forehead movements and new microswitch technology. Disabil Rehabil Assist Technol 2:293–297
Lancioni GE, Olivetti Belardinelli M, Chiapparino C, Angelillo MT, Stasolla F, Singh NN, O’Reilly MF, Sigafoos J, Oliva D (2008a) Learning in post-coma persons with profound multiple disabilities: two case evaluations. J Dev Phys Disabil 20:209–216
Lancioni GE, Olivetti Belardinelli M, Oliva D, Signorino M, De Tommaso M, Megna G, Singh NN, O’Reilly MF, Sigafoos J (2008b) Successful extension of assessment and rehabilitation intervention for an adolescent with postcoma multiple disabilities through a learning setup. Eur J Phys Rehabil Med 44:449–453
Lancioni GE, Olivetti Belardinelli M, Stasolla F, Singh NN, O’Reilly MF, Sigafoos J, Angelillo MT (2008c) Promoting engagement, requests and choice by a man with post-coma pervasive motor impairment and minimally conscious state through a technology-based program. J Dev Phys Disabil 20:379–388
Lancioni GE, O’Reilly MF, Singh NN, Buonocunto F, Sacco V, Colonna F, Navarro J, Lanzilotti C, Olivetti Belardinelli M, Bosco A, Megna G, De Tommaso M (2009a) Evaluation of technology-assisted learning setups for undertaking assessment and providing intervention to persons with a diagnosis of vegetative state. Dev Nerorehabil 12:411–420
Lancioni GE, O’Reilly MF, Singh NN, Buonocunto F, Sacco V, Colonna F, Navarro J, Oliva D, Megna G, Bosco A (2009b) Technology-based intervention options for post-coma persons with minimally conscious state and pervasive motor disabilities. Dev Neurorehabil 12:24–31
Lancioni GE, Singh NN, O’Reilly M, Sigafoos J, De Tommaso M, Megna G, Bosco A, Buonocunto F, Sacco V, Chiapparino C (2009c) A learning assessment procedure to re-evaluate three persons with a diagnosis of post-coma vegetative state and pervasive motor impairment. Brain Inj 23:154–162
Lancioni GE, Singh NN, O’Reilly MF, Sigafoos J, Buonocunto F, Sacco V, Colonna F, Navarro J, Lanzilotti C, Bosco A, Megna G, De Tommaso M (2009d) A technology-assisted learning setup as assessment supplement for three persons with a diagnosis of post-coma vegetative state and pervasive motor impairment. Res Dev Disabil 30:1034–1043
Laureys S, Fins JJ (2008) Are we equal in death? Avoiding diagnostic error in brain death. Neurology 70:e14–e15
Laureys S, Perrin F, Schnakers C, Boly M, Majerus S (2005) Residual cognitive function in comatose, vegetative and minimally conscious states. Curr Opin Neurol 18:726–733
Monti MM, Coleman MR, Owen AM (2009) Neuroimaging and the vegetative state: resolving the behavioral assessment dilemma? Ann N Y Acad Sci 1157:81–89
Owen AM, Coleman MR (2008) Detecting awareness in the vegetative state. Ann N Y Acad Sci 1129:130–138
Schacter DL (1997) The cognitive neuroscience of memory: perspectives from neuroimaging research. Philos Trans R Soc Lond B Biol Sci 352:1689–1695
Schmitter-Edgecombe M (2006) Implications of basic science research for brain injury rehabilitation. J Head Trauma Rehabil 21:131–141
Schnakers C, Ledoux D, Majerus S, Damas P, Damas F, Lambermont B et al (2008) Diagnostic and prognostic use of bispectral index in coma, vegetative state and related disorders. Brain Inj 22:926–931
Schnakers C, Vanhaudenhuyse A, Giacino J, Ventura M, Boly M, Majerus S et al (2009) Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol 9:35
Sun R, Zhang X, Slusarz P, Mathews R (2007) The interaction of implicit learning, explicit hypothesis testing learning and implicit-to-explicit knowledge extraction. Neural Netw 20:34–47
Tshibanda L, Vanhaudenhuyse A, Boly M, Soddu A, Bruno M, Moonen G, et al (2009) Neuroimaging after coma. Neuroradiology, 1–10
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Bosco, A., Lancioni, G.E., Olivetti Belardinelli, M. et al. Vegetative state: efforts to curb misdiagnosis. Cogn Process 11, 87–90 (2010). https://doi.org/10.1007/s10339-009-0355-y
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DOI: https://doi.org/10.1007/s10339-009-0355-y