Addressing Pain for a Proper Rehabilitation Process in Patients With Severe Disorders of Consciousness

Consciousness constitutes a fundamental prerequisite in the individual appraisal and experience of pain. In the same way, a person needs to be able to report on pain perception. Patients who suffered a severe brain injury with disorders of consciousness (DOC) represent a spectrum of pathologies affecting patients\u27 capacity to interact with the external world. In these patients, the most relevant aspects in response to pain are physiologic and behavioral. The treatments and management of pain are challenging issues in these patients, arising serious ethical concerns and bringing emotional load among medical staff, caregivers, and relatives. In this review, we report the importance of having a correct pain management in DOC patients, to individuate the best pharmacological treatment that can make the difference in detecting a behavioral response, indicative of a change in the level of consciousness, and in planning a more effective rehabilitative approach

The timecourse of electrophysiological brain\u2013heart interaction in doc patients

Disorders of Consciousness (DOC) are a spectrum of pathologies affecting one\u2019s ability to interact with the external world. Two possible conditions of patients with DOC are Unresponsive Wakefulness Syndrome/Vegetative State (UWS/VS) and Minimally Conscious State (MCS). Analysis of spontaneous EEG activity and the Heart Rate Variability (HRV) are effective techniques in exploring and evaluating patients with DOC. This study aims to observe fluctuations in EEG and HRV parameters in the morning/afternoon resting-state recording. The study enrolled 13 voluntary Healthy Control (HC) subjects and 12 DOC patients (7 MCS, 5 UWS/VS). EEG and EKG were recorded. PSDalpha, PSDtheta powerband, alpha-blocking, alpha/theta of the EEG, Complexity Index (CI) and SDNN of EKG were analyzed. Higher values of PSDalpha, alpha-blocking, alpha/theta and CI values and lower values of PSD theta characterized HC individuals in the morning with respect to DOC patients. In the afternoon, we detected a significant difference between groups in the CI, PSDalpha, PSDtheta, alpha/theta and SDNN, with lower PSDtheta value for HC. CRS-R scores showed a strong correlation with recorded parameters mainly during evaluations in the morning. Our finding put in evidence the importance of the assessment, as the stimulation of DOC patients in research for behavioural response, in the morning

What impact can hospitalization environment produce on the ANS functioning in patients with Unresponsive Wakefulness Syndrome?–24-hour monitoring

Objectives: Studies showed that the recovery of patients with Unresponsive Wakefulness Syndrome (UWS) is also correlated to the recovery of circadian rhythms. In this study, we observed the correlations between patients with UWS biometrical and ambient parameters. Methods: A dedicated monitoring system was realized to record and correlate the level of noise and luminosity with biometric Heart Rate (HR), Heart Rate Variability (HRV) and Breath Rate (BR) parameters. Eleven patients with UWS were recruited and monitored for 13 ± 7 days. Correlation of ambient and biometric parameters was analyzed by Spearman’s test. Wilcoxon’s test was used to compare the biometric parameters in two different moments of daily activity in the rehabilitation unit (night and day). Patients showed a moderate negative or positive correlation between biometric and ambient parameters. Results: Significant differences between night and morning (0.0001 \u3c p ≤ 0.001) were found for HR, HRV and BR in seven, five and four patients, respectively, at Wilcoxon’s test. HR and BR were higher during the night while HRV was lower. Conclusion: In patients with UWS, lower HRV and higher HR and BR during the night might be indicative of interference in sleep/wake cycles. The modifications of the environment surrounding the patient due to the unit procedures of the staff and/or some interaction modalities of the relatives may have an effect on residual endogenous mechanisms of self-regulation. However, differences between night and day in the biometrical parameters are not necessarily linked to the changes in the environment care unit