Objective-To identify the number of patients who were misdiagnosed as being in the vegetative state and their characteristics.Design-Retrospective study of the clinical records of the medical, occupational therapy, and clinical psychology departments.Setting-20 bed unit specialising in the rehabilitation of patients with profound brain damage, including the vegetative state.Subjects-40 patients admitted between 1992 and 1995 with a referral diagnosis of vegetative state.Outcome measures-Patients who showed an ability to communicate consistently using eye pointing or a touch sensitive single switch buzzer.Results-Of the 40 patients referred as being in the vegetative state, 17 (43%) were considered as having been misdiagnosed; seven of these had been presumed to be vegetative for longer than one year, including three for over four years. Most of the misdiagnosed patients were blind or severely visually impaired. All patients remained severely physically disabled, but nearly all were able to communicate their preference in quality of life issues-some to a high level.Conclusions-The vegetative state needs considerable skill to diagnose, requiring assessment over a period of time; diagnosis cannot be made, even by the most experienced clinician, from a bedside assessment. Accurate diagnosis is possible but requires the skills of a multidisciplinary team experienced in the management of people with complex disabilities. Recognition of awareness is essential if an optimal quality oflife is to be achieved and to avoid inappropriate approaches to the courts for a declaration for withdrawal of tube feeding. IntroductionThe vegetative state is a rare disorder which is diagnosed

This paper reviews the current state of bedside behavioral assessment in brain-damaged patients with impaired consciousness (coma, vegetative state, minimally conscious state). As misdiagnosis in this field is unfortunately very frequent, we first discuss a number of fundamental principles of clinical evaluation that should guide the assessment of consciousness in brain-damaged patients in order to avoid confusion between vegetative state and minimally conscious state. The role of standardized behavioral assessment tools is particularly stressed. The second part of this paper reviews existing behavioral assessment techniques of consciousness, showing that there are actually a large number of these scales. After a discussion of the most widely used scale, the Glasgow Coma Scale, we present several new promising tools that show higher sensitivity and reliability for detecting subtle signs of recovery of consciousness in the post-acute setting.

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InfoSky is a system enabling users to explore large, hierarchically structured document collections. Similar to a real-world telescope, InfoSky employs a planar graphical representation with variable magnification. Documents of similar content are placed close to each other and are visualised as stars, forming clusters with distinct shapes. For greater performance, the hierarchical structure is exploited and force-directed placement is applied recursively at each level on much fewer objects, rather than on the whole corpus. Collections of documents at a particular level in the hierarchy are visualised with bounding polygons using a modified weighted Voronoi diagram. Their area is related to the number of documents contained. Textual labels are displayed dynamically during navigation, adjusting to the visualisation content. Navigation is animated and provides a seamless zooming transition between summary and detail view. Users can map metadata such as document size or age to attributes of the visualisation such as colour and luminance. Queries can be made and matching documents or collections are highlighted. Formative usability testing is ongoing; a small baseline experiment comparing the telescope browser to a tree browser is discussed.

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