Language Assessment in Patients with Disorders of Consciousness

Abstract

The assessment of residual language abilities in patients with disorders of consciousness (DoC) after severe brain injury is particularly challenging due to their limited behavioral repertoire. Moreover, associated language impairment such as receptive aphasia may lead to an underestimation of actual consciousness levels. In this review, we examine past research on the assessment of residual language processing in DoC patients, and we discuss currently available tools for identifying language-specific abilities and their prognostic value. We first highlight the need for validated and sensitive bedside behavioral assessment tools for residual language abilities in DoC patients. As regards neuroimaging and electrophysiological methods, the tasks involving higher level linguistic commands appear to be the most informative about level of consciousness and have the best prognostic value. Neuroimaging methods should be combined with the most appropriate behavioral tools in multimodal assessment protocols to assess receptive language abilities in DoC patients in the most complete and sensitive manner.

Clinical application of recommendations for neurobehavioral assessment in disorders of consciousness: an interdisciplinary approach

“…Active and passive paradigms in using fMRI and EEG have demonstrated utility in identifying CMD in behaviorally unresponsive patients. However, it has been found that passive paradigms have a greater likelihood of capturing preserved consciousness ( Kondziella et al, 2016 ; Aubinet et al, 2022 ). The scientific understanding of CMD is evolving, but current evidence suggests it is likely a distinct phenomenon separate from the DoC spectrum ( Kondziella and Stevens, 2022 ), more akin to a functionally locked-in syndrome.…”

“…Although outside the scope of this paper, there are tools available for assessing agitation, confusion, attention, orientation, language and communication in persons with DoC demonstrating MCS+ or emergence behaviors. These assessments can include the Confusion Assessment Protocol, Agitated Behavior Scale, Orientation Log and the Loewenstein Communication Scale ( Bogner et al, 1999 ; Sherer et al, 2005 ; Frey et al, 2007 ; Spiteri et al, 2021 ; Aubinet et al, 2022 ). Figure 1 presents an overview of recommended strategies to optimize the patient and environment to ensure accuracy of assessment results.…”