Nonverbal communication of trauma patients in a state of minimal consciousness

Abstract

Introduction. In spite of the rapid development in various communication-support technologies for those waking up from a coma, studies describing the sole process of reconstructing communication in this group of patients are scarce. Objective. The aim of this study was to analyze communication reactions in a minimal state of consciousness and describe the nonverbal behaviours characteristic for each stages significant for the therapy of communication. Materials and method. 18 severely brain-injured patients in a minimal state of consciousness participated in the half-year observation study, which included people experiencing at least 4 weeks of consciousness disorder/coma. Age of patients 25±5 years. Psychological assessment included: observation of various attempts of communications undertaken by patients, caregivers and family interview, the Glasgow Coma Scale (GCS) and Individual Communication Sheet. Results. Data analysis showed a significant increase in preverbal communication, both in primal and sensory areas when compared between Stage II (GCS=6-8 points) and Stage III (GCS=9-12 points). After a time, primary communication reached a high level. Patients produced communication attempts from the behaviour organization level, and an increase in the nonverbal communication level was noted. Based on observations, nonverbal communication profiles for each stage of waking up from a coma were introduced. Conclusions. It was found that in the process of waking up from a coma the patients communicate with the use of the preverbal level of primal communication, the sensory and behaviour organization activities. The characteristics of the communication reactions show that in Stage III there is a significant increase in two preverbal communication areas: primal and sensory acts, when compared with Stage II.

Unaided communication behaviours displayed by adults with severe cerebrovascular accidents and little or no functional speech: A scoping review

“…This scoping review supports the notion that unaided communication behaviours occur on a continuum and the acquisition thereof is a process that occurs at various stages (e.g. waking up from a coma and expressing needs and wants) (Rasmus et al, 2019;Rowland, 2011). This suggests that when a developmental approach is followed, the acquisition of unaided communication behaviours occurs prior to verbal communication.…”

“…This suggests that when a developmental approach is followed, the acquisition of unaided communication behaviours occurs prior to verbal communication. However, the person with a severe CVA and little or no functional speech may still access a range of unaided communication behaviours after some verbal communication has been attained (Rasmus et al., 2019; Rowland, 2011).…”

“…To achieve this, the individual's communication behaviour may include unintentional, pre‐intentional and intentional communication functions (see Table 4) (Austin, 2013; Rowland, 2011). However, the progression from unintentional to intentional communication functions can only occur during interaction with and reinforcement of behaviour by communication partners (Austin, 2013; Rasmus et al., 2019; Rowland, 2011). Therefore, for persons with severe CVA and little or no functional speech to progress to intentional communication, partners need to understand and identify the various communication functions that can be accessed through unaided communication behaviours.…”

“…To access various communication functions, partners should be alerted to the fact that unaided behaviour is often ambiguous and complex (Holt et al., 2012; Lin et al., 2010; Rasmus et al., 2019). Due to the mind‐body connection, behaviour does not occur randomly but may instead be determined by thoughts, feelings and experiences (Holt et al., 2012).…”

Language Assessment in Patients with Disorders of Consciousness

“…Two other bedside assessments focus on a listing of “communication abilities.” First, the Loewenstein Communication Scale 26 scores the patient's mobility, respiration, visual responsiveness, the presence of auditory comprehension, verbal communication, and alternative communication. Second, the Individual Nonverbal Communication Rating Scale 27 combines patient observation, family interviews, and scores of the Glasgow Coma Scale. 28 This rating scale provides an estimation of preverbal, verbal, and interpersonal communication as well as creative expression, and considers the emotional, language, and cognitive or social levels.…”