The value of midbrain morphology in predicting prognosis in chronic disorders of consciousness: A preliminary ultrasound study

Virtual Reality Based Cognitive Rehabilitation in Minimally Conscious State: A Case Report with EEG Findings and Systematic Literature Review

“…Concerning the first point, our case-report, consistently with the literature data we reviewed here, suggests that VR could be a valuable methodology to support rehabilitation, as it allows obtaining positive functional motor and cognitive outcomes [13,14,48,56]. VR is the multisensory and interactive simulation of ecological scenarios, generally presented in a three-dimensional way, with which the patient can interact [15,[58][59][60][61].…”

“…Various studies have shown that VR activates different perceptual and experiential aspects, with the stimulation of multiple perceptual channels, thanks to the use of auditory and visual feedback [ 13 , 14 , 32 , 33 ]. This complex sensory stimulation may increase the patient’s awareness of his/her performance, inducing changes in neural plasticity processes [ 13 , 14 , 56 , 68 , 69 , 70 ]. These effects could be due both to the reactivation/amplification of brain neurotransmission and the involvement of mirror neurons, thanks to the visual-motor information coming from the observation of the stimuli in the VR screen [ 16 ].…”

“…This data was consistent with the literature evidence on the suitability of EEG-based approaches in understanding the processes subtending awareness and their pathophysiology [ 30 , 36 , 39 , 44 , 71 , 72 , 73 ]. In fact, some studies indicate that EEG, as well as other advanced neurophysiological approaches, could be useful to differentiate patients with DoC, with regard to those in a functional locked-in syndrome to reduce the still high misdiagnosis rate [ 46 , 47 , 49 , 56 ]. In particular, various types of neurophysiological data in a pre- and post-intervention design demonstrated that clinical neurophysiology could help in both assessing the clinical severity and measuring the brain activity related to the patient’s recovery [ 45 , 50 , 51 , 52 , 53 , 54 , 55 , 57 ].…”

“…Indeed, different neurophysiological approaches, including EEG and event-related potentials (ERPs), have been used to evaluate patients’ outcomes or diagnosis. Specifically, (i) two studies used ERP to monitor residual cognitive functions [ 42 , 43 ]; (ii) eight studies used EEG/ERP to evaluate residual brain activity of DoC patients potentially suggesting cognition [ 44 , 45 , 46 , 47 , 48 , 49 , 55 , 56 ]; (iii) two studies used the enrichment environment or VR to stimulate cognitive function and awareness recovery in DoC patients, without EEG monitoring [ 13 , 14 ]; (iv) seven studies used other neurophysiological tools in DoCs, without EEG or VR, to evaluate residual brain activity of DoC patients [ 50 , 51 , 52 , 53 , 54 , 57 ]. These studies suggest that VR and several types of neurophysiological assessment, both individually and in combination, are potentially effective in corroborating DoC differential diagnosis and prognosis.…”

Disorders of Consciousness: Ethical Issues of Diagnosis, Treatment, and Prognostication

“…28,29 This field continues to grow with investigators continuously incorporating new techniques such as diffusion-weighted imaging, ultrasonography, and complex brain network activity models in DOC. [30][31][32] Functional imaging research has focused on demonstrating the presence of covert cognition by fMRI in patients who lack outward clinical signs of consciousness by assessing for specific cortical activation patterns in response to motor tasks or commands, known to be nonreflexive in healthy controls, in persons unable to move. 21,[33][34][35][36] The landmark study by Owen et al in which a patient who clinically appeared to be in a VS/UWS was able to activate the supplementary motor area when asked to imagine playing tennis and the parahippocampal gyrus when instructed to remember a familiar house or room.…”