Browsing by Author "Blacker, Danielle"
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- Disorders of ConsciousnessPublication . Teixeira, Liliana; Blacker, Danielle; Rocha, NunoA disorder of consciousness (DoC) is a state where consciousness has been affected by damage to the brain. DoC range in the form of a hierarchy, including coma, vegetative state and minimally conscious state. The most common way to assess consciousness is to observe their responses to stimulation. However, observing these responses and detecting purposeful behaviours is extremely challenging. Several studies have shown that misdiagnosis is common. It is crucial to optimise the way consciousness assessments are performed. Clinical management of DoC patients, from treatment of pain to end-of-life decisions, depends on behavioural observations. In the present chapter, we review the challenges posed by the assessment of consciousness and the importance of combining clinical assessment with complementary methods of assessment, such as positron emission tomography, functional magnetic resonance imaging and electroencephalography. According to the diagnosis established, the patient will follow different care pathways. Although therapeutic options of DoC are still limited, basic therapies include artificial nutrition and hydration, physical and occupational therapies as well as sensory stimulation. Pharmacologic trials, deep brain stimulation and multisensory stimulations are some of the therapeutic options for DoCs. Recently, it was removed the requirement to obtain legal sanction for every decision to withdraw clinically assisted nutrition and hydration from people in DoCs. This has led to an entire paradigm shift, from a focus on the diagnosis to a focus on the patient's best interest. Although these decisions will spare the courts' involvement, one should never disregard reaching a correct diagnosis for this vulnerable population.
- Repeated Clinical Assessment Using Sensory Modality Assessment and Rehabilitation Technique for Diagnosis in Prolonged Disorders of ConsciousnessPublication . da Conceição Teixeira, Liliana; Blacker, Danielle; Campos, Carlos; Garrett, Carolina; Duport, Sophie; Rocha, NunoThe recommended way to assess consciousness in prolonged disorders of consciousness is to observe the patient’s responses to sensory stimulation. Multiple assessment sessions have to be completed in order to reach a correct diagnosis. There is, however, a lack of data on how many sessions are sufficient for validity and reliability. The aim of this study was to identify the number of Sensory Modality Assessment and Rehabilitation Technique (SMART) assessment sessions needed to reach a reliable diagnosis. A secondary objective was to identify which sensory stimulation modalities are more useful to reach a diagnosis.