Browsing by Author "Rocha, Nuno"
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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.
- Livro de Atas da 1ª Conferência Lusófona de Terapia OcupacionalPublication . Ribeiro, Jaime; Trigueiro, Maria João; Marques, António; Pinto, Élia Silva; Reis, Helena; Sousa, Helena; Ferreira, Isabel; Braúna, Mônica; Rocha, Nuno; Portugal, Paula; Santana, Raquel; Pestana, Susana; Coelho, Tiago; Pedrosa, Varela Vanda; Simões-Silva, VítorA 1ª Conferência Lusófona de Terapia Ocupacional ocorreu no dia 9 de julho de 2021, em modo virtual (vídeo conferência). Esta conferência surgiu do Núcleo Académico da Terapia Ocupacional (NATO) da Rede Académica de ciências da Saúde da Lusofonia (RACS). Pretendeu dinamizar e disseminar a produção científica em Terapia Ocupacional, em língua portuguesa. Pretendeu também contribuir significativamente para a discussão dos temas mais atuais e emergentes e contar com a participação de investigadores e profissionais do mundo lusófono. Só com partilha de conhecimento científico é possível fazer progredir a profissão e sustentar a prática em evidência sólida de forma a promover conhecimento e reconhecimento da Terapia Ocupacional. Nesta primeira edição, em formato virtual, no seguimento da pandemia que assolou o planeta, foram apresentados assincronamente 15 pósteres em formato vídeo e disponibilizados em https://www.youtube.com/playlist?list=PLKUR7eWoyi2QAmZdHuB8qapIIA3PGxPVf . Foram também apresentadas de forma síncrona 14 comunicações livres que resultaram em 13 artigos completos que foram publicados na RevSALUS - Revista Científica Internacional da Rede Académica das Ciências da Saúde da Lusofonia – RACS - https://revsalus.com/index.php/RevSALUS . Uma comunicação oral encontra-se em artigo completo neste livro. Neste livro de Atas encontram-se publicados os resumos dos artigos completos publicados na RevSalus assim com os artigos curtos que originaram os vídeo-pósteres. Com mais de 100 participantes internacionais, esta edição obteve um sucesso considerável atendendo à sua novidade e constrangimentos pandémicos. O futuro augura-se frutífero e preenchido numa rede lusófona que expande de forma sustentável. Sucessos para a Terapia Ocupacional e para a Rede Académica das Ciências da Saúde da Lusofonia.
- New taxonomy for prolonged disorders of consciousness may help with decisions on withdrawal of clinically assisted nutrition and hydration: A proposed decision-making pathwayPublication . Teixeira, Liliana da Conceição; Rocha, Nuno; Nunes, RuiThe number of patients surviving severe brain injury is increasing; however, many are left in a prolonged disorder of consciousness. With appropriate treatment, these patients can survive for years. Unless a living will exists; the doctors can authorize withdrawal of artificial nutrition and hydration for these patients, based on best interests. There is an urge to revise the current terminology used in prolonged disorders of consciousness (vegetative state and minimally conscious state) to better reflect our understanding of these conditions, which will, in turn, ease the challenges faced when making a decision about withdrawal of artificial nutrition and hydration of these patients. A decision-making pathway based on a new taxonomy is proposed. The importance of reassessment is reinforced to clarify diagnosis and help with prognosis. Adopting a new classification for prolonged disorders of consciousness would clarify how we think about these patients
- 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.