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Disorders of Consciousness

2020-06Book part Open access
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datacite.subject.sdg03:Saúde de Qualidade
datacite.subject.sdg04:Educação de Qualidade
datacite.subject.sdg17:Parcerias para a Implementação dos Objetivos
dc.contributor.authorTeixeira, Liliana
dc.contributor.authorBlacker, Danielle
dc.contributor.authorRocha, Nuno
dc.date.accessioned2025-07-30T16:44:47Z
dc.date.available2025-07-30T16:44:47Z
dc.date.issued2020-06
dc.descriptionEISBN - 978981144677-1
dc.description.abstractA 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.eng
dc.identifier.citationda Conceição Teixeira, Liliana & Blacker, Danielle & Rocha, Nuno. (2020). Disorders of Consciousness. DOI: https://doi.org/10.2174/9789811446771120010005.
dc.identifier.doi10.2174/9789811446771120010005
dc.identifier.isbn9789811446757
dc.identifier.isbn978981144677-1
dc.identifier.urihttp://hdl.handle.net/10400.8/13800
dc.language.isoeng
dc.peerreviewedyes
dc.publisherBentham Science Publishers
dc.relation.hasversionhttps://www.benthamdirect.com/content/books/9789811446771.chapter-2
dc.relation.ispartofMultidisciplinary Interventions for People with Diverse Needs - A Training Guide for Teachers, Students, and Professionals
dc.rights.uriN/A
dc.subjectAnoxia
dc.subjectAssessment
dc.subjectBrain injury
dc.subjectComa
dc.subjectConsciousness
dc.subjectDiagnosis
dc.subjectDisorders of consciousness
dc.subjectEmergence
dc.subjectMinimally conscious state
dc.subjectMisdiagnosis
dc.subjectPrognosis
dc.subjectTreatment
dc.subjectVegetative state
dc.titleDisorders of Consciousnesseng
dc.typebook part
dspace.entity.typePublication
oaire.citation.titleMultidisciplinary Interventions for People with Diverse Needs - A Training Guide for Teachers, Students, and Professionals
oaire.versionhttp://purl.org/coar/version/c_be7fb7dd8ff6fe43
person.familyNameda Conceição Teixeira
person.givenNameLiliana
person.identifier1298780
person.identifier.ciencia-id9811-DD3D-DD0F
person.identifier.orcid0000-0001-9408-859X
person.identifier.ridAAD-8708-2019
relation.isAuthorOfPublicationb949135a-bbec-4770-8d74-502c0ba04029
relation.isAuthorOfPublication.latestForDiscoveryb949135a-bbec-4770-8d74-502c0ba04029

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A 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.
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