Disorders of Consciousness, An Issue of Physical Medicine and Rehabilitation Clinics of North America

1st Edition, Volume 35-1 - November 21, 2023
Editors: Sunil Kothari, Bei Zhang
Language: English
Hardback ISBN:
9 7 8 - 0 - 4 4 3 - 1 8 3 5 4 - 6
eBook ISBN:
9 7 8 - 0 - 4 4 3 - 1 8 3 5 5 - 3

In this issue of Physical Medicine and Rehabilitation Clinics, guest editors Drs. Sunil Kothari and Bei Zhang bring their considerable expertise to the topic of Disorders of… Read more

Disorders of Consciousness, An Issue of Physical Medicine and Rehabilitation Clinics of North America

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In this issue of Physical Medicine and Rehabilitation Clinics, guest editors Drs. Sunil Kothari and Bei Zhang bring their considerable expertise to the topic of Disorders of Consciousness. The past few years have seen many developments throughout the entire field of disorders of consciousness, from neuroanatomy to the release of several clinical practice guidelines. In this issue, top experts in the field discuss key topics that bring you up to date with many of these changes.

Cover image
Title page
Table of Contents
Copyright
Contributors
Forthcoming Issues
Foreword
Preface
Conceptualizing Consciousness: a Change in Perspective: The Elephant Still Surprises Those only Touching Its Trunk
Key points
Introduction
The nature of the problem
Approaches
Discussion and clinical relevance
Clinics care points
Disclosure
Disorders of Consciousness: Classification and Taxonomy
Key points
Disorders of consciousness: an evolving taxonomy
Summary
Clinics care points
Disclosure
Structural and Functional Neuroanatomy of Core Consciousness: A Primer for Disorders of Consciousness Clinicians
Key points
Introduction
Neuroanatomy of wakefulness and awareness
Sleep
Summary
Clinics care points
Declarations of interests
Neuroimaging in Disorders of Consciousness and Recovery
Key points
Introduction
Structural imaging
Functional imaging
Summary
Clinics care points
Disclosure
Disorders of Consciousness Programs: Components, Organization, and Implementation
Key points
Introduction
Discussion
Summary
Clinics care points
Disclosure
Evaluation and Management of Disorders of Consciousness in the Acute Care Setting
Key points
Definition and mechanisms
Clinical assessment
Diagnostic evaluation
Treatment
Prognosis and ethical challenges
Summary
Clinics care points
Disclosure
Special Considerations in Behavioral Assessments for Disorders of Consciousness
Key points
Introduction
Mindsets and biases in the assessment of disorders of consciousness
An illustrative real-life scenario
Setting the patient up for success
The role of rehabilitation clinicians
An illustrative real-life scenario (continued)
Individualized quantitative behavioral assessment (IQBA)
Clinics care points
Disclosure
Appendix. An IQBA practice case
Technological Modalities in the Assessment and Treatment of Disorders of Consciousness
Key points
Background
Assessments
Treatment
Clinics care points
Disclosure
Medical, Neurologic, and Neuromusculoskeletal Complications
Key points
Introduction
Paroxysmal sympathetic hyperactivity
Hydrocephalus
Spasticity and contracture
Critical Illness Polyneuropathy and Myopathy
Movement Disorders
Seizures
Neuroendocrine disturbances
Infection
Disclosure
Strategy and Philosophy for Treating Pain and Sleep in Disorders of Consciousness
Key points
Evaluating and treating sleep in disorders of consciousness
Evaluating and treating pain in disorders of consciousness
Summary
Disclosure
Pharmacology in Treatment of Patients with Disorders of Consciousness
Key points
Introduction
Monoamines including dopamine
GABA
Discussion
Disclosure
Prognostication and Trajectories of Recovery in Disorders of Consciousness
Key points
Background
Discussion
Summary
Clinics care points
Emergence from Disorders of Consciousness: Optimizing Self-Agency Through Communication
Key points
Introduction
Neuroanatomy of language
Bedside assessment of communication
The role of imaging
Confounds in assessment
Patterns of recovery
The role of rehabilitation
The use of augmentative and alternative communication in early recovery
Augmentative and alternative communication strategies and technology to support long-term communication needs
New and emerging communication technologies for disorders of consciousness
Emerging consciousness, communication, and the family
Communication, self-agency, and ethical considerations
Summary
Clinics care points
Disclosure
Education, Training, and Support Across the Continuum of Recovery for Caregivers of Persons with Disorders of Consciousness
Key points
Introduction
Research
Guidelines
Considerations for addressing caregiver needs across the continuum of recovery
Discussion
Future directions
Summary
Clinics care point
Disorders of Consciousness Rehabilitation: Ethical Dimensions and Epistemic Dilemmas
Key points
Access to neurorehabilitative care
Ethics, equity and access to diagnostic, prognostic and therapeutic technologies and research
Supporting autonomy in settings of liminal self-expression and reemergent agency
Beneficence, nonmaleficence, and disability bias in disorders of consciousness rehabilitation
Revisiting goals of care and prognostic uncertainty in the rehabilitation setting
Ethics and epistemology in disorders of consciousness nosology and diagnostic criteria
Summary
Clinics care points
Funding/acknowledgments
Disorders of Consciousness in Children: Assessment, Treatment, and Prognosis
Key points
Introduction
Discussion
Summary
Clinics care points
Disclosure

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Disorders of Consciousness, An Issue of Physical Medicine and Rehabilitation Clinics of North America

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Sunil Kothari

Bei Zhang