Lomonosov Psychology Journal
ISSN 0137-0936
eISSN 2309-9852
En Ru
ISSN 0137-0936
eISSN 2309-9852

Recovery of consciousness: opportunities for neuropsychological assessment and rehabilitation

Relevance. Neuropsychological rehabilitation and assessment are the priority tasks in practice of a clinical psychologist. The modern rehabilitation system can be considered as a partnership between patients, their families and different specialists participating in the rehabilitation process. The existing approaches to neurorehabilitation are aimed at the earliest possible intervention. It`s of particular importance for patients with disorders of consciousness, whose number has been increasing in connection with the development of medicine in recent decades. This leads to the need to develop tools for specialized neuropsychological assessment and methods of neuropsychological rehabilitation of patients in the early stages of recovery of consciousness.

Objective. To summarize neuropsychological diagnostic and rehabilitation experience of working with patients with disorders of consciousness after brain lesions.

Methods. We analyze practical guidelines, applied research and our own hands-on experience of working with patients with disorders of consciousness after brain lesions.

Results. Based on the analysis, the recommended diagnostic tools are formulated that can be used to identify the current level of consciousness and to assess various parameters of psychic activity of patients with disorders of consciousness. In addition, the main directions and neuropsychological methods of rehabilitation work recommended for recovery of consciousness and continuing to be developed now are highlighted.

Conclusion. A new diagnostic and rehabilitation material is presented, which is recommended for use in neuropsychological practice by practicing clinical psychologists with patients with disorders of consciousness after brain lesions.

Acknowledgments: we would like to express our great appreciation to Professor Galina Ivanova, also Valentina Bykova and Olga Maksakova for comments that greatly improved the manuscript.

References

Abbate, C., Trimarchi, P.D., Basile, I., Mazzucchi, A., Devalle, G. (2014). Sensory stimulation for patients with disorders of consciousness: from stimulation to rehabilitation. Frontiers in Human Neuroscience, 8 (616). Retrieved from https://www.frontiersin.org/articles/10.3389/fnhum.2014.00616/full (review date: 23.02.2021). DOI: 10.3389/fnhum.2014.00616

Ansell, B.J., Keenan, J.E. (1989). The Western Neuro Sensory Stimulation Profile: a tool for assessing slow-to-recover head-injured patients. Archives of Physical Medicine and Rehabilitation, 70 (2), 104–108. DOI: 0.5555/uri:pii:0003999389901263

Belkin, V.A., Pozdnyakov, D.G., Belkin, A.A. (2019). Cognitive motor dissociation diagnosis in patients with chronic disorders of consciousness. Nevrologiya, neiropsikhiatriya, psikhosomatika (Neurology, Neuropsychiatry, Psychosomatics), 11 (3), 46–51. DOI: 10.14412/2074-2711-2019-3S-46-51 (in Russ.).

Bespalov, B.I. (2013). Materials of the XIV International Readings in the memory of L.S. Vygotsky. Psychology of consciousness: origins and research perspectives. In V.T. Kudryavtsev (Eds.), The problem of consciousness in L.S. Vygotsky’s theory (pp. 8–15). Moscow: RGGU. (in Russ.).

Boly, M., Laureys, S. (2018). Functional ‘unlocking’: bedside detection of covert awareness after severe brain damage. Brain, 141 (5), 1239–1241. DOI: 10.1093/brain/awy080

Bykova, V.I., Luk'yanov, V.I., Fufaeva, E.V. (2015). Dialogue with the patient in low consciousness state after severe brain danages. Konsul'tativnaya psikhologiya i psikhoterapiya (Counseling Psychology and Psychotherapy), 23 (3), 9–31. (in Russ.).

Coleman, M.R., Rodd, J.M., Davis, M.H., Johnsrude, I.S., Menon, D.K., Pickar, J.D., Owen, A.M. (2007). Do vegetative patients retain aspects of language comprehension? Evidence from fMRI. Brain, 130 (10), 2494–2507. Retrieved from https://academic.oup.com/brain/article/130/10/2494/373595?login=true (review date: 23.02.2021). DOI: 10.1093/brain/awm170

Di, H.B., Yu, S.M., Weng, X.C., Laureys, S., Yu, D., Li, J.Q., Qin, P.M., Zhu, Y.H., Zhang, S.Z., Chen, Y.Z. (2007). Cerebral response to patient’s own name in the vegetative and minimally conscious states. Neurology, 68 (12), 895–899. DOI: 10.1212/01.wnl.0000258544.79024.d0

Dobrokhotova, T.A. (2006). Neuropsychiatry. Moscow: BINOM. (in Russ.).

Dobrokhotova, T.A., Zaitsev, O.S., Gogitidze, N.V. (1991). Psychostimulation therapy in the rehabilitation of patients with severe traumatic brain injury, accompanied by prolonged coma: guidelines. Moscow. (in Russ.).

Doig, E., Lane-Brown, A. (2012). Responsiveness of Instruments to Assess Disorders of Consciousness: A Literature Review. Brain Impairment, 13 (3), 285–315. DOI: 10.1017/BrImp.2012.29

Formisano, R., D’Ippolito, M., Catani, S. (2013). Functional locked-in syndrome as recovery phase of vegetative state. Brain Injury, 27 (11), 1332–1332. DOI: 10.3109/02699052.2013.809555

Fufaeva, E.V., Mikadze, Yu.V., Luk'yanov, V.I. (2017). Neuropsychological evaluation of children in low conciseness state after a severe traumatic brain injury. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova (S.S. Korsakov Journal of Neurology and Psychiatry), 117 (11), 33–40. (in Russ.).

Giacino, J., Hirsch, J., Schiff, N.D., Laureys, S. (2006). Functional neuroimaging applications for assessment and rehabilitation planning in patients with disorders of consciousness. Archives of Physical Medicine and Rehabilitation, 87 (12), 67–76. DOI: 10.1016/j.apmr.2006.07.272

Giacino, J.T., Kalmar, K., Whyte, J. (2004). The JFK Coma Recovery Scale-Revised: Measurement Characteristics and Diagnostic Utility. Archives of Physical Medicine and Rehabilitation, 85 (12), 2020–2029. DOI: 10.1016/j.apmr.2004.02.033

Gill-Thwaites, H. (1997). The Sensory Modality Assessment Rehabilitation Technique — a tool for assessment and treatment of patients with severe brain injury in a vegetative state. Brain Injury, 11 (10), 723–734. DOI: 10.1080/026990597123098

Hagen, C., Malkmus, D., Durham, P. (1979). Levels of Cognitive Functioning. Downey, Calif: Rancho Los Amigos Hospital.

Heine, L., Tillmann, B., Hauet, M., Juliat, A., Dubois, A., Laureys, S., Kandel, M., Plailly, J., Luaute, J., Perrin, F. (2017). Effects of preference and sensory modality on behavioural reaction in patients with disorders of consciousness. Brain Injury, 31 (10), 1307–1311. DOI: 10.1080/ 02699052.2017.1306108

Ivannikov, V.A. (2015). On the nature and origin of the human psyche. Natsional'nyi psikhologicheskii zhurnal (National Psychological Journal), 3 (19), 15–23. (in Russ.).

Khomskaya, E.D. (2005). Neuropsychology. St. Petersburg: Piter. (in Russ.).

Kondrat'eva, E.A., Yakovenko, I.V. (2014). Vegetative state (etiology, pathogenesis, diagnosis and treatment). St. Petersburg: FGBU “RNKhI im. prof. A.L. Polenova” Minzdrava Rossii. PP. 356–361 (in Russ.).

Kovyazina, M.S., Fomina, K.A. (2017). To the question about theoretical substantiation of clinical and psychological approach to rehabilitation of diseased with reduced level of consciousness. Consilium Medicum, 19 (2.1), 53–55. (in Russ.).

Laureys, S., Faymonville, M.E., Peigneux, P., Damas, P., Lambermont, B., Del Fiore, G., Degueldre, C., Aerts, J., Luxen, A., Franck, G., Lamy, M., Moonen, G., Maquet, P. (2002). Cortical Processing of Noxious Somatosensory Stimuli in the Persistent Vegetative State. NeuroImage, 17 (2), 732–741. DOI: 10.1006/nimg.2002.1236

Leont'ev, A.N. (2004). Activity, consciousness, personality. Moscow: Smysl; Akademiya. (in Russ.).

Luriya, A.R. (2003). Basics of neuropsychology: manual. Moscow: Akademiya. (in Russ.).

Magee, W.L., Siegert, R.J., Daveson, B.A., Lenton-Smith, G., Taylor, S.M. (2013). Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC): Standardisation of the principal subscale to assess awareness in patients with disorders of consciousness. Neuropsychological Rehabilitation, 24 (1), 101–124. DOI: 10.1080/09602011.2013.844174

Maksakova, O.A., Ignat'eva, N.S., Zaitsev, O.S. (2016). The role and principles of psychologist’s work in the neurosurgical clinic. Rossiiskii neirokhirurgicheskii zhurnal imeni professora A.L. Polenova (Russian Neurosurgical Journal named after Professor A.L. Polenov), 7 (4), 37–44. (in Russ.).

Mochalova, E.G., Legostaeva, L.A., Zimin, A.A., Yusupova, D.G., Sergeev, D.V., Ryabinkina, Yu.V., Bodin, E., Suponeva, N.A., Piradov, M.A. (2018). The Russian version of Coma Recovery Scale-revised — a standardized method for assessment of patients with disorders of consciousness. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova (S.S. Korsakov Journal of Neurology and Psychiatry), 3 (2), 25–31. (in Russ.).

Monti, M.M., Coleman, M.R., Owen, A.M. (2009). Executive functions in the absence of behavior: functional imaging of the minimally conscious state. Progress in Brain Research, 177, 249–60. DOI: 10.1016/S0079-6123(09)17717-8

Monti, M.M., Pickard, J.D., Owen, A.M. (2013). Visual Cognition in Disorders of Consciousness: from V1 to Top-Down Attention. Human Brain Mapping, 34 (6), 1245–1253. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/hbm.21507 (review date: 23.02.2021). DOI: 10.1002/hbm.21507

Monti, M.M., Vanhaudenhuyse, A., Coleman, M.R., Boly, M., Pickard, J.D., Tshibanda, L., Owen, A.M., Laureys, S. (2010). Willful modulation of brain activity in disorders of consciousness. The New England Journal of Medicine, 362 (7), 579–589. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMoa0905370 (review date: 23.02.2021). DOI: 10.1056/NEJMoa0905370

Nachev, P., Hacker, P.M.S. (2010). Covert cognition in the persistent vegetative state. Progress in Neurobiology, 91 (1), 68–76. DOI: 10.1016/j.pneurobio.2010.01.009

Oknina, L.B., Sharova, E.V., Zaitsev, O.S. (2017). Wavelet-synchrony of brain evoked responses during listening to naturalistic stimuli in the prognosis of consciousness recovery (Study 1: wavelet-synchrony during listening to instrumental music). Fiziologiya cheloveka (Human Physiology), 43 (6), 15–23. DOI: 10.7868/S0131164617060078 (in Russ.).

Okumura, Y., Asano, Y., Takenaka, S., Fukuyama, S., Yonezawa, S., Kasuya, Y., Shinoda, J. (2014). Brain activation by music in patients in a vegetative or minimally conscious state following diffuse brain injury. Brain Injury, 28 (7), 944–950. DOI: 10.3109/02699052.2014.888477

Owen, A.M., Coleman, M.R., Boly, M., Davis, M.H., Laureys, S., Pickard, J.D. (2006). Detecting awareness in the vegetative state. Science, 313 (5792), 1402. DOI: 10.1126/science.1130197

Pape, T.L., Rosenow, J.M., Harton, B., Patil, V., Guernon, A., Parrish, T., Froehlich, K., Burress, C., McNamee, S., Herrold, A.A., Weiss, B., Wang, X. (2012). Preliminary framework for familiar auditory sensory training (FAST) provided during coma recovery. Journal of Rehabilitation Research & Development, 49 (7), 1137–1152. DOI: 10.1682/JRRD.2011.08.0154

Pape, T.L., Tang, C., Guernon, A., Lundgren, S., Blahnik, M., Wei, Y., Querubin, M., Zollman, F., Soneru, I. (2009). Predictive value of the Disorders of Consciousness Scale (DOCS). PM&R, 1 (2), 152–161. DOI: 10.1016/j.pmrj.2008.11.002

Perrin, F., Schnakers, C., Schabus, M., Degueldre, C., Goldman, S., Bredart, S., Faymonville, M-E., Lamy, M., Moonen, G., Luxen, A., Maquet, P., Laureys, S. (2006). Brain response to one’s own name in vegetative state, minimally conscious state, and locked-in syndrome [Electronic resource]. Archives of Neurology, 63 (4), 562–569. URL: https://jamanetwork.com/journals/jamaneurology/article-abstract/791093 (date of retrieval: 23.02.2021). DOI: 10.1001/archneur.63.4.562

Pistarini, C., Maggioni, G. (2018). Early rehabilitation of Disorders of Consciousness (DOC): management, neuropsychological evaluation and treatment. Neuropsychological Rehabilitation, 28 (8), 1319–1330. DOI: 10.1080/09602011.2018.1500920

Psychology of consciousness (2001). In L.V. Kulikov (Eds.). St. Petersburg: Piter. (in Russ.).

Pundole, A., Crawford, S. (2017). The assessment of language and the emergence from disorders of consciousness. Neuropsychological Rehabilitation, 28 (8), 1285–1294. DOI: 10.1080/09602011.2017.1307766

Rader, M.A., Ellis, D.W. (1994). The Sensory Stimulation Assessment Measure (SSAM): a tool for early evaluation of severely brain-injured patients. Brain Injury, 8 (4), 309–321. DOI: 10.3109/02699059409150982

Report of the American Congress of Rehabilitation Medicine, Brain Injury-Interdisciplinary Special Interest Group, Disorders of Consciousness Task Force: Seel, R.T., Sherer, M., Whyte, J., Katz, D.I., Giacino, J.T., Rosenbaum, A.M., Hammond, F.M., Kalmar, K., Pape, T.L., Zafonte, R., Biester, R.C., Kaelin, D., Kean, J., Zasler, N. (2010). Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Archives of Physical Medicine and Rehabilitation, 91 (12), 1795–1813. DOI: 10.1016/j.apmr.2010.07.218

Rubinshtein, S.L. (2002). Basics of general psychology. St. Petersburg: Piter. (in Russ.).

Sanz, L.R.D., Aubinet, C., Cassol, H., Bodart, O., Wannez, S., Bonin, E.A.C., Barra, A., Lejeune, N., Martial, C., Chatelle, C., Ledoux, D., Laureys, S., Thibaut, A., Gosseries, O. (2021). SECONDs Administration Guidelines: A Fast Tool to Assess Consciousness in Brain-injured Patients. JoVE Journal, 168 (e61968). Retrieved from https://www.jove.com/t/61968/seconds-administration-guidelines-fast-tool-to-assess-consciousness?sta... (review date: 27.05.2021). DOI: 10.3791/61968

Schiff, N.D. (2015). Cognitive Motor Dissociation. Following Severe Brain Injuries. JAMA Neurology, 72 (12), 1413–1415. DOI: 10.1001/jamaneurol.2015.2899

Schiff, N.D., Rodriguez-Moreno, D., Kamal, A., Kim, K.H.S., Giacino, J.T., Plum, F., Hirsch, J. (2005). fMRI reveals large-scale network activation in minimally conscious patients. Neurology, 64 (3), 514–523. DOI: 10.1212/01.WNL.0000150883.10285.44

Schnakers, C., Magee, W.L., Harris, B. (2016). Sensory Stimulation and Music Therapy Programs for Treating Disorders of Consciousness. Frontiers in Psychology, 7 (297). Retrieved from https://www.frontiersin.org/articles/10.3389/fpsyg.2016.00297/full (review date: 23.02.2021). DOI: 10.3389/fpsyg.2016.00297

Schnakers, C., Vanhaudenhuyse, A., Giacino, J., Ventura, M., Boly, M., Majerus, S., Moonen, G., Laureys, S. (2009). Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment. BMC Neurology, 9 (35). Retrieved from https://link.springer.com/article/10.1186/1471-2377-9-35 (review date: 27.05.2021). DOI: 10.3389/fpsyg.2016.00297

Shiel, A., Horn, S., Wilson, B.A., McLellan, D.L., Watson, M., Campbell, M. (2000). The Wessex Head Injury Matrix scale: a preliminary report on a scale to assess and monitor patients recovery after severe head injury. Clinical Rehabilitation, 14 (4), 408–416. DOI: 10.1191/0269215500cr326oa

Tavangar, H., Shahriary-Kalantary, M., Salimi, T., Jarahzadeh, M., Sarebanhassanabadi, M. (2015). Effect of family members' voice on level of consciousness of comatose patients admitted to the intensive care unit: a single-blind randomized controlled trial. Advanced Biomedical Research, 4 (106). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513326/ (review date: 23.02.2021). DOI: 10.4103/2277-9175.157806

Vygotsky, L.S. (1983). Problems of the development of the psyche. In Vygotsky L.S. Collected works. Vol. 3. Moscow: Pedagogika. (in Russ.).

Wang, J., Hu, X., Hu, Z., Sun, Z., Laureys, S., Di, H. (2020). The misdiagnosis of prolonged disorders of consciousness by a clinical consensus compared with repeated coma-recovery scale-revised assessment. BMC Neurology, 20 (343). Retrieved from https://link.springer.com/article/10.1186/s12883-020-01924-9 (review date: 23.02.2021). DOI: 10.1186/s12883-020-01924-9

Wundt, V. (1896). Outlines of psychology. St. Petersburg: Izdanie F. Pavlenkova. (in Russ.).

Zakrepina, A.V. (2012). Pedagogical technologies in complex rehabilitation of children with severe brain injury. Moscow: Paradigma. (in Russ.).

Recieved: 04/26/2021

Accepted: 06/15/2021

Published: 09/15/2021

Keywords: clinical psychology; neuropsychology; disorders of consciousness; neuropsychological assessment; neuropsychological rehabilitation

Available online since: 15.09.2021

Issue 3, 2021