Technology-based intervention to help persons with minimally conscious state and pervasive motor disabilities perform environmentally relevant adaptive behavior

Persons with a diagnosis of minimally conscious state and pervasive motor disabilities tend to be passive and isolated. A way to help them improve their adaptive behavior (relate to their environment) involves the use of intervention packages combining assistive technology with motivational strategies. The types of assistive technology included in those packages may consist of (a) microswitches allowing direct access to environmental stimuli, (b) combinations of microswitches and voice output communication devices (VOCAs) allowing stimulus access and calls for caregivers' attention, respectively, and (c) computer presentations of stimulus options and microswitches allowing choice among those options and access to them.     

More dead than dead: perceptions of persons in the persistent vegetative state

Patients in persistent vegetative state (PVS) may be biologically alive, but these experiments indicate that people see PVS as a state curiously more dead than dead. Experiment 1 found that PVS patients were perceived to have less mental capacity than the dead. Experiment 2 explained this effect as an outgrowth of afterlife beliefs, and the tendency to focus on the bodies of PVS patients at the expense of their minds. Experiment 3 found that PVS is also perceived as “worse” than death: people deem early death better than being in PVS. These studies suggest that people perceive the minds of PVS patients as less valuable than those of the dead – ironically, this effect is especially robust for those high in religiosity.     

EEG oscillatory states as neuro-phenomenology of consciousness as revealed from patients in vegetative and minimally conscious states

The value of resting electroencephalogram (EEG) in revealing neural constitutes of consciousness (NCC) was examined. We quantified the dynamic repertoire, duration and oscillatory type of EEG microstates in eyes-closed rest in relation to the degree of expression of clinical self-consciousness. For NCC a model was suggested that contrasted normal, severely disturbed state of consciousness and state without consciousness. Patients with disorders of consciousness were used. Results suggested that the repertoire, duration and oscillatory type of EEG microstates in resting condition quantitatively related to the level of consciousness expression in brain-damaged patients and healthy-conscious subjects. Specifically, results demonstrated that (a) decreased number of EEG microstate types was associated with altered states of consciousness, (b) unawareness was associated with the lack of diversity in EEG alpha-rhythmic microstates, and (c) the probability for the occurrence and duration of delta-, theta- and slow-alpha-rhythmic microstates were associated with unawareness, whereas the probability for the occurrence and duration of fast-alpha-rhythmic microstates were associated with consciousness. In conclusion, resting EEG has a potential value in revealing NCC. This work may have implications for clinical care and medical-legal decisions in patients with disorders of consciousness.     

The analytic state of consciousness as a form of play and a foundational transference

The analytic state of consciousness is a particular regressive altered state in the patient characterized by an increased sensitivity and reactivity to impressions arising from both the inner world and the analyst, a heightened sense of dependence and vulnerability, a permeability of boundaries in regard to the analyst, and a shift toward functioning on the basis of omnipotent fantasy in the analytic relationship. These changes are accompanied by a feeling of realness of one's psychic reality, but without any true loss of reality testing. Based on an analysis of the structure of play, this state can itself be understood as a kind of play; it serves as a foundational transference underlying more specific transference manifestations; and it is central to the analytic process. Over time, in response to physical aspects of the analytic setting, its safety, the analyst's emotional accompaniment, and a generally restrained analytic stance (an issue I discuss in some detail), it emerges in a more developed form that promotes symbolization and ownership of aspects of self, greater emotional presence, and a deeper sense of meaning in one's experience. Additionally, the concept of the analytic state of consciousness provides a new look at the role of abstinence and frustration in analytic process.     

Transcranial direct-current stimulation enhances implicit motor sequence learning in persons with Parkinson's disease with mild cognitive impairment

Implicit motor sequence learning (IMSL) is affected in Parkinson's disease (PD). Research in healthy young participants shows the potential for transcranial direct-current stimulation (tDCS) over the primary motor cortex (M1) to enhance IMSL. In PD, only null effects have been reported to date. We determined concurrent, short-term, and long-term effects of anodal tDCS over M1 on IMSL, as measured by the serial reaction time (SRT) task, in persons with PD with mild cognitive impairment (MCI). Concurrent (anodal/sham tDCS intervention during the SRT task), short-term (5 min post-intervention), and long-term (1 week post-intervention) effects on IMSL were evaluated in persons with idiopathic PD (Hoehn and Yahr stage II-III) with MCI. Results of 11 persons with PD (8 men and 3 women; mean age = 77.1 years; mean disease duration = 7.7 years) showed significant IMSL in the anodal (p = .016), but not in the sham tDCS condition (p = .937). Post-hoc analyses showed that IMSL reached statistical significance at 1 week post-intervention (p < .001). Anodal tDCS over M1 exerted beneficial effects on IMSL in persons with PD with MCI, in particular one week post-intervention. Our study is the first to report a positive effect of tDCS on IMSL in PD. Further research should include a larger, more cognitively diverse sample and additional follow-up periods.     

The burdens-benefits ratio consideration for medical administration of nutrition and hydration to persons in the persistent vegetative state.

In this article, Harvey notes the initial confusion about the statement made by the pope concerning artificial nutrition and hydration on patients suffering persistent vegetative states (PVS) due to misunderstanding through the translation of the pope's words. He clarifies and assesses what was meant by the statement. He also discusses the problems of terminology concerned with the subject of PVS. Harvey concludes that the papal allocution was in line with traditional Catholic bioethics, and that while maintaining the life of a patient is favorable, in particular cases this presumption wanes when it is clear that this treatment modality would be futile or very burdensome.     

Slow gait as a motor marker of mild cognitive impairment? the relationships between functional mobility and mild cognitive impairment

The purpose of this study was to evaluate the association between functional mobility and mild cognitive impairment in older adults. A total of 800 older adults were recruited (653 controls and 147 subjects with MCI [88 subjects with aMCI and 59 subjects with naMCI]). Motor performance was measured with the Timed Up and Go test (TUG). The demographic factors associated with MCI were: age (OR = 1.05; 95% CI: 1.01–1.09) and the level of education (OR = 0.73; 95% CI: 0.68–0.79). An independent clinical factor associated with MCI was the TUG (OR = 1.14; 95% CI: 1.03–1.27). In the aMCI group, the relation between the TUG and cognitive status occurred (OR = 1.15; 95% CI: 1.02–1.31), whereas in the naMCI group this relationship was not observed. There is an association between cognitive dysfunction and impaired motor performance in older adults with MCI.     

The link between motor impairment level and motor imagery ability in children with developmental coordination disorder

The present study examined motor imagery ability in children with developmental coordination disorder (DCD). Specifically, it explored whether children with varying degrees of motor impairment differed in their ability to perform motor imagery tasks. Fourty-two children scoring below the 15th percentile on the Movement ABC were split into two groups--DCD severe (DCD-S), scoring on or below the 5th percentile, and DCD mild (DCD-M), scoring from the 6th to 15th percentiles--and compared to 21 age matched controls. Participants performed two motor imagery tasks--hand (performed without and with specific imagery instructions) and whole-body rotation. The results demonstrated that children in the DCD-S group had a generalized motor imagery deficit in that they were less accurate across tasks than controls (and the DCD-M group on the hand task) and showed little benefit when given specific imagery instructions. The DCD-M group appeared capable of performing simpler motor imagery transformations, but were less successful as task complexity increased. Unlike the DCD-S group, the DCD-M group did show some benefit from specific imagery instructions with increases in accuracy on the hand task. These results suggest that a motor imagery deficit does exist in many children with DCD but that its presentation can vary--factors such as the individual child's level of motor impairment and task complexity appear to be linked to the profile of deficits observed, which could explain the inconsistent findings of previous studies. Although this study lends support to the theory that a deficit in internal modeling is an underlying problem for children with DCD, still more research is required to develop the theory further.     

Influence of functional impairment and social support on depressive symptoms in persons with diabetes

Tested the buffering model of social support among 158 adults with diabetes. We predicted that, among patients with higher levels of illness-related impairment, adequate social support would act as a buffer against depression. Measures included the Beck Depression Inventory; the Sickness Impact Profile; and an assessment of the adequacy of social support to enable the patient to deal with illness-related tasks, domestic chores, financial responsibilities, and emotional needs. Depressive symptoms correlated positively with functional impairment (r = .58, p less than .001) and negatively with the adequacy of social support (r = -.31, p less than .001). In addition, social support moderated depression in the face of greater impairment such that, among patients who reported the most illness-related functional disabilities, adequate support provided a relative protection from depression. The findings suggest that individuals with inadequate support are most at risk to become depressed when disability related to illness increases.     

Memory effects of motor activation in subject-performed tasks and sign language

Research on memory has consistently shown that when a subject-performed task (SPT) is compared with a traditional verbal task (VT), enactment at the encoding of verbal materials (i.e., SPT) yields better memory performance than does nonenactment (i.e. VT). There is some controversy regarding the extent to which motor activation per se might be causing this effect, and whether or not SPTs may be influenced by memory strategies. The purpose of this study was to contribute toward a solution of these questions. The effect of SPT encoding was compared with the effect of encoding by means of a sign language task (SLT). The SLT condition is claimed to be a verbal/linguistic task with a major relevant motor component. The motor activation in SLT is in the present study seen to be the main difference between the SLT and the VT, and the main similarity between the SLT and the SPT. Control conditions were tested in order to evaluate possible effects of translation and imagery in the SLT condition. Subjects in the SLT condition performed similarly to subjects in the SPT condition in free recall. Subjects in both these conditions outperformed subjects in the control conditions. The SPT and SLT superiority is suggested to be caused mainly by relevant motor activation.     

Missing piece of the puzzle in the science of consciousness: Resting state and endogenous correlates of consciousness

Consciousness still stands as one of the most interesting and the most elusive problems of neuroscience. Finding its correlates is the first step toward its satisfactory explanation. Several theories have proposed its correlates but none of them seem to be generally accepted even though most of them share some very similar elements. These elements are the activity of the thalamus, which is considered by some as the central region for consciousness, and gamma synchronization, which should be the general principal for the emergence of conscious experience. However, all of these proposed theories share one characteristic and that is that they do not take into consideration the recently discovered endogenous activity of the brain, which is generally associated with the default mode network. Although the activity of this large scale brain network is in correlation with various levels of consciousness it is still missing in discussions of consciousness. This review recognizes the importance of endogenous activity and points out the important discoveries of endogenous activity that could be an important step toward a satisfactory explanation of consciousness.     

Learning and memory impairment in rats fed a high saturated fat diet

At the age of 1 month, three separate groups of Long-Evans rats were placed on 20% (w/w) fat (40% of calories) diets high in either saturated fatty acids (lard-based) or polyunsaturated fatty acids (soybean oil-based) or standard laboratory chow (Purina, 4.5% (w/w) fat). After 3 months, all rats were administered three tests of learning and memory--Olton's radial arm maze, a variable-interval delayed alternation task, and the Hebb-Williams maze series. The lard-fed group was impaired on all tests. The soybean oil-fed group was slightly impaired on some measures, relative to the chow-fed group, but consistently performed better than the lard-fed group. The results indicate that a diet high in saturated fatty acids can impair a wide range of learning and memory functions and are in line with biochemical and physiological evidence showing widespread effects of such diets on brain function.     

Spirituality as a coping mechanism for family caregivers of persons with aphasia

This study sought to describe spirituality resourcing of family caregivers for people with aphasia (PWA). A purposive sample of 14 female family caregivers of PWA from a historically disadvantaged South African community were participants (married = 42%; age range 21 to 65 years). They completed interviews regarding the spiritual support that they received when caring for their family member with aphasia. Thematic analysis of the data yielded findings to suggest spiritual interpretation of their experiences, importance of prayer as a source of hope and healing, and significance of social support from church fellowship. Spirituality is a resource for coping with the carer-role among community women with responsibility over family members with aphasia.     

Microswitch technology and contingent stimulation to promote adaptive engagement in persons with minimally conscious state: a case evaluation

This study assessed whether a post-coma woman functioning at the lower end of the minimally conscious state would (a) develop adaptive responding through the use of microswitch technology and contingent stimulation, (b) consolidate and maintain her responding over time, and (c) show evidence of response-consequences awareness (learning and discrimination). The study involved an ABABB¹CB¹ sequence in which the A represented baseline phases, the B and B¹ intervention phases, and the C a control phase with continuous stimulation. Results indicated that the woman developed adaptive responding and consolidated it over the intervention phases of the study. The woman also showed evidence of being aware of response-consequences links. Potential implications and limitations of these findings are discussed.