Methodological Considerations in the Neuropsychological Study of Central Nervous System Underarousal with a Specific Emphasis on Coma

Several obstacles exist that impede the scientific study of pathological underarousal (stupor and coma). For instance, there is a lack of a clear, rational, standardized taxonomy with which to describe the phenomenon. Moreover, there is considerable confusion of the construct of arousal with other neurobehavioral constructs. The field also suffers from a general lack of acceptably reliable and valid instruments, especially measures of long-term outcome. Additionally, current treatments for chronic pathological underarousal are frequently presumptive and applied haphazardly, and thus do little to elucidate the process of recovery. It is suggested that biomedical and neuropsychological approaches to the study and treatment of pathological underarousal are complementary and that it is useful to view pathological underarousal as a behavioral, as well as a medical, phenomenon.     

意识障碍：概念、分类与评定

意识障碍是严重脑损伤后面临的重要问题,目前对其基本概念的认识尚存不足。通过对国外研究的最新进展的分析,并结合自身临床实践,回顾了意识障碍各种概念的起源及分类,归纳了用于意识障碍评定的诸多量表,并根据其特点提出临床应用建议。     

关于昏迷病人的诊断

昏迷是神经内科常见的危机症状之一,诊断复杂,涉及多学科、多系统,搜集有价值的诊断信息、扩充背景知识、培养科学的思维方法将有助于提高对昏迷患者的诊断。     

OPERANT PROCEDURES AND THE COMATOSE PATIENT

Operant procedures were tested on three patients who had been in vegetative coma for 6 months, 10 months, and 38 months. A discrete trial procedure was used to test compliance to verbal requests for three behaviors for each patient, including lateral head movement or finger movement, eye focus or eye squeeze, and mouth movement. The design for each patient consisted of multiple baselines across three behaviors with a withdrawal phase and a reinstatement phase (ABAB) for one behavior. Baseline phases were followed by contingent music phases in which 15-second taped excerpts of patients' preferred music sounded immediately following the emission of targeted behaviors. The contingent music treatment affected all three behaviors for Patient 1, but was less effective for two out of three behaviors for the second and third patients who had been in coma for more extensive periods of time. Results are discussed in terms of the potential contributions of the use of operant assessment and treatment procedures in an area of medicine where they have not been used before.     

Response system analysis: What the neuropsychologist can contribute to the rehabilitation of individuals emerging from coma

The process of coma emergence is defined and important issues are identified. Rehabilitative goals for persons emerging from coma are best served by a focus on their response capabilities, rather than sensory stimulation. A method called response system analysis is described to guide assessment and treatment of response capabilities.