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Volume 87, Issue 12, Supplement, Pages 67-76 (December 2006)


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Functional Neuroimaging Applications for Assessment and Rehabilitation Planning in Patients With Disorders of Consciousness

Joseph T. Giacino, PhDaCorresponding Author Informationemail address, Joy Hirsch, PhDb, Nicholas Schiff, MDc, Steven Laureys, MD, PhDd

Abstract 

Giacino JT, Hirsch J, Schiff N, Laureys S. Functional neuroimaging applications for assessment and rehabilitation planning in patients with disorders of consciousness.

Objective

To describe the theoretic framework, design, and potential clinical applications of functional neuroimaging protocols in patients with disorders of consciousness.

Data Sources

Recent published literature and authors’ own work.

Study Selection

Studies using functional neuroimaging techniques to investigate cognitive processing in patients diagnosed with vegetative and minimally conscious state.

Data Extraction

Not applicable.

Data Synthesis

Positron-emission tomography activation studies suggest that the vegetative state represents a global disconnection syndrome in which higher order association cortices are functionally disconnected from primary cortical areas. In contrast, patterns of activation in functional magnetic resonance imaging studies of patients in the minimally conscious state show preservation of large-scale cortical networks associated with language and visual processing.

Conclusions

Novel applications of functional neuroimaging in patients with disorders of consciousness may aid in differential diagnosis, prognostic assessment and identification of pathophysiologic mechanisms. Improvements in patient characterization may, in turn, provide new opportunities for restoration of function through interventional neuromodulation.

a JFK Johnson Rehabilitation Institute, and New Jersey Neuroscience Institute, JFK Medical Center, Edison, NJ

b Functional MRI Research Center, Center for Neurobiology and Behavior, Columbia University, New York, NY

c Department of Neurology and Neuroscience, Weill College of Medicine, Cornell University, New York, NY

d Cyclotron Research Center and Department of Neurology, University of Liege, Liege, Belgium

Corresponding Author InformationReprint requests to Joseph T. Giacino, PhD, New Jersey Neuroscience Institute, 65 James St, Edison, NJ 08818

 Supported in part by the National Institute on Disability and Rehabilitation Research (grant no. H133A031713-04), National Cancer Institute Cancer Center Support, Charles A. Dana Fund, National Institute of Neurological Disorders and Stroke (grant no. R21 NS43451), the University Hospital of Liège, Belgium, and the Mind Science Foundation.

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Laureys is Research Associate at the Belgian National Funds for Scientific Research.

PII: S0003-9993(06)01262-7

doi:10.1016/j.apmr.2006.07.272


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