How should functional imaging of patients with disorders of consciousness contribute to their clinical rehabilitation needs?
How should functional imaging of patients with disorders of consciousness contribute to their clinical rehabilitation needs?
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DOI：
10.1097/wco.0b013e3280106ba9
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发表时间：
2006-12
影响因子：
4.8
通讯作者：
Owen AM
中科院分区：
文献类型：
--
作者：
Laureys S;Giacino JT;Schiff ND;Schabus M;Owen AM
我们讨论了基于证据的意识障碍的神经康复问题，以及最近在植物人状态和最低意识状态下获得的功能性神经影像学数据。已发表的数据不足以对植物人状态和最低意识状态患者的任何神经康复治疗提出建议。电生理学和功能成像研究已被证明是有用的，在测量非交流性脑损伤患者的剩余脑功能。尽管这些研究原则上可以客观量化植物人状态和最低意识状态下康复治疗的假定脑效应，但迄今为止尚未在此背景下使用。如果没有对照研究和仔细的患者选择标准，就不可能评价意识障碍治疗干预的潜力。还需要阐明这种治疗的神经生理学作用。多模式神经影像学技术的整合最终将提高我们在潜在机制基础上理清结果差异的能力，并更好地指导我们在严重急性脑损伤后遇到的具有挑战性的患者人群中的治疗选择。
We discuss the problems of evidence-based neurorehabilitation in disorders of consciousness, and recent functional neuroimaging data obtained in the vegetative state and minimally conscious state. Published data are insufficient to make recommendations for or against any of the neurorehabilitative treatments in vegetative state and minimally conscious state patients. Electrophysiological and functional imaging studies have been shown to be useful in measuring residual brain function in noncommunicative brain-damaged patients. Despite the fact that such studies could in principle allow an objective quantification of the putative cerebral effect of rehabilitative treatment in the vegetative state and minimally conscious state, they have so far not been used in this context. Without controlled studies and careful patient selection criteria it will not be possible to evaluate the potential of therapeutic interventions in disorders of consciousness. There also is a need to elucidate the neurophysiological effects of such treatments. Integration of multimodal neuroimaging techniques should eventually improve our ability to disentangle differences in outcome on the basis of underlying mechanisms and better guide our therapeutic options in the challenging patient populations encountered following severe acute brain damage.