The chronic clinical setting

Abstract

The past 15 years have provided an unprecedented collection of discoveries that have increased our scientific understanding of recovery of human consciousness following severe brain damage. Differentiating between patients in “unresponsive/vegetative” and minimally conscious states still represents a major challenge with profound ethical concerns in terms of medical management. Valid diagnosis is of highest importance in chronic clinical settings, relying on standardized behavioral assessments and neuroimaging paradigms to detect subtle signs of consciousness. An improved assessment of brain function in coma and related states is not only changing nosology and medical care, but also offers a better-documented diagnosis and prognosis and helps to further identify the neural correlates of human consciousness. Recent treatment interventions aimed at accelerating the recovery of awareness show encouraging results, with improvements of behavioral signs of consciousness of severely brain-injured patients. These new insights in this field also raise new legal questions regarding treatment strategies, rehabilitation, and end-of-life decisions.