The vegetative state - a condition in which someone is awake but unaware with no evidence of a working mind - is both emotive and challenging. This condition and that of someone who gains partial recovery of mental and neurological functions - known as the minimally conscious state - have provoked intense debate and considerable interest amongst scientists, health care professionals, ethicists, philosophers and lawyers. This unique special issue unites many experts in the field to review and discuss the many advances made in our understanding of these conditions. The strength of this special issue lies in the wide range of topics discussed - from definitions and diagnostic criteria to hotly debated topics such as whether a person in the vegetative state is truly unaware. This edition will serve as both a useful reference to those caring for people in these conditions as well as to those investigating the physiological basis of human consciousness.
Part 1: Definitions, Diagnosis, Prevalence and Ethics. B. Jennett, Foreword. Part 1.1: Definitions and Current Diagnostic Guidelines. J.T. Giacino, K. Kalamar, Diagnostic and Prognostic Guidelines for the Vegetative and Minimally Conscious States. D. Bates, The Vegetative State and the Royal College of Physicians Guidance. J.G. Beaumont, P.M. Kenealy, Incidence and Prevalence of the Vegetative and Minimally Conscious States. S. Ashwal, Recovery of Consciousness and Life Expectancy of Children in a Vegetative State. Part 1.2: Neuropathophysiology. D. Graham et al., Neuropathology of the Vegetative State after Head Injury. Part 1.3: Neurological Assessment. R.A. Barker, The Neurological Assessment of Patients' Vegetative and Minimally Conscious States. J.D. Pickard et al., Hydrocephalus, Ventriculomegaly and the Vegetative State: A Review. Part 1.4: Legal Issues. S.A.M. McLean, Permanent Vegetative State: The Legal Position. N.D.Zasler, Forensic Assessment Issues in Low Level Neurological States. Part 1.5: Ethical Issues. C. Borthwick, Ethics and the Vegetative State. C. Province, The Vegetative State: Promoting Greater Clarity and Improved Treatment. Part 2: Functional Imaging, Electrophysiology and Mechanical Intervention. J.D. Pickard, Foreword. Part 2.1: Functional and Structural Imaging. B. Beuthien-Baumann et al., Functional Imaging of Vegetative State Applying Single Photon Emission Tomography and Positron Emission Tomography. M. Boly et al., Cerebral Processing of Auditory and Noxious Stimuli in Severely Brain Injured Patients: Differences Between VS and MCS. A.M. Owen et al., Residual Auditory Function in Persistent Vegetative State: A Combined PET and fRMI Study. T. Bekinschtein et al., Assessing Level of Consciousness and Cognitive Changes from Vegetative State to Full Recovery. Part 2.2: Electrophysiology. E.J. Kobylarz, N.D. Schiff, Neurophysiological Correlates of Persistent Vegetative and Minimally Conscious States. B. Kotchoubey, Apallic Syndrome is not Apallic: Is Vegetative State Vegetative? J-M. Guérit, Neurophysiological Patterns of Vegetative and Minimally Conscious States. C. Fischer, J. Luauté, Evoked Potentials for the Prediction of Vegetative State in the Acute Stage of Coma. C.Schnakers et al., Bispectral Analysis of Electroencephalogram Signals During Recovery from Coma: Preliminary Findings. Part 2.3: Mechanical Intervention. E.B. Cooper et al., Electrical Treatment of Reduced Consciousness: Experience with Coma and Alzheimer’s Disease. T. Yamamoto, Y. Katayama, Deep Brain Stimulation Therapy for the Vegetative State. Part 2.4: Pharmaceutical Intervention. W. Matsuda et al., Levodopa Treatement for Patients in Persistent Vegetative or Minimally Conscious States. Part 3: Behavioural Assessment and Rehabilitation Techniques. B.A. Wilson, Foreword. Part 3.1: Behavioural Assessment Tools. F.C. Wilson et al., Vegetative and Minimally Conscious States: Serial Assessment Approaches in Diagnosis and Management. M. Rappaport, The Disability and Coma/Near-Coma Scales in Evaluating Severe Head Injury. K. Kalmar, J.T. Giacino, The JFK Coma Recovery Scale – Revised. Part 3.2. Rehabilitation. K. Andrews, Rehabilitation Practice following Profound Brain Damage. M. Reimer, C-L. LeNavenec, Rehabilitation Outcome Evaluation after Very Severe Brain Injury. L. Elliott, L. Walker, Rehabilitation Intervention for Vegetative and Minimally Conscious Patients. A. Shiel, B.A Wilson, Can Behaviours Observed in the Early Stages of Recovery after Traumatic Brain Injury Predict Poor Outcome? R. Munday, Vegetative and Minimally Conscious States: How Can Occupational Therapists Help? K. Naudé, M. Hughes, Considerations for the Use of Assistive Technology in Patients with Impaired States of Consciousness. W.L. Magee, Music Therapy with Patients in Low Awareness States: Approaches to Assessment and Treatment in Multidisciplinary Care. H. Finch, Nutrition and Hydration for the Vegetative State and Minimally Conscious State Patient. S. Crawford, J.G. Beaumont, Psychological Needs of Patients in Low Awareness States, their Families and Health Professionals.