Purpose: To gauge the understanding and opinions of clinical neuropsychologists and speech and language therapists (SLT) in relation to vegetative (VS) and minimally conscious (MCS) patients relative to available practice guidelines. Method: Semi-structured questionnaires were sent to all UK Practitioner Full Members of the EPS Division of Neuropsychology (307) and SLT managers (371) in March to April 2002 examining post qualification clinical practice, professional-family involvement and views on neuro-rehabilitation access. Difference(s) in clinical practice among clinical neuropsychologists and SLTs were observed. Results: Some 27% returned questionnaires (n = 184). Despite significant working experience, most respondents poorly defined both VS and MCS. Among clinical neuropsychologists and speech and language therapists not working with these patients, less positive attitudes regarding the value of neuro-rehabilitation were endorsed. Conclusions: Despite the development of SMART training for VS, there is a dearth of specific training in MCS assessment and management. The need to improve professional understanding among these staff groups is highlighted.
|Journal||DISABILITY AND REHABILITATION|
|Publication status||Published (in print/issue) - 5 Mar 2007|
Bibliographical noteReference text: 1. Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state: First of two parts. New England J Med 1994;330:1499 – 1508.
2. International Working Party Report on the Vegetative State. London: Royal Hospital for Neurodisability; 1996.
3. Royal College of Physicians. The permanent vegetative state. A working party report. London: Royal College of Physicians; 1996.
4. Giacino JT, Zasler ND, Katz DI, Kelly JP, Rosenberg JH, Filley CM. Development of practice guidelines for assessment and management of the vegetative and minimally
conscious states. J Head Trauma Rehabil 1997;12(4): 79 – 89.
5. Royal College of Physicians. The vegetative state: Guidance on diagnosis and management. A report of a working party of the Royal College of Physicians. London: Royal College of Physicians; 2003.
6. Dyer C. Permanent loss of awareness is crucial to diagnosis of PVS. BMJ 2003;327:67.
7. Gill-Thwaites H, Munday R. The Sensory Modality Assessment and Rehabilitation Technique (SMART): A comprehensive and integrated assessment and treatment protocol for the vegetative state and minimally responsive patient. Neuropsychological Rehabil 1999;9:305 – 320.
8. Shiel A, Wilson BA, McLellan L, et al. The Wessex Head Injury Matrix (WHIM). Bury St Edmunds, UK: Thames Valley Test Company; 2000.
9. Wilson FC, Graham LE, Watson T. Vegetative and minimally conscious state(s): Serial assessment approaches in diagnosis and management. Neuropsychological Rehabil 2005;15(3/4): 431 – 441.
10. Adams JH, Graham DI, Jennet B. The neuropathology of the vegetative state after an acute brain insult. Brain 2000; 123(7):1327 – 1338.
11. Giacino JT, Ashwal S, Childs N, et al. The minimally conscious state: Definition and diagnostic criteria. Neurology 2002;58:349 – 353.
12. Giacino JT, Kalmar K. The vegetative and minimally conscious states: A comparison of clinical features and functional outcome. J Head Trauma Rehabil 1997;12(4): 36 – 51.
13. Andrews K, Murphy L, Munday R, et al. Misdiagnosis of the vegetative state: Retrospective study in a rehabilitation unit. BMJ 1996;313:13 – 16.
14. Childs NL, Mercer WN, Childs HW. Accuracy of diagnosis of persistent vegetative state. Neurology 1993;43:1465 – 1467.
15. Childs NL, Mercer WN. Late improvement in consciousness after post-traumatic vegetative state. New England J Med 1996;334:24 – 25.
16. Wilson FC, Harpur J, Watson T, Morrow J. Vegetative state and minimally responsive patients – regional survey, longterm case outcomes and service recommendations. Neuro
Rehabilitation 2002;17:231 – 236.
17. Royal College of Physicians and British Society of Rehabilitation Medicine. Rehabilitation following acquired brain injury: National clinical guidelines. In: Turner-Stokes L, editor. London: RCP, BSRM; 2003.
18. Bekinschtein T, Niklison J, Sigman L, et al. Emotion processing in the minimally conscious state. J Neurol NeurosurgPsychiatry 2004;75:788.
19. Schiff ND, Ribary U, Moreno DR, et al. Residual cerebral activity and behavioural fragments can remain in the persistently vegetative brain. Brain 2002;125(6):1210 – 1234.
20. Wilson FC, Harpur J, Watson T, Morrow J. Adult survivors of severe cerebral hypoxia – case series survey and comparative analysis. NeuroRehabilitation 2003;18:291 – 298.
21. Ng YS, Chua KS. States of severely altered consciousness: Clinical characteristics, medical complications and functional outcome after rehabilitation. NeuroRehabilitation 2005;20(2): 97 – 105.
22. Whyte J, Katz D, Long D, Di Pasquale MC, Polansky M, Kalmar K, Giacino J, Childs N, Mercer W, Novak P, Maurer P, Eifert B. Predictors of outcome in prolonged post traumatic disorders of consciousness and assessment of medication effects: A multicentre study. Arch Phys Med Rehabil 2005;86(3):453 – 462.
- Professional attitudes
- vegetative state
- minimally conscious state