Riganello F.,The S Anna Institute And Ran Research In Advanced Neurorehabilitation |
Dolce G.,The S Anna Institute And Ran Research In Advanced Neurorehabilitation |
Cortese M.D.,The S Anna Institute And Ran Research In Advanced Neurorehabilitation |
Sannita W.G.,University of Genoa |
Sannita W.G.,State University of New York at Stony Brook
Brain Research Journal | Year: 2013
The functional assessment and prediction of outcome of subjects with severe disorder of consciousness such as those in the vegetative (VS) or minimally conscious (MCS) states requests that the residual brain function of these subjects be characterized. Ad hoc scales to assessment residual cognitive processes or responses to nociception (Coma Recovery Scale-R, Wessex Head Injury Matrix, Nociception Come Scale) and fMRI/PET scan protocols have been implemented. fMRI studies have identified cortical areas activated by external input also in subjects otherwise unambiguously diagnosed as being in a VS. However, activated primary cortices do not appear functionally connected to higher order (associative) cortices and evidence of the corticocortical interplay deemed crucial for conscious perception, emotional response and cognitive processes to occur is lacking. In this respect, MCS subjects show a partially restored and functionally connected activity in these cortical areas, but the estimated diagnostic error between the VS and MCS remains high (up to 25-45%). The CNS and autonomic nervous systems are thought to interact in physiological conditions and a model (the Central Autonomic Network; CAN) has been developed to describe the bidirectional functional connection between the heart and brain. This relationship becomes crucial in the severe disorder of consciousness. Measures of heart rate variability (HRV) are thought to reflect the relationship between brain function and the CAN and advanced artificial intelligence procedures (e.g. Data Mining and Machine Learning) have documented the HRV suitability in detecting the autonomic system functional status and residual responsiveness in the severe disorder of consciousness. © Nova Science Publishers, Inc.