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The Effect of Positioning on the Level of Arousal and Awareness in Patients in the Vegetative State or the Minimally Conscious State: A Replication and Extension of a Previous Finding

Published online by Cambridge University Press:  07 January 2014

Barbara A. Wilson ,
Samira Dhamapurkar ,
Catherine Tunnard ,
Peter Watson  and
Gerhard Florschutz
Barbara A. Wilson*
Affiliation:
Raphael Medical Centre, Tonbridge, Kent, UK Oliver Zangwill Centre, Ely, UK MRC Cognition and Brain Sciences Unit, Cambridge, UK
Samira Dhamapurkar
Affiliation:
Raphael Medical Centre, Tonbridge, Kent, UK
Catherine Tunnard
Affiliation:
South London and Maudsley NHS Foundation Trust, UK
Peter Watson
Affiliation:
MRC Cognition and Brain Sciences Unit, Cambridge, UK
Gerhard Florschutz
Affiliation:
Raphael Medical Centre, Tonbridge, Kent, UK
*
Address for correspondence: Barbara A. Wilson PhD, The Oliver Zangwill Centre, Princess of Wales Hospital, Lynn Road, Ely, Cambs, CB6 1DN, UK. E-mail: [email protected]
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Abstract

In 2005 Elliott et al. published a paper entitled ‘Effect of posture on levels of arousal and awareness in vegetative and minimally conscious patients: a preliminary investigation’. Twelve patients, of whom 5 were in the vegetative state (VS) and 7 in the minimally conscious state (MCS), were assessed with the Wessex Head Injury Matrix (WHIM) when supine and when upright on a tilt table. The present study replicated and extended these findings by including a third position, sitting, in addition to supine and standing. We assessed 16 patients (8 in the VS and 8 in the MCS) with mixed aetiologies and compared the observed behaviours in three different positions (supine, sitting and standing) using the WHIM. Most patients (75%) showed more behaviours when in the upright position, compared to lying down (p < .003). Our findings are similar to those seen in the study reported by Elliott et al. With regard to sitting, 62.5% of patients were more responsive when assessed sitting in a wheelchair (p < .05) than in a supine position, and almost 69% were more responsive if assessed in an upright position compared to sitting. This was particularly true for patients in the MCS, where 87.5% did better if assessed on a tilt table or standing frame compared to sitting, suggesting that positional changes can have an effect on the level of arousal and awareness among patients in the VS and MCS.

Keywords

consciousnesshead injurypersistent vegetative staterehabilitation
Type
Brief Report
Information
Brain Impairment , Volume 14 , Issue 3 , December 2013 , pp. 475 - 479
Copyright
Copyright © The Author(s), published by Cambridge University Press on behalf of Australian Academic Press Pty Ltd 2013 

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References

Bruno, M., Vanhaudenhuyse, A., Thibaut, A., Moonen, G., & Laureys, S. (2011). From unresponsive wakefulness to minimally conscious and functional locked-in syndromes: Recent advances in our understanding of disorders of consciousness. Journal of Neurology, 258, 1373–1384.CrossRefGoogle ScholarPubMed
Elliott, L., Coleman, M., Shiel, A., Wilson, B.A., Badwan, D., Menon, D., & Pickard, J. (2005). Effect of posture on levels of arousal and awareness in vegetative and minimally conscious state patients: A preliminary investigation. Journal of Neurology, Neurosurgery and Psychiatry, 76, 298–299.CrossRefGoogle ScholarPubMed
Gill-Thwaites, H., & Munday, R. (2004). The sensory modality assessment and rehabilitation technique (SMART): a valid and reliable assessment for vegetative and minimally conscious state patients. Brain Injury, 18, 1255–1269.CrossRefGoogle Scholar
Royal College of Physicians, London. (2003). The vegetative state: guidance on diagnosis and management. A report of a working party of the Royal College of Physicians. Clinical Medicine, 2, 249–254.Google Scholar
Seel, R., Sherer, M., Whyte, J., Katz, D., Giacino, J., Rosenbaum, A., . . . Zasler, N. (2010). Assessment scales for disorders of consciousness: Evidence based recommendations for clinical practice and research. Archives of Physical Medicine and Rehabilitation, 91, 1795–1813.CrossRefGoogle ScholarPubMed
Shiel, A., Wilson, B.A., McLellan, L., Horn, S., & Watson, M. (2000). The Wessex Head Injury Matrix (WHIM). Bury St Edmunds, UK: Thames Valley Test Company.Google ScholarPubMed
Wilson, B.A., Hinchcliffe, A., Kapur, N., Tunnard, C., & Florschutz, G. (2013). Paradoxical improvement more than two years after onset of tuberculous meningitis: a case study. Brain Injury, 27, 944–950.CrossRefGoogle Scholar