Purpose of review
We discuss the problems of evidence-based
neurorehabilitation in disorders of consciousness, and
recent functional neuroimaging data obtained in the
vegetative state and minimally conscious state.
Recent findings
Published data are insufficient to make recommendations for
or against any of the neurorehabilitative treatments in
vegetative state and minimally conscious state patients.
Electrophysiological and functional imaging studies have
been shown to be useful in measuring residual brain function
in noncommunicative brain-damaged patients. Despite the
fact that such studies could in principle allow an objective
quantification of the putative cerebral effect of rehabilitative
treatment in the vegetative state and minimally conscious
state, they have so far not been used in this context.
Summary
Without controlled studies and careful patient selection
criteria it will not be possible to evaluate the potential of
therapeutic interventions in disorders of consciousness.
There also is a need to elucidate the neurophysiological
effects of such treatments. Integration of multimodal
neuroimaging techniques should eventually improve our
ability to disentangle differences in outcome on the basis of
underlying mechanisms and better guide our therapeutic
options in the challenging patient populations encountered
following severe acute brain damage.