The Assessment and Rehabilitation of Vegetative and Minimally Conscious Patients

By: Martin R Coleman

This volume, which is published by Psychology Press, a division of the Taylor & Francis Group, is actually a special issue of the Journal of Neuropsychological Rehab. The guest editor, Martin R. Coleman, of the Cambridge Coma Study Group, at Cambridge University in the United Kingdom has done a wonderful job of bringing together current thoughts on issues germane to management of patients with disorders of consciousness in this important scientific effort.

The book is divided into 3 main parts. The first dealing with "definition, diagnosis, prevalence and ethics". The second with "functional imaging, electrophysiology and mechanical intervention" and the third, with "behavioral assessment and rehabilitation techniques".

The contributing array of international authors provide both an interdisciplinary as well as multi-disciplinary set of perspectives of assessment and management issues in both vegetative and minimally conscious state patients.

There are the expected standard articles and then the less expected as well; for example, the review article by John Picard, et al. on hydrocephalus/ventriculomegaly in the context of both assessment and management of with persons of disorders of consciousness.

Legal and ethical issues are also discussed in this section and although the medicolegal issues aren't particularly new they are given a fresh spin as germane to this subset of special patients.

More importantly, the chapter on ethics including Chris Borthwick's on "Ethics in the Vegetative State," and Cindy Province's on "Vegetative State, promoting greater clarity and improved treatment" are a particularly welcome addition to discussions of this topic.

Section II provides, probably, some of the more "teasing" albeit promising information on the role of newer modalities in the assessment and treatment of persons with disorders of consciousness including structural and functional imaging, electrophysiological modalities, including EPs and bispectral analysis of EEG, among others, mechanical interventions such as peripheral nerve stimulation and deep brain stimulation and lastly, pharmacotherapeutic interventions.

Unfortunately, the latter discussion is limited to only one article by Matsuda, et al. on use of Levadopa in persons in persistent vegetative or minimally conscious state.... this section certainly could have been expanded with an expanded discussion of the utility of other drug classes and review of some of the ongoing research in with other drug classes including use of Amantadine, as one example.

The last section of the book deals with behavioral assessment and rehabilitation techniques. Familiar names of individuals who have been involved in development of assessment measures and/or the study of such measures over the last 10-20 years such as Maurice Rappaport and Joseph Giacino, among others, abound in this section of the book.

Rehabilitation issues are also discussed in this chapter from a multidimensional perspective which is not often provided as it relates to this particular topic.

I was pleased to see relatively in-depth discussions on the role of occupational therapy, assistive technology, music therapy, nutritional aspects, as well as, psychological needs of lower level neurological patients, all discussed in this latter section of the book.

The one area that was relatively ignored was the role of physical therapy which received only 4.5 pages. Additionally, it would have been appropriate for inclusion of more expanded discussion on spasticity, contracture and neuro-orthopedic management of this patient population, as well as, further discussion of tracheostomy and dysphagia management given the frequency of these problems in the population in question.

Overall, however, it is this reviewer's opinion that the book is an excellent treatise on the subject matter of vegetative and minimally conscious state patients with a focus on neurorehabilitation aspects of this unique patient population.

The book brings together an interdisciplinary, well known, group of authors with extensive clinical experience in the area of DOC. The editor has also tried to reinforce the need for evidence based practice to be documented with each contributor's article.

I also liked the use of a separate forward in each part of the book which, in a sense, set the tone for the articles in that section.

These forwards were written, respectively, by Bryan Jennett, John Pickard and Barbara Wilson. The publication includes numerous tables, figures, and pictures and is well indexed.

On a scale of 0-10, 0 being the worst and 10 being the best, I would rate this publication at a 9. It is a reference for anyone involved in clinical care and/or research of persons with disorders of consciousness, whether physician, psychologist, therapist, nurse, social worker or lawyer.

I would, therefore, highly recommend this publication.

Hard Cover
Psychology Press, Ltd. 
27 Church Hove East Sussex
VN#3 2FA
568 Pages 
2005
ISPN1-84169-992-6

Review by: 
Nathan D. Zasler, M.D., FAAPM&R, FAADEP, DAAPM 
CEO & Medical Director, Concussion Care Centre of Virginia, Ltd. and Tree of Life Services, Inc. 
Chairperson, IBIA