Bedside patient engagement monitor for rehabilitation in disorders of consciousness – demonstrative case-reports

Abstract

Aim

A chronic disorder of consciousness (DOC) is a devastating condition for the patients and their families. Achieving improved communication with patients in this state is of utmost importance. Over recent years we have seen some progress in the development of rehabilitation protocols for patients with DOC by which the patient’s limited actions impact the environment (e.g. activate music) based on the principle of contingent stimulation. However, one of the major factors, which hinders further progress, is the limited overt responsiveness of the patient, which poses a severe limitation on the ability of the therapists to evaluate whether specific interventions have an impact. In this work, we harness a novel electrophysiological marker the Brain Engagement Index (BEI), which enables simple monitoring of patient’s engagement during interventions, intending to overcome this limitation.

Methods

We combine the BEI marker with the contingent stimulation principle, to propose a 4-levels protocol for advancing communication with DOC patients.

Results

The potential of the evolving protocol is demonstrated with 4 representative case reports. Each case report demonstrates one level of the protocol.

Conclusions

The protocol seems to be both feasible and effective for better clarification of the communication abilities of DOC patients. We recommend its continued evaluation employing a more structured study.

IMPLICATIONS FOR REHABILITATION

• We suggest a systematic method for rehabilitation of patients with disorders of consciousness

• It is based upon monitoring patient engagement in real-time and selecting interventions accordingly

Keywords:

• Disorders of consciousness
• rehabilitation
• electrophysiology
• brain monitoring

Acknowledgments

The authors wish to acknowledge and thank the following occupational therapists and speech pathologies for their work within the protocol and their contributing remarks: Michal Shimonov Shvartz, Noy Turgeman, Hadassah Fortinsky, Dana Berger Miron, Esther Maymon, Roni Millman Shiber, Reut Stark, Orly Shay and Naomi Furman.

Disclosure statement

GS is the founder of BrainMARC LTD, the company, which developed the BEI. GB is a consultant to BrainMARC LTD. Other authors do not have a conflict of interests.

Notes

1 * The use of BEI for tuning the treatment is applicable to all the levels of the protocol