The vegetative state (VE) refers to a state of wakefulness where the patient is unable to respond to himself, herself, or the surroundings. When patients are in a vegetative state, only reflex motor responses may be observed. Patients are unable to interact voluntarily with their surroundings, although they preserve their autonomic functions such as respiration, cardiac rhythm, and the regulation of temperature. The vegetative state may be diagnosed soon after brain damage and may be partially or totally reversible. However, it may progress to a permanent vegetative state or even to the death of the patient.
The main clinical signs of a vegetative state are as follows:
- The patient shows no sign of awareness of himself, herself, or the surroundings.
- The patient preserves his or her sleep and wake cycle, alternating between periods in which he or she is ‘awake’ and ‘asleep’.
- The patient opens his or her eyes spontaneously or when stimulated.
- There is a lack of evidence of continued, reproducible, intentional, or voluntary response to visual, auditory, tactile, or nociceptive (pain) stimuli.
- The patient does not respond to orders, nor does he or she articulate or speak recognizable words.
- The cardiorespiratory function and control of arterial pressure are usually preserved. The patient has double incontinence (urinary and faecal).
- The patient does not demonstrate intentional movement (he or she may have reflexes such as involuntary smiling or the withdrawal reflex in response to pain).
- The patient occasionally cries, smiles, or frowns, although these responses are not consciously related to any stimulus.
- Ante estímulos dolorosos presentan respuestas como retirada, mímica o gestos de desagrado como fruncir el ceño
- Antes estímulos auditivos (un ruido fuerte, la voz…) comienza una breve orientación hacia ellos
- The patient displays automatic responses to certain stimuli such as:
- Painful stimuli, which cause responses such as flexor withdrawal, miming, or expressions of dislike such as frowning.
- Auditory stimuli (loud noises, voices, etc.), which cause a brief orientation towards the stimuli. Visual stimuli, which cause a brief gazing response.
With patients in a vegetative state, the aim from a cognitive perspective is to achieve an ‘adequate interaction with the environment’ through voluntary and consistent responses to environmental stimuli. To achieve this, clinicians should use an overall approach through stimulation. Such an approach is designed to give patients confidence and allow them to make sense of the world around them once again. We use two techniques to do so: basal stimulation and multisensory stimulation.
At the Nisa Hospitals Neurorehabilitation Unit, we specialize in the evaluation and treatment of patients with an altered state of consciousness (coma, vegetative state or unresponsive wakefulness syndrome, and minimally conscious state). In fact, our research team is conducting ongoing research into improving our understanding of the neural changes that occur between the coma state and the recovery of consciousness.
We have therefore developed a specific programme of therapy for patients with an altered state of consciousness. The programme includes a clinical and neurological evaluation as well as pharmacological treatment, multisensory and basal stimulation, physiotherapy and posture therapy, and stimulation of the orofacial muscles, among other treatments.
Our medical assistance for patients with an altered state of consciousness has recently been developed with the approval of the Federation of Brain Damage Associations (FEDACE). This collaboration has led to Spain’s first handbook on the unresponsive wakefulness syndrome and the minimally conscious state. The handbook provides the latest knowledge on diagnosing, evaluating, and treating patients with an altered state of consciousness. It also offers practical accounts from our health professionals based on their vast experience of treating patients with an altered state of consciousness (http://fedace.org/sindrome-de-vigilia-sin-respuesta-y-de-minima-con- ciencia-cuaderno-fedace-13/)