Abstract
BackgroundVisual fixation plays a key role in the differentiation between vegetative state/unresponsive wakefulness (VS/UWS) syndrome and minimally conscious state (MCS). However, the use of different stimuli changes the frequency of visual fixation occured in patients, thereby possibly affecting the accuracy of the diagnosis. In order to establish a standardized assessment of visual fixation in patients in disorders of consciousness (DOC), we compared the frequency of visual fixation elicited by mirror,a ball and a light.MethodVisual fixation was assessed in eighty-one post-comatose patients diagnosed with a MCS or VS/UWS. Occurrence of fixation to different stimuli was analysis used Chi-square testing.Result40 (49%) out of the 81 patients showed fixation to visual stimuli. Among those, significantly more patients (39, 48%) had visual fixation elicited by mirror compared to a ball (23, 28%) and mirror compared to a light (20, 25%).ConclusionThe use of a mirror during the assessment of visual fixation showed higher positive response rate, compared to other stimuli in eliciting a visual fixating response. Therefore, fixation elicited by a mirror can be a very sensitive and accurate test to differentiate the two disorders of consciousness.
Highlights
Visual fixation plays a key role in the differentiation between vegetative state/unresponsive wakefulness (VS/UWS) syndrome and minimally conscious state (MCS)
Visual fixation was evaluated through the standardized methodology as described in the Coma Recovery ScaleRevised (CRS-R) [7]
Patients’ visual reaction was visually judged by one experienced assessor who was blinded to diagnosis, and was unaware of the hypothesis of this study, and the same examiner conducted the trials in all patients
Summary
Visual fixation plays a key role in the differentiation between vegetative state/unresponsive wakefulness (VS/UWS) syndrome and minimally conscious state (MCS). In order to establish a standardized assessment of visual fixation in patients in disorders of consciousness (DOC), we compared the frequency of visual fixation elicited by mirror,a ball and a light. There are many behavioral scales available for the evaluation of visual fixation in patients in postcomatose states. These disorders of consciousness (DOC) include VS ( coined unresponsive wakefulness syndrome) [1], and MCS [2]. The scales all use different stimuli to assess visual fixation: the Coma Recovery ScaleRevised (CRS-R) recommends using a brightly colored or illuminated object. The Disorders of Consciousness Scale (DOCS) uses an object (e.g., ball). The Wessex Head Injury Matrix (WHIM) uses a person, and the Western Neuro Sensory Stimulation
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