![]() ![]() ![]() More recently, the dramatic increase in survivable brain injuries occurring during military conflicts is also emphasizing the need for improved tools with which to assess consciousness. These cases highlighted the need to assess an individual's level of consciousness beyond simply observing their behavioural status. This public fascination with consciousness was well exemplified by the media attention focused upon the medical/legal/ethical problems of the Terri Schiavo and Terry Wallis cases. The dilemma of assessing consciousness is also of public interest - and the public is looking towards medical science for insights. Given the myriad of common disorders that alter consciousness, the need for more sophisticated clinical assessment methods is an important and pragmatic issue. While philosophy has focused on the mind-body problem, and psychology has focused on knowledge of experience, remarkably little attention has been paid to the practical problems that arise from our inability to rigorously evaluate consciousness in the clinical setting. Based on the evidence to-date, electroencephalographic and neuroimaging based assessments of consciousness provide valuable information for evaluation of residual function, formation of differential diagnoses, and estimation of prognosis.Ĭonsciousness is a poorly-defined concept, the meaning of which is more a matter of debate than an issue of certainty. This paper reviews recent advances in physiologically based measures that enable better evaluation of consciousness states (coma, vegetative state, minimally conscious state, and locked in syndrome). The solution must involve objective, physiologically based measures that do not rely on behaviour. While these methods have some utility, estimates of misdiagnosis are worrisome (as high as 43%) - clearly this is a major clinical problem. Current methods for evaluating altered levels of consciousness are highly reliant on either behavioural measures or anatomical imaging. However, times are changing and the need to clinically assess consciousness is increasingly becoming a real-world, practical challenge. In clinical neurology, a comprehensive understanding of consciousness has been regarded as an abstract concept - best left to philosophers.
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