Alteraciones de la Consciencia: proTocolos de Intervención y Valoración Activa
Consellería de educación, investigación, cultura y deporte. Dirección general de universidad, investigación y ciencia. Generalitat valenciana.
Neuro Rehabilitation
2019 to 2021
Grant Number
Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales VITHAS (NeuroRHB)
i3B Institute

Between 30-40% of cases of severe acquired brain damage may produce disorders of consciousness. The clinical evolution of patients can be very varied, from coma states, in which patients are unable to respond to the environment, to vegetative states, in which reflex motor responses persist, and to states of minimal awareness, in which awareness of oneself or the environment is appreciated. The disorders of consciousness represent an additional challenge for health services because they are especially vulnerable to suffer a risk of neglect under the justification that “nothing can be done.” This delay is vital because it involves wasting a unique temporary therapeutic window in terms of brain plasticity. The therapeutic approaches used to date are based on pharmacological strategies or multisensory stimulation of the patient, both with limited effectiveness to promote the emergence of consciousness. Similarly, diagnostic tools have been shown to be strongly biased by the therapist’s interpretation and provide little reliability and precision to characterize these states. In recent years there seems to be a certain tendency to use brain activity as much as a possible more precise and objective diagnostic marker, which is evaluated by electroencephalographic studies of evoked potentials versus attentional tasks, such as a therapeutic marker, which is promoted by non-invasive brain stimulation techniques.

Faced with established paradigms based on diagnosis by electroencephalography of constant processing and constant non-invasive brain stimulation, project ACTIVA proposes a radically innovative paradigm in both domains based on the interaction of the patient through conscious responses. From the diagnostic point of view, project ACTIVA proposes a hierarchical evaluation protocol of consciousness based on the progressive exploration of different levels of processing, expanding the study of attention to semantic and emotional processing. From the therapeutic point of view, project ACTIVA proposes a multimodal stimulation approach that includes auditory, visual and proprioceptive stimulation, and non-invasive brain stimulation by direct current, since the latter technique seems to act as an adjunct to other interventions, in both motor and cognitive field. This intervention will not only combine different modes of stimulation, but will provide them with a context of coherence, requiring the active participation of the participants, which has been possible in less severe states of the pathology, but so far impossible in patients with disorders of consciousness, in which all intervention has been passive.