J Neurol Neurosurg Psychiatry 76:298-299 doi:10.1136/jnnp.2004.047357
  • Letter

Effect of posture on levels of arousal and awareness in vegetative and minimally conscious state patients: a preliminary investigation

  1. L Elliott1,
  2. M Coleman2,
  3. A Shiel3,
  4. B A Wilson4,
  5. D Badwan5,
  6. D Menon6,
  7. J Pickard7
  1. 1Department of Physiotherapy, Addenbrooke’s NHS Trust, Cambridge, UK
  2. 2Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
  3. 3Faculty of Medicine, National University of Ireland, Galway, Ireland
  4. 4MRC Cognition and Brain Sciences Unit, Cambridge, UK
  5. 5Royal Leamington Spa Rehabilitation Hospital, Warwick, UK
  6. 6Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
  7. 7Wolfson Brain Imaging Centre, Cambridge, UK
  1. Correspondence to:
 L Elliott
 Senior Physiotherapist, Physiotherapy Department, Box 185, Addenbrooke’s Hospital, Cambridge, CB2 2QQ, UK;

    Moderate to severe brain injury is estimated to occur in 25 individuals per 100 000 population every year. Of these, 10–20% never fully regain consciousness but remain in a vegetative or minimally conscious state.1 Patients in the vegetative state may appear at times to be wakeful, with cycles of eye closure and eye opening resembling those of sleep and waking, but show no sign of awareness or of a functioning mind.2 In contrast, patients considered to be in a minimally conscious state are said to show inconsistent but definite evidence of awareness despite profound cognitive impairment.3

    At present, the pathophysiology underlying the vegetative and minimally conscious states is unclear, a standard treatment approach is lacking, and very little has been discovered to advance rehabilitation techniques. It is widely acknowledged that active rehabilitation should begin …