
Contents
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Introduction: why palliative care and brain injury? Introduction: why palliative care and brain injury?
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Disorders of consciousness Disorders of consciousness
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Nosology and prognostication Nosology and prognostication
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Coma Coma
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Persistent and permanent vegetative states Persistent and permanent vegetative states
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Minimally conscious state and emergence from MCS Minimally conscious state and emergence from MCS
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Diagnostic assessment Diagnostic assessment
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Medical management Medical management
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Neuro-palliative care Neuro-palliative care
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Pain Pain
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Suffering Suffering
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Goals of care: restoration of functional communication Goals of care: restoration of functional communication
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Surrogate decision-making Surrogate decision-making
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Right to care and right to die Right to care and right to die
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Bereavement Bereavement
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Expanding the mission of palliative care Expanding the mission of palliative care
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References References
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Online references Online references
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5.3 Neuro-palliative care and disorders of consciousness
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Published:March 2015
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Abstract
Neuro-palliative care is an important resource for patients and families confronting severe brain injury. Although many clinicians equate brain injury with certain death or futility, survivors have substantial needs that might be met by palliative care expertise. This chapter suggests that the boundaries of palliative medicine include those with severe brain injury, most notably those in the minimally conscious state, and that with this nosological expansion practitioners of palliative care reflect carefully on often nihilistic attitudes directed towards patients with disorders of consciousness. This chapter establishes how to better meet the needs of these patients and their surrogates, reviewing definitional criteria for the vegetative and minimally conscious states, highlighting advances in diagnostic and therapeutic interventions (such as neuroimaging, drugs, and deep brain stimulation) and considering what neuroprosthetic devices tell us of the capacity of patients to experience-and functionally communicate-pain, distress, and suffering.
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