The main features of early rehabilitation after severe brain damage are discussed in the article. The most important component for the entire rehabilitation process and the subsequent life of the patient is considered restoration of consciousness. Team seems to be a key factor in regaining consciousness along with the restoration of vital functions, movement, cognition, and behavior in these patients. The basic working principle is feedback to any minimal movement, or vegetative signal of a patient, beyond specific professional targets. A network of feedbacks with a patient and between professionals, that is, free flow of information, can be built only through work in a transdisciplinary team mode. The net of feedbacks with the patient and inter-professional ones builds up the team as Non-linear Complex System. Characteristics of “Team-Patient” system status are energy, entropy, and complexity. Teamwork techniques are individualized for resulting optimization of system condition. Increase of complexity is a powerful tool for propulsion of recovery process. Then consciousness may appear as a result of system self-organization. The article reflects the authors’ view on interdisciplinary studies of the phenomenon of consciousness through its impairment and recovery. It focuses on the work of the “proper rehabilitation team”, the mechanisms of its action and methods for researching the occurring phenomena.
KeywordsSevere Brain DamageUnconsciousnessNeurorehabilitationTeam as Complex SystemMind-Body Problem
Cullen, N., Chundalama, J., Bayley, M. and Jutai, J. (2007) The Efficacy of Acquired Brain Injury Rehabilitation. Brain Injury, 21, 113-132. https://doi.org/10.1080/02699050701201540
Teasell, R., Bayona, N., Marshall, S., et al. (2007) A Systematic Review of the Rehabilitation of Moderate to Severe Acquired Brain Injuries. Brain Injury, 21, 107-112. https://doi.org/10.1080/02699050701201524
Melin, J. (2018) Patient Participation in Physical Medicine and Rehabilitation: A Concept Analysis. International Physical Medicine & Rehabilitation Journal, 3, 36-42. https://doi.org/10.15406/ipmrj.2018.03.00071
LeDoux, J.E., Michel, M. and Lau, H. (2020) A Little History Goes a Long Way toward Understanding Why We Study Consciousness the Way We Do Today. PNAS, 117, 6976-6984. https://doi.org/10.1073/pnas.1921623117
Nagel, T. (1974). What Is It Like to Be a Bat? The Philosophical Review, 83, 435-450. https://doi.org/10.2307/2183914
Dennet, D. (1978) Brainstorms: Philosophical Essays on Mind and Psychology. MIT Press, Cambridge.
Searle, J.R. (1992) The Rediscovery of the Mind. MIT Press, Cambridge. https://doi.org/10.7551/mitpress/5834.001.0001
Chalmers, D. (1995) The Conscious Mind: In Search of a Fundamental Theory. Oxford University Press, Oxford.
Chalmers, D.J. (1997) Moving forward to the Problems of Consciousness. Journal of Consciousness Studies, 4, 3-46.
Vasil’ev, V.V. (2010) Challenging Problem of Consciousness and Two Arguments in Favor of Interactionism. (In Russian) http://ecsocman.hse.ru
Hasegawa, H.H., Jamieson, G.A. and Ashkan, K. (2012) Neurosurgery and Consciousness: Historical Sketch and Future Possibilities. Journal of Neurosurgery, 117, 455-462. https://doi.org/10.3171/2012.6.JNS112136
Penrose, R. (1989) The Emperor’s New Mind: Concerning Computers, Minds and The Laws of Physics. Oxford University Press, Oxford.
Penrose, R. and Hameroff, S. (2011) Consciousness in the Universe: Neuroscience, Quantum Space-Time Geometry and Orch OR Theory. Journal of Cosmology, 14, 1-17.
Tononi, G. (2004) An Information Integration Theory of Consciousness. BMC Neuroscience, 5, 42. https://doi.org/10.1186/1471-2202-5-42
Tononi, G. (2008) Consciousness as Integrated Information: A Provisional Manifesto. Biology Bulletin, 215, 216-242. https://doi.org/10.2307/25470707
Crick, F. and Koch, C. (1998) Consciousness and Neuroscience. Cerebral Cortex, 8, 97-107. https://doi.org/10.1093/cercor/8.2.97
Dennet, D.C. (2005) Sweet Dreams. Philosophical Obstacles to a Science of Consciousness. A Bradford Book, The MIT Press, Cambridge. https://doi.org/10.7551/mitpress/6576.001.0001
Andersen, H.K. (2017) Reductionism in the Biomedical Sciences. In: Solomon, M., Simon, J.R. and Kincaid, H., Eds., The Routledge Companion to Philosophy of Medicine, Routledge, New York, 81-89.
Foucault, M. (1963) The Birth of the Clinic: An Archaeology of Medical Perception. (In Russian)
Giacino, J.T., Ashwal, S. and Childs, N. (2002) The Minimally Conscious State: Definition and Diagnostic Criteria. Neurology, 58, 349-353. https://doi.org/10.1212/WNL.58.3.349
Wijdicks, E.F.M. and Cranford, R.E. (2005) Clinical Diagnosis of Prolonged States of Impaired Consciousness in Adults. Mayo Clinic Proceedings, 80, 1037-1046. https://doi.org/10.4065/80.8.1037
Laureys, S. and Boly, M. (2012) Unresponsive Wakefulness Syndrome. Archives Italiennes de Biologie, 150, 31-35.
Cairns, H., Oldfield, R.C., Pennybacker, J.B., et al. (1941) Akinetic Mutism with Epidermoid Cyst of the Third Ventricle (with a Report on Associated Disturbance of Brain Potentials). Brain, 64, 273-290.
Dobrokhotova, T.A., Potapov, A.A., Zaytsev, O.S., et al. (1996) Reversible Post-Coma Unconscious States. Sotsial’naya i Klinicheskaya Psikhiatriya, 3, 22-25. (In Russian)
Davis, A.E. and Gimenez, A. (2003) Cognitive-Behavioral Recovery in Comatose Patients Following Auditory Sensory Stimulation. Journal of Neuroscience Nursing, 35, 202-209. https://doi.org/10.1097/01376517-200308000-00006
Boly, M. and Seth, A.K. (2012) Modes and Models in Disorders of Consciousness Science. Archives Italiennes de Biologie, 150, 172-184.
Casarotto, S., Rosanova, M., Gosseries, O., Boly, M., Massimini, M. and Sarasso, S. (2016) Exploring the Neurophysiological Correlates of Loss and Recovery of Consciousness: Perturbational Complexity. In: Monti, M.M. and Sannita, W.G., Eds., Brain Function and Responsiveness in Disorders of Consciousness, Springer International Publishing, Berlin, 93-104. https://doi.org/10.1007/978-3-319-21425-2_8
Sevdalis, N. (2013) Non-Technical Skills and the Future of Teamwork in Healthcare Settings. The Health Foundation. https://psnet.ahrq.gov/issue/non-technical-skills-and-future-teamwork-healthcare-settings
Winson, R., Wilson, B.A. and Bateman, A. (2017) The Brain Injury Rehabilitation Workbook. Guilford Press, New York. https://www.guilford.com/books/The-Brain-Injury-Rehabilitation-Workbook/Winson-Wilson-Bateman/9781462528509
Baker, D.P., Gustafson, S., Beaubien, J., Salas, E. and Barach, P. (2005) Medical Teamwork and Patient Safety: The Evidence-Based Relation. AHRQ Pub. No. 05-0053, April 2005. Agency for Healthcare Research and Quality, Rockville. http://www.ahrq.gov/qual/medteam
Gorman, J.C., Amazeen, P.G. and Cooke, N.J. (2012) Team Coordination Dynamics. Nonlinear Dynamics, Psychology, and Life Sciences, 14, 265-289.
Shapiro, B.Yu. (2002) Principles of Interdisciplinary Team Work. In: Firsov, M.V. and Shapiro, B.Yu., Eds., Psychology of Social Work: The Content and Methods of Psychosocial Practice, Akademiya, Moscow, 35-68. (In Russian)
Mindell, A. (1989) COMA: Key to Awakening. Shambhala Publications Inc., Boulder.
Naydin, V., Maksakova, О., Krotkova, O. and Smirnova, N. (2002) Neurorehabilitation after Brain Injury. In: Clinical Guidelines for Head Injury, Vol. 3, Antidor, Moscow, 516-542.
Hilleboe, H.E. (1964) Teamwork in Rehabilitation—From Fancy to Fact. American Journal of Public Health and the Nation’s Health, 54, 751-757. https://doi.org/10.2105/AJPH.54.5.751
Körner, M., Wirtz, M.A., Bengel, J. and Göritz, A.S. (2015) Relationship of Organizational Culture, Teamwork and Job Satisfaction in Interprofessional Teams. BMC Health Services Research, 15, 243. https://doi.org/10.1186/s12913-015-0888-y
Karol, R.L. (2014) Team Models in Neurorehabilitation: Structure, Function, and Culture Change. NeuroRehabilitation, 34, 655-669. https://doi.org/10.3233/NRE-141080
Suddick, K.M. and De Souza, L. (2006) Therapists’ Experiences and Perceptions of Teamwork in Neurological Rehabilitation: Reasoning behind the Team Approach, Structure and Composition of the Team and Team-Working Processes. Physiotherapy Research International, 11, 72-83. https://doi.org/10.1002/pri.325
Mathieu, J.E., Goodwin, G.F., Heffner Tonia, S., Eduardo, S. and Cannon-Bowers, J.A. (2000) The Influence of Shared Mental Models on Team Process and Performance. Journal of Applied Psychology, 85, 273-283. https://doi.org/10.1037/0021-9010.85.2.273
Shanahan, C., Best, C., Finch, M. and Sutton, C. (2007) Measurement of the Behavioral, Cognitive, and Motivational Factors Underlying Team Performance. Air Operational Division, Commonwealth of Australia.
Bernshtein, N.A. (2008) Biomechanics and Physiology of Movements. Selected Psychological Works. 3rd Edition, MPSI. (In Russian)
Bernstein, N.A. (1967) The Co-Ordination and Regulation of Movements. Pergamon Press, Oxford.
Maksakova, O. (2014) Teamwork as a Way to Recovery of Consciousness. Vopr. Neurochir. 1. http://www.mediasphera.ru/journals/burdenko
Boadella, D. (2015) Life Streams. An Introduction to Biosynthesis. Routledge, Abingdon-on-Thames. https://doi.org/10.4324/9781315737713
Zhavoronkova, L.A., Zharikova, A.V. and Maksakova, O.A. (2010) Integrating Role of Voluntary Postural Control Recovery during Rehabilitation of Patients with Traumatic Brain Injury. Zh Vyssh Nerv Deiat I P Pavlova, 60, 678-688. (In Russian)
Wilson, B.A., Evans, J.J., Emslie, H., Balleny, H., Watson, P.C. and Baddeley, A.D. (1999) Measuring Recovery from Post-Traumatic Amnesia. Brain Injury, 13, 505-520. https://doi.org/10.1080/026990599121412
Maksakov, V. and Urakov, S. (2003) Psychologist in a Neurosurgical Clinic: Work with Korsakov’s Syndrome. Moscow Psychotherapeutic Journal, No. 2, 106-113. (In Russian)
Nott, M.T., Chapparo, C. and Heard, R. (2008) Effective Occupational Therapy Intervention with Adults Demonstrating Agitation during Post-Traumatic Amnesia. Brain Injury, 22, 669-683. https://doi.org/10.1080/02699050802227170
Zhavoronkova, L.A., Maksakova, O.A., Zharikova, A.V., Flerov, I.S., Shchekut’ev, G.A. and Naidin, V.L. (2009) EEG Markers of the Stabilotraining Effect during the Rehabilitation of Patients with Posttraumatic Korsakoff’s Syndrome. Human Physiology, 35, 142-151. https://doi.org/10.1134/S0362119709020029
Rosen, M.A., Dietz, A.S., Yang, T., Priebe, C.E. and Pronovost, P.J. (2015) An Integrative Framework for Sensor-Based Measurement of Teamwork in Healthcare. Journal of the American Medical Informatics Association, 22, 11-18.
Correa, U.C., Alegre, F.A.M., Freudenheime, A.M., et al. (2012) The Game of Futsal as an Adaptive Process. Nonlinear Dynamics, Psychology, and Life Sciences, 16, 185-204.
Hazy, J.K. and Silberstang, J. (2009) Leadership within Emergent Events in Complex Systems: Micro-Enactments and the Mechanisms of Organizational Learning and Change. International Journal of Learning and Change, 3, 230-247. https://doi.org/10.1504/IJLC.2009.024690
Stevens, R.H., Galloway, T.L., Wang, P., et al. (2012) Cognitive Neurophysiologic Synchronies: What Can They Contribute to the Study of Teamwork? Human Factors, 54, 489-502. https://doi.org/10.1177/0018720811427296
Stevens, R., Gorman, J.C., Amazeen, P., Likens, A. and Galloway, T. (2013) The Organizational Neurodynamics of Teams. Nonlinear Dynamics, Psychology, and Life Sciences, 17, 67-86.
Maksakova, O.A. and Lukianov, V.A. (2008) Kinetographic Assessment of the Functional State of Healthy Humans: A Pilot Study. Fiziologiya Cheloveka, 34, 178-187. https://doi.org/10.1134/S0362119708020047
Lukyanov, V.I., Maksakova, O.A., Menshikov, I.S., Menshikova, O.R., Senko, O.V. and Chaban, A.N. (2012) Functional State and Efficiency of Participants in Laboratory Markets. Theory and Control Systems, 6, 202-219.
Wieser, M., Buetler, L. and Vallery, H. (2012) Quantification of Clinical Scores through Physiological Recordings in Low-Responsive Patients: A Feasibility Study. Journal of NeuroEngineering and Rehabilitation, 9, Article No. 30. http://www.jneuroengrehab.com/content/9/1/30 https://doi.org/10.1186/1743-0003-9-30
Gosseries, O., Schnakers, C., Ledoux, D., et al. (2011) Automated EEG Entropy Measurements in Coma, Vegetative State/Unresponsive Wakefulness Syndrome and Minimally Conscious State. Functional Neurology, 36, 25-30.
Metzinger, Th. (2000) Neural Correlates of Consciousness—Empirical and Conceptual Questions. MIT Press, Cambridge, 43. https://doi.org/10.7551/mitpress/4928.001.0001
Korb, W., Geißler, N. and Strauß, G. (2015) Solving Challenges in Inter- and Trans-Disciplinary Working Teams: Lessons from the Surgical Technology Field. Artificial Intelligence in Medicine, 63, 209-219. https://doi.org/10.1016/j.artmed.2015.02.001