Results specify cognitive capabilities in disorders of consciousness, and determine their prognostic value. Specifically the N400 ERP is suggested as an important tool to assess information-processing capacities that can predict the likelihood of recovery of patients in UWS or MCS.

The personal significance of a language statement depends on its communicative context. However, this is rarely taken into account in neuroscience studies. Here, we investigate how the implied source of single word statements alters their cortical processing. Participants' brain event-related potentials were recorded in response to identical word streams consisting of positive, negative, and neutral trait adjectives stated to either represent personal trait feedback from a human or to be randomly generated by a computer. Results showed a strong impact of perceived sender. Regardless of content, the notion of receiving feedback from a human enhanced all components, starting with the P2 and encompassing early posterior negativity (EPN), P3, and the late positive potential (LPP). Moreover, negative feedback by the "human sender" elicited a larger EPN, whereas positive feedback generally induced a larger LPP. Source estimations revealed differences between "senders" in visual areas, particularly the bilateral fusiform gyri. Likewise, emotional content enhanced activity in these areas. These results specify how even implied sender identity changes the processing of single words in seemingly realistic communicative settings, amplifying their processing in the visual brain. This suggests that the concept of motivated attention extends from stimulus significance to simultaneous appraisal of contextual relevance. Finally, consistent with distinct stages of emotional processing, at least in contexts perceived as social, humans are initially alerted to negative content, but later process what is perceived as positive feedback more intensely.

ObjectiveLittle is known about the long-term outcome of patients with disorders of consciousness (DOCs) such as unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS). We describe the disease course of a large group of DOC patients 2–14 years after brain damage.MethodsIn 102 patients (59 UWS, 43 MCS), clinical and demographic variables from disorder onset were related to the patients' outcomes 2–14 years after discharge. Etiology, age at event, time since onset, gender, and home care versus institutional care were assessed as predictors and similarities and differences between UWS and MCS determined.ResultsSeventy-one percent of the patients had passed away or showed no improvement in condition. Twenty-nine percent regained consciousness and developed some communicative capacities. The time a syndrome persisted did not predict clinical outcome in either condition. Six patients regained consciousness after more than 3 years. Of these, five had been UWS (42% of recovered UWS, three traumatic origins, one tumor, one hypoxia) and one MCS (5% of recovered MCS, traumatic origin). In UWS, younger patients, those cared for at home, and in tendency those with traumatic origins, were more likely to recover. In MCS, no reliable outcome predictors were found.InterpretationCurrent predictors are too vague for single patient predictions. This study identifies a subgroup of late-recovering patients, casting doubt on the 12-month boundary, after which UWS is stated to be permanent. Routine reexamination, use of more reliable outcome predictors and research determining optimal care settings are needed to inform the crucial decisions made for these patients.

Language has an intrinsically evaluative and communicative function. Words can serve to describe emotional traits and states in others and communicate evaluations. Using electroencephalography (EEG), we investigate how the cerebral processing of emotional trait adjectives is modulated by their perceived communicative sender in anticipation of an evaluation. 16 students were videotaped while they described themselves. They were told that a stranger would evaluate their personality based on this recording by endorsing trait adjectives. In a control condition a computer program supposedly randomly selected the adjectives. Actually, both conditions were random. A larger parietal N1 was found for adjectives in the supposedly human-generated condition. This indicates that more visual attention is allocated to the presented adjectives when putatively interacting with a human. Between 400 and 700 ms a fronto-central main effect of emotion was found. Positive, and in tendency also negative adjectives, led to a larger late positive potential (LPP) compared to neutral adjectives. A centro-parietal interaction in the LPP-window was due to larger LPP amplitudes for negative compared to neutral adjectives within the ‘human sender’ condition. Larger LPP amplitudes are related to stimulus elaboration and memory consolidation. Participants responded more to emotional content particularly when presented in a meaningful ‘human’ context. This was first observed in the early posterior negativity window (210–260 ms). But the significant interaction between sender and emotion reached only trend-level on post hoc tests. Our results specify differential effects of even implied communicative partners on emotional language processing. They show that anticipating evaluation by a communicative partner alone is sufficient to increase the relevance of particularly emotional adjectives, given a seemingly realistic interactive setting.

Patients with migraine seem to react cortically more intensely to all kinds of pictorial stimuli, regardless of emotional content. This facilitated processing may be related to the high cortical responsivity shown in various other event-related potential studies and might contribute to the recurring intense headache attacks.

To demonstrate the possibility for hidden rehabilitation potential even following most severe brain injury and the uncertainty of current prognosis factors for coma and unresponsive wakefulness syndrome, we detail the rehabilitation of J. W., after coma from traumatic brain injury. Originally, with many negative prognosis factors and several medical complications, prognosis was devastating. But, with continuing treatment, J. W. improved to a high level of independence in everyday life. This shows the need for rehabilitation research to further specify the “prognostic power” of various combinations of prognosis factors, so that practitioners can come to accurate single‐case recommendations when both positive and negative predictors are present.

Background: Currently, the clinical outcome of patients with very severe head injuries and subsequent chronic disorders of consciousness is seen as generally very poor. Here, we specify individual outcome chances for disorders of consciousness (DOC) patients on the basis of clinical and EEG data and identify different subgroups of DOC patients, who vary substantially regarding their outcome chances. Methods: We employed data from 102 patients with DOC and used standard clinical protocol data (age, etiology, diagnosis, gender) and early sensory (N100, Mismatch Negativity) and late cognitive (P300, N400) EEG event related potentials (ERPs) to predict patients recovery rates. Results: Two significant prediction models emerged: In both, subgroups of patients with good (51%, tree 1) to very good recovery chances (97%, tree 2) could be identified. The first model was obtained from standard clinical data. The second model included late cognitive ERPs (N400 and P300) and resulted in considerably better patient classification. Moreover, when taking cognitive event related potentials into account, the standard protocol data did not add further significant information, neither did early ERPs (N100, MMN). This highlights that cognitive ERPs provide decisive information about an individual patient's prognosis. Conclusion: The presented information about outcome chances of individual disorders of consciousness patients will be vital for these patients and critical for clinical professionals who have to direct specialized treatments and council relatives. Legal guardians and families, in turn, need to know what to expect in the future in order to prepare for the challenges ahead.

BackgroundDisorders-of-consciousness (DOC) are rare conditions leading to very severe physical and mental disabilities. Providing care for DOC patients has been described as a stressful experience, eroding the physical and psychological health of the caregiver. Different forms of care may have different impacts on the caregivers and institutionalized care has been suggested to have an unburdening effect, but this possibility has never been empirically studied. To address this issue, in this study caregiver-burden between family-caregivers who provide home care themselves and those who have placed their patients in a specialized care unit is compared.MethodThe demographics of the caregivers, life satisfaction, coping strategies, meaning in life, and grief reactions were assessed with questionnaires in 81 long term (m = 7.9 years) caregivers (44 patients in specialized care-units, 37 patients taken care of at home).ResultsCaregiver groups were similar on the vast majority of demographic factors. Remarkably, there were no major differences in self-assessed burden and distress between the two caregiver groups. They both demonstrated generally reduced life satisfaction, were especially dissatisfied with their amount of spare time, and many caregivers in both groups demonstrated long lasting grief reactions, as well as a somewhat enhanced crisis of meaning. However, caregivers with patients in institutionalized care exhibited enhanced self-accusation as well as reduced satisfaction with their own health. Home care caregivers, on the other hand, report below average opportunities to care for themselves.ConclusionSurprisingly, placement in institutionalized care in itself does not seem to disburden caregivers as much as expected as the amount of subjective care-giving burden and reported distress is on average similarly high, although profiles differ somewhat according to type of care. Moreover, vast inter-individual variability can be observed. Further research should address the mechanisms that foster positive adjustment and reduce negative impacts for care providers regardless of type of care, enabling the health care system, institutions and self-aid groups alike, to provide more specific support for caregivers by addressing the topics of quality-of-life, own health, self care, and grief reactions.Electronic supplementary materialThe online version of this article (10.1186/s40359-018-0272-x) contains supplementary material, which is available to authorized users.