Percorrer por autor "Estraneo, Anna"
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- Consensus on covert awareness: a Delphi studyPublication . Schnakers, Caroline; Overbeek, Berno; Fullmer, Niko; Teixeira, Liliana; Zandalasini, Matteo; Yatsko, Kseniia; Morrissey, Ann-Marie; Zasler, Nathan; Estraneo, AnnaIdentifying wilful brain activity in patients with disorders of consciousness is critical, as some patients fail to exhibit behavioural signs of consciousness at the bedside but respond to active tasks via neuroimaging or electrophysiological measures. Standardized terminology for this subgroup is absent while it is essential for advancing research and clinical care. The objective of this study was to determine the level of consensus among a large group of international experts on terminology and definitions for this clinical entity, as described by terms such as covert awareness, cognitive motor dissociation, functional locked-in syndrome, and non-behavioural minimally conscious state. A Delphi study was conducted using REDCap to evaluate expert agreement on terminology and definitions. The study was conducted among international experts, primarily from Europe/UK, the USA and other regions. Ninety-six experts participated. Among these, 75 (78%) completed both rounds. Participants were predominantly clinical scientists (71%) working in rehabilitation settings (63%). A Delphi method was followed. Consensus on terminology and related definitions was defined as a median score of 5, an interquartile range ≤1 and ≥75% agreement (scores of 4 or 5). Within two rounds, consensus was achieved for over two- thirds of the statements. The term ‘Covert Awareness’ and its associated definition were identified as the preferred terminology by an international expert panel. We recommend the use of ‘Covert Awareness’ since our large group of international experts consistently agreed on such preferred term for this subgroup of patients with disorders of consciousness. This consensus (>75% agreement) establishes a foundation both for future research and clinical standardization. The findings have implications for improving diagnostic accuracy and advancing understanding of covert awareness, although further study is needed to refine and apply the agreed-upon definition in clinical practice.
- Optimizing neurobehavioral assessment for patients with disorders of consciousness: Proposal of a comprehensive pre-assessment checklist for cliniciansPublication . Keech, Kristen; Schnakers, Caroline; Murtaugh, Brooke; O’Brien, Katherine; Slomine, Beth; Briand, Marie-Michèle; Formisano, Rita; Thibaut, Aurore; Estraneo, Anna; Noé, Enrique; Gosseries, Olivia; Teixeira, Liliana da Conceição; da Conceição Teixeira, LilianaClinicians are challenged by the ambiguity and uncertainty in assessing level of consciousness in individuals with disorder of consciousness (DoC). There are numerous challenges to valid and reliable neurobehavioral assessment and classification of DoC due to multiple environmental and patient-related biases including behavioral fluctuation and confounding or co-occurring medical conditions. Addressing these biases could impact accuracy of assessment and is an important aspect of the DoC assessment process. A pre-assessment checklist was developed by a group of interdisciplinary DoC clinical experts and researchers based on the existing literature, current validated tools, and expert opinions. Once finalized, the checklist was electronically distributed to clinicians with a range of experience in neurobehavioral assessment with DoC. Respondents were asked to use the checklist prior to completing a neurobehavioral assessment. A survey was also provided to respondents to obtain feedback regarding checklist feasibility and utility in optimizing the behavioral assessments. Thirty-three clinicians completed the survey after using the checklist. Over half of the respondents were a combination of physicians, neuropsychologists, and physical therapists. All respondents served the adult DoC population and 42% percent had over ten years of clinical experience. Eighty percent reported they found the format of the checklist useful and easy to use. All respondents reported the checklist was relevant to preparing for behavioral assessment in the DoC population. Eighty-four percent reported they would recommend the use of the tool to other clinicians. The use of a pre-assessment checklist was found to be feasible and efficacious in increasing interdisciplinary clinician’s ability to optimize the patient and environment in preparation for neurobehavioral assessment. Initial results of clinicians’ perception of the utility of a pre-assessment checklist were positive. However, further validation of the tool is needed with larger sample sizes to improve representation of clinical use across disciplines and care settings.