“vEGETAbLE”? (MINIMALLy? CONsCIOus?? sTATE!)

Is “loss of consciousness” an appropriate term for a medical diag nosis? Does this terminology serve for decision making about treatment (initiation or termination)? Does unconsciousness mean no awareness of anything beyond the body? Can one be aware of oneself without being aware of the surroundings? Is it possible that information which was possibly registered in the unconscious can be transferred to the conscious state? Who controls these changes, and where? This article discusses a pra gmatic approach to treatment and therapy for patients in vegetative and minimally conscious states in respect to palliative care, rehabilitation and emotional aspects. Evaluation and treatment of a person in “Altered State of Con sciousness” (ASC) should integrate cognitive and emotional elements. We should always remember that even if we are not able to detect reaction to input, this does not mean that the person who received the input did have any self-reaction (feeling) toward it, even though he is diagnosed as ACS. Clinical pragmatism can help us to anticipate the needs of these patients by presenting familiar and strongly emotionally loaded visual displays, by approaching them with consistent stimulation through associations of visual, auditory and tactile stimuli that might trigger an emotional reaction. We attempt to elicit motor output, starting with barely recognizable reaching for the target object, and to anticipate “signaling” responses that resemble classical conditioned reflexes, which could be considered a prime positive effect of systematic stimulation.