Nonverbal communication of trauma patients in a state of minimal consciousness
More details
Hide details
Department of Psychology, UKW, Bydgoszcz, Poland
Old Polish University, Kielce, Poland
Department of Psychology, UG,Gdansk, Poland
Pedagogical University, Krakow, Poland
Jolanta Góral-Półrola   

Old Polish University, Ponurego Piwnika str. 49, 25-666 Kielce, Poland
In spite of the rapid development in various communication-support technologies for those waking up from a coma, studies describing the sole process of reconstructing communication in this group of patients are scarce.

The aim of this study was to analyze communication reactions in a minimal state of consciousness and describe the nonverbal behaviours characteristic for each stages significant for the therapy of communication.

Material and methods:
18 severely brain-injured patients in a minimal state of consciousness participated in the half-year observation study, which included people experiencing at least 4 weeks of consciousness disorder/coma. Age of patients 25±5 years. Psychological assessment included: observation of various attempts of communications undertaken by patients, caregivers and family interview, the Glasgow Coma Scale (GCS) and Individual Communication Sheet.

Data analysis showed a significant increase in preverbal communication, both in primal and sensory areas when compared between Stage II (GCS=6–8 points) and Stage III (GCS=9–12 points). After a time, primary communication reached a high level. Patients produced communication attempts from the behaviour organization level, and an increase in the nonverbal communication level was noted. Based on observations, nonverbal communication profiles for each stage of waking up from a coma were introduced.

Di HB, Yu SM, Weng XC, Laureys S, Yu D, Li JQ, et al. Cerebral response to patient’s own name in the vegetative and minimally conscious states. Neurology. 2007; 68: 895–9.
Bardin JC, Schiff ND, Voss HU. Pattern classification of volitional functional magnetic resonance imaging responses in patients with severe brain injury. Arch Neurol. 2012; 69: 176–181.
Pąchalska M, Kaczmarek B, Kropotov JD. Neuropsychologia kliniczna. Od teorii do praktyki. Warszawa: Wydawnictwo Naukowe PWN. 2014.
van Erpa WS, Lavrijsena JCM, van de Laara FA, Vosc PE, Laureysb S, Koopmansa RT CM. The vegetative state/unresponsive wakefulness syndrome: a systematic review of prevalence studies. Eur J Neurol. 2014; 21: 1361–1368.
Pąchalska M, Góral-Pólrola J, Mueller A, Kropotov JD. Neuropsychology and the neurophysiology of perceptual microgenesis. Acta Neuropsychol. 2017; 15(4): 365–389. doi: 10.5604/01.3001.0010.7243.
Jennett B. The Vegetative State: Medical Facts, Ethical and Legal Dilemmas. Cambridge University Press, Cambridge, UK, 2002.
Bruno MA, Vanhaudenhuyse A, Thibaut A, Moonen G, Laureys S. From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: Recent advances in our understanding of disorders of consciousness. J Neurol. 2011; 58: 1373–1384.
Laureys S. Differences in brain metabolism between patients in coma, vegetative state, minimally conscious state and locked-in syndrome. Eur J Neurol. 2003; 10: 224.
Bykova VI, Lukianov VI, Fufaeva EV. Communicative activity of children in the state of suppressed consciousness after severe traumatic brain injury. Acta Neuropsychol. 2014; 12(4): 429–443.
Pąchalska M. Neuropsychologia kliniczna: urazy mózgu. Warszawa: Wydawnictwo Naukowe PWN; 2007.
Seel R, Whyte J, Katz DL, et al. Assessment Scales for Disorders of Consciousness: Evidence- Based Recommendations for Clinical Practice and Research. Arch Phys Med Rehabil. 2010; 91(12): 1795–1813. dot:
Pąchalska M. Individual Nonverbal Communication Rating Scale. Teaching Reintegration Center, Polish Neuropsychological Society, 2015.
Kropotov, J.D. Functional neuromarkers for psychiatry. San Diego: Academic Press, Elsevier. 2016.
Chantsoulis M, Półrola P, Góral-Półrola J, Hajdukiewicz A, Supiński J, Kropotov JD, Pachalska M. Application of ERPs neuromarkers for assessment and treatment of a patient with chronic crossed aphasia after severe TBI and long-term coma – Case Report. Ann Agric Environ Med. 2017; 24(1): 141–147. doi: 10.5604/12321966.1232770.
Pąchalska M, Góral-Pólrola J, Mueller A, Kropotov JD. Neuropsychology and the neurophysiology of perceptual microgenesis. Acta Neuropsychol. 2017; 15(4): 365–389.
Chantsoulis M, Mirski A, Rasmus A, Kropotov JD, Pachalska M. Neuropsychological rehabilitation for traumatic brain injury patients. Ann Agric Environ Med. 2015; 22(2): 368–379.
Pąchalska M, MacQueen BD, Brown JW. Microgenetic theory: Brain and mind in time. In: Encyclopedia of the history of psychological theories, ed. R.W. Rieber, T. 26. Frankfurt: Springer, 2012: 675–708.
Kaczmarek BL, Pachalska M. Leon Kaczmarek’s theory of speech and its significance for contemporary neuropsychology. Acta Neuropsychol. 2014; 12(2): 127–142.
Tomaszewski W, Mańko G, Ziołkowski A, Pąchalska M. An evaluation of the health-related quality of life of patients aroused from prolonged coma when treated by physiotherapists with or without training in the “Academy of Life” program. Ann Agric Environ Med. 2013; 20(2): 319–323.
Schwieger A, Brown JW. Phylogeny, Ontogeny, and Microgeny in Linguistic Process: Perception and Action as Progressive Specification, Brain & Language 2000; 71, 213–216.
Schweiger A. Reflections on Perception and Action. In: Cognitive Microgenesis: A Neuropsychological Perspective, R. Hanlon, ed. 1991, Springer-Verlag New York Inc.
Brown J. Microgenetic Theory and Process Thought. Imprint Academic, Exeter. 2015.
Brown J, Pąchalska M. The nature of the symptom and its relevance for neuropsychology. Acta Neuropsychol. 2003; 1(1): 1–11.
de Gelder B. Toward a Biological Theory of Emotional Body Language Biological Theory 2006; 1(2): 130–132.
Laureys S, Owen AM, Schiff ND. Brain function in coma, vegetative state, and related disorders. Lancet Neurology 2004; 3(9): 537–546.