title: Assessment of visual fixation in vegetative and minimally conscious states.
abstract: BACKGROUND
  Visual fixation plays a key role in the differentiation between vegetative state/unresponsive wakefulness (VS/UWS) syndrome and minimally conscious state (MCS). However, the use of different stimuli changes the frequency of visual fixation occured in patients, thereby possibly affecting the accuracy of the diagnosis. In order to establish a standardized assessment of visual fixation in patients in disorders of consciousness (DOC), we compared the frequency of visual fixation elicited by mirror,a ball and a light.
  
  
  METHODS
  Visual fixation was assessed in eighty-one post-comatose patients diagnosed with a MCS or VS/UWS. Occurrence of fixation to different stimuli was analysis used Chi-square testing.
  
  
  RESULTS
  40 (49%) out of the 81 patients showed fixation to visual stimuli. Among those, significantly more patients (39, 48%) had visual fixation elicited by mirror compared to a ball (23, 28%) and mirror compared to a light (20, 25%).
  
  
  CONCLUSIONS
  The use of a mirror during the assessment of visual fixation showed higher positive response rate, compared to other stimuli in eliciting a visual fixating response. Therefore, fixation elicited by a mirror can be a very sensitive and accurate test to differentiate the two disorders of consciousness.
authors.affiliation: International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, 310036 Hangzhou, China. dihaibo19@aliyun.com.
authors.forename: Haibo
authors.initials: H
authors.lastname: Di
authors.forename: Yunzhi
authors.initials: Y
authors.lastname: Nie
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Hu
authors.forename: Yong
authors.initials: Y
authors.lastname: Tong
authors.forename: Lizette
authors.initials: L
authors.lastname: Heine
authors.forename: Sarah
authors.initials: S
authors.lastname: Wannez
authors.forename: Wangshan
authors.initials: W
authors.lastname: Huang
authors.forename: Dan
authors.initials: D
authors.lastname: Yu
authors.forename: Minhui
authors.initials: M
authors.lastname: He
authors.forename: Aurore
authors.initials: A
authors.lastname: Thibaut
authors.forename: Caroline
authors.initials: C
authors.lastname: Schnakers
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
mesh_terms: D000328:Adult; D003244:Consciousness Disorders / Q000175:diagnosis; D005260:Female; D005403:Fixation, Ocular; D006801:Humans; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000175:diagnosis*