title: From disorders of consciousness to early neurorehabilitation using assistive technologies in patients with severe brain damage.
abstract: OBJECTIVE
  The purpose of this review is to provide an update on the latest challenges addressed by neurorehabilitation initiated very early after the brain damage, such as dealing with disorders of consciousness in terms of diagnosis, prognosis and rehabilitative treatment, or determining best timing for first rehabilitative intervention, best therapeutic approaches and best modalities.
  
  
  RESULTS
  Early management of patients with severe brain damage requires a multidisciplinary rehabilitative approach that encompasses clinical skills in various fields, standard therapies, and assistive technologies.Despite a high rate of misdiagnosis and poor outcome prediction in disorders of consciousness, the observation of subtle motor signs may be a promising way to reach accurate diagnosis and better outcome prediction. Neurosensory stimulation remains the current treatment to promote emergence from disorders of consciousness.Early timing of neurological rehabilitation is definitively efficient, but a safety period should be respected. Some standard therapies and assistive technologies have demonstrated explicit evidence in neurological recovery and high treatment dose is needed to emphasize the therapeutic effect, but several controversies persist in treatment evidence.
  
  
  CONCLUSIONS
  Current advancements have provided growing evidence for early neurorehabilitation, which should be definitively applied, but further studies are explicitly needed to diminish persistent controversies in the field.
authors.affiliation: aAcute Neurorehabilitation Unit bDepartment of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Pignat
authors.forename: Jane
authors.initials: J
authors.lastname: Jöhr
authors.forename: Karin
authors.initials: K
authors.lastname: Diserens
mesh_terms: D001930:Brain Injuries / Q000150:complications / Q000534:rehabilitation*; D003244:Consciousness Disorders / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D000066530:Neurological Rehabilitation / Q000379:methods* / Q000592:standards; D012656:Self-Help Devices