Publications

Selected Publications:

  • Giacino J, Fins J, Laureys S, Schiff N. Disorders of consciousness: The state of the science. Nature Reviews Neurology 2014;10(2):99-114. PubMed
    • Abstract: The concept of consciousness continues to defy definition and elude the grasp of philosophical and scientific efforts to formulate a testable construct that maps to human experience. Severe acquired brain injury results in the dissolution of consciousness, providing a natural model from which key insights about consciousness may be drawn. In the clinical setting, neurologists and neurorehabilitation specialists are called on to discern the level of consciousness in patients who are unable to communicate through word or gesture, and to project outcomes and recommend approaches to treatment. Standards of care are not available to guide clinical decision-making for this population, often leading to inconsistent, inaccurate and inappropriate care. In this Review, we describe the state of the science with regard to clinical management of patients with prolonged disorders of consciousness. We review consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures. We conclude with a provocative discussion of bioethical and medicolegal issues that are unique to this population and have a profound impact on care, as well as raising questions of broad societal interest.

 

  • Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, Kelly JP, Rosenberg JH, Whyte J, Zafonte RD, Zasler ND. The minimally conscious state: Definition and diagnostic criteria. Neurology 2002;58:349-53. PubMed
    • OBJECTIVE: To establish consensus recommendations among health care specialties for defining and establishing diagnostic criteria for the minimally conscious state (MCS).
    • BACKGROUND: There is a subgroup of patients with severe alteration in consciousness who do not meet diagnostic criteria for coma or the vegetative state (VS). These patients demonstrate inconsistent but discernible evidence of consciousness. It is important to distinguish patients in MCS from those in coma and VS because preliminary findings suggest that there are meaningful differences in outcome.
    • METHODS: An evidence-based literature review of disorders of consciousness was completed to define MCS, develop diagnostic criteria for entry into MCS, and identify markers for emergence to higher levels of cognitive function.
    • RESULTS: There were insufficient data to establish evidence-based guidelines for diagnosis, prognosis, and management of MCS. Therefore, a consensus-based case definition with behaviorally referenced diagnostic criteria was formulated to facilitate future empirical investigation.
    • CONCLUSIONS: MCS is characterized by inconsistent but clearly discernible behavioral evidence of consciousness and can be distinguished from coma and VS by documenting the presence of specific behavioral features not found in either of these conditions. Patients may evolve to MCS from coma or VS after acute brain injury. MCS may also result from degenerative or congenital nervous system disorders. This condition is often transient but may also exist as a permanent outcome. Defining MCS should promote further research on its epidemiology, neuropathology, natural history, and management.

 

  • Giacino JT, Whyte J, Bagiella E, Kalmar K, Childs N, Khademi A, Eifert B, Long D, Katz DI, Cho S, Yablon SA, Luther M, Hammond FM, Nordenbo A, Novak P, Mercer W, Maurer-Karattup P, Sherer M. Placebo-controlled trial of amantadine for severe traumatic brain injury. N Eng J Med 2012;366:819-26. PubMed
    • BACKGROUND: Amantadine hydrochloride is one of the most commonly prescribed medications for patients with prolonged disorders of consciousness after traumatic brain injury. Preliminary studies have suggested that amantadine may promote functional recovery.
    • METHODS: We enrolled 184 patients who were in a vegetative or minimally conscious state 4 to 16 weeks after traumatic brain injury and who were receiving inpatient rehabilitation. Patients were randomly assigned to receive amantadine or placebo for 4 weeks and were followed for 2 weeks after the treatment was discontinued. The rate of functional recovery on the Disability Rating Scale (DRS; range, 0 to 29, with higher scores indicating greater disability) was compared over the 4 weeks of treatment (primary outcome) and during the 2-week washout period with the use of mixed-effects regression models.
    • RESULTS: During the 4-week treatment period, recovery was significantly faster in the amantadine group than in the placebo group, as measured by the DRS score (difference in slope, 0.24 points per week; P=0.007), indicating a benefit with respect to the primary outcome measure. In a prespecified subgroup analysis, the treatment effect was similar for patients in a vegetative state and those in a minimally conscious state. The rate of improvement in the amantadine group slowed during the 2 weeks after treatment (weeks 5 and 6) and was significantly slower than the rate in the placebo group (difference in slope, 0.30 points per week; P=0.02). The overall improvement in DRS scores between baseline and week 6 (2 weeks after treatment was discontinued) was similar in the two groups. There were no significant differences in the incidence of serious adverse events.
    • CONCLUSIONS: Amantadine accelerated the pace of functional recovery during active treatment in patients with post-traumatic disorders of consciousness. (Funded by the National Institute on Disability and Rehabilitation Research; ClinicalTrials.gov number, NCT00970944.).

 

  • Giacino JT, Katz DI, Whyte J. Neurorehabilitation in disorders of consciousness. Semin Neurol. 2013 Apr; 33(2):142-56. PMID: 23888398. PubMed
    • Abstract: Survivors of severe acquired brain injury often experience prolonged disturbance in consciousness following emergence from coma. Most individuals pass through the vegetative or minimally conscious states en route to eventual recovery of consciousness, although either condition may be permanent. Rehabilitation clinicians charged with the care of these patients face numerous challenges as there are many open questions concerning diagnostic and prognostic accuracy, the natural history of recovery, and the most effective approaches to prevent medical complications and facilitate functional recovery. The last 5 years have been witness to a marked increase in well-designed empirical investigations concerning the rehabilitation of patients with disorders of consciousness. In this article, the authors review recent evidence concerning key factors that influence the course of recovery, present a model of care designed to mitigate medical complications, describe a systematic approach to assessment, and review the effectiveness of treatment interventions utilized in the rehabilitation setting.

 

  • Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004 Dec; 85(12):2020-9. PMID: 15605342. PubMed
    • OBJECTIVE: To determine the measurement properties and diagnostic utility of the JFK Coma Recovery Scale-Revised (CRS-R).O DESIGN: Analysis of interrater and test-retest reliability, internal consistency, concurrent validity, and diagnostic accuracy.
    • SETTING: Acute inpatient brain injury rehabilitation hospital.
    • PARTICIPANTS: Convenience sample of 80 patients with severe acquired brain injury admitted to an inpatient Coma Intervention Program with a diagnosis of either vegetative state (VS) or minimally conscious state (MCS).
    • INTERVENTIONS: Not applicable.
    • MAIN OUTCOME MEASURES: The CRS-R, the JFK Coma Recovery Scale (CRS), and the Disability Rating Scale (DRS).
    • RESULTS: Interrater and test-retest reliability were high for CRS-R total scores. Subscale analysis showed moderate to high interrater and test-retest agreement although systematic differences in scoring were noted on the visual and oromotor/verbal subscales. CRS-R total scores correlated significantly with total scores on the CRS and DRS indicating acceptable concurrent validity. The CRS-R was able to distinguish 10 patients in an MCS who were otherwise misclassified as in a VS by the DRS.
    • CONCLUSIONS: The CRS-R can be administered reliably by trained examiners and repeated measurements yield stable estimates of patient status. CRS-R subscale scores demonstrated good agreement across raters and ratings but should be used cautiously because some scores were underrepresented in the current study. The CRS-R appears capable of differentiating patients in an MCS from those in a VS.

List of Publications:

  1. Brian L. Edlow, Camille Chatelle, Camille A. Spencer, Catherine J. Chu, Yelena G. Bodien, Kathryn L. O’Connor, Ronald E. Hirschberg, Leigh R. Hochberg, Joseph T. Giacino, Eric S. Rosenthal, Ona Wu. Early detection of consciousness in patients with acute severe traumatic brain injury. Brain, 2017; DOI: 10.1093/brain/awx176. Oxford Academic
  2. Nelson LD, Ranson J, Ferguson AR, Giacino JT, Okonkwo DO, Valadka AB, Manley GT, McCrea MA; Validating multidimensional outcome assessment using the TBI Common Data Elements: An analysis of the TRACK-TBI Pilot sample. TRACK-TBI Investigators. J Neurotrauma. 2017 Jun 8. Epub ahead of print. PMID 28595478. PubMed
  3. Philippus A, Mellick D, O’Neil-Pirozzi T, Bergquist T, Guller Bodien Y, Sander AM, Dreer LE, Giacino J, Novack T. Impact of religious attendance on psychosocial outcomes for individuals with traumatic brain injury: A NIDILRR funded TBI Model Systems study. Brain Inj. 2016; 30(13-14):1605-1611. PMID: 27625074. PubMed
  4. Fisher LB, Pedrelli P, Iverson GL, Bergquist TF, Bombardier CH, Hammond FM, Hart T, Ketchum JM, Giacino J, Zafonte R. Prevalence of suicidal behaviour following traumatic brain injury: Longitudinal follow-up data from the NIDRR Traumatic Brain Injury Model Systems. Brain Inj. 2016; 30(11):1311-1318. PMID: 27541868. PubMed
  5. Bodien YG, Giacino JT. Challenges and Pitfalls Associated with Diagnostic and Prognostic Applications of Functional Neuroimaging in Disorders of Consciousness. Open Neuroimag J. 2016; 10:23-31. PMID: 27347262; PMCID: PMC4894860. PubMed
  6. Chatelle C, Bodien YG, Carlowicz C, Wannez S, Charland-Verville V, Gosseries O, Laureys S, Seel RT, Giacino JT. Detection and Interpretation of Impossible and Improbable Coma Recovery Scale-Revised Scores. Arch Phys Med Rehabil. 2016 Aug; 97(8):1295-1300.e4. PMID: 26944708. PubMed
  7. Bodien YG, Carlowicz CA, Chatelle C, Giacino JT. Sensitivity and Specificity of the Coma Recovery Scale–Revised Total Score in Detection of Conscious Awareness. Arch Phys Med Rehabil. 2016 Mar; 97(3):490-492.e1. PMID: 26342571; PMCID: PMC5018674 [Available on 03/01/17]. PubMed
  8. Hauger SL, Schnakers C, Andersson S, Becker F, Moberget T, Giacino JT, Schanke AK, Løvstad M. Neurophysiological Indicators of Residual Cognitive Capacity in the Minimally Conscious State. Behav Neurol. 2015; 2015:145913. PMID: 26504351; PMCID: PMC4609423. PubMed
  9. Wu X, Zou Q, Hu J, Tang W, Mao Y, Gao L, Zhu J, Jin Y, Wu X, Lu L, Zhang Y, Zhang Y, Dai Z, Gao JH, Weng X, Zhou L, Northoff G, Giacino JT, He Y, Yang Y. Intrinsic Functional Connectivity Patterns Predict Consciousness Level and Recovery Outcome in Acquired Brain Injury. J Neurosci. 2015 Sep 16; 35(37):12932-46. PMID: 26377477; PMCID: PMC4571611. PubMed
  10. Qin P, Wu X, Duncan NW, Bao W, Tang W, Zhang Z, Hu J, Jin Y, Wu X, Gao L, Lu L, Guan Y, Lane T, Huang Z, Bodien YG, Giacino JT, Mao Y, Northoff G. GABAA receptor deficits predict recovery in patients with disorders of consciousness: A preliminary multimodal [(11) C]Flumazenil PET and fMRI study. Hum Brain Mapp. 2015 Oct; 36(10):3867-77. PMID: 26147065. PubMed
  11. McDonnell E, Giacino JT, Kolakowsky-Hayner SA. A brief overview of the Coma Recovery Scale-revised: updates from the COMBI. J Head Trauma Rehabil. 2015 Mar-Apr; 30(2):143-5. PMID: 25734842. PubMed
  12. Rosenbaum AM, Giacino JT. Clinical management of the minimally conscious state. Handb Clin Neurol. 2015; 127:395-410. PMID: 25702230. PubMed
  13. Smart CM, Giacino JT. Exploring caregivers’ knowledge of and receptivity toward novel diagnostic tests and treatments for persons with post-traumatic disorders of consciousness. NeuroRehabilitation. 2015; 37(1):117-30. PMID: 26409697. PubMed
  14. Estraneo A, Moretta P, Cardinale V, De Tanti A, Gatta G, Giacino JT, Trojano L. A multicentre study of intentional behavioural responses measured using the Coma Recovery Scale-Revised in patients with minimally conscious state. Clin Rehabil. 2015 Aug; 29(8):803-8. PMID: 25381347. PubMed
  15. Schnakers C, Giacino JT, Løvstad M, Habbal D, Boly M, Di H, Majerus S, Laureys S. Preserved covert cognition in noncommunicative patients with severe brain injury? Neurorehabil Neural Repair. 2015 May; 29(4):308-17. PMID: 25160566. PubMed
  16. Løvstad M, Andelic N, Knoph R, Jerstad T, Anke A, Skandsen T, Hauger SL, Giacino JT, Røe C, Schanke AK. Rate of disorders of consciousness in a prospective population-based study of adults with traumatic brain injury. J Head Trauma Rehabil. 2014 Sep-Oct; 29(5):E31-43. PMID: 24413075. PubMed
  17. Gerrard P, Zafonte R, Giacino JT. Coma Recovery Scale-Revised: evidentiary support for hierarchical grading of level of consciousness. Arch Phys Med Rehabil. 2014 Dec; 95(12):2335-41. PMID: 25010536. PubMed
  18. Cunningham C, Chen WC, Shorten A, McClurkin M, Choezom T, Schmidt CP, Chu V, Bozik A, Best C, Chapman M, Furman M, Detyniecki K, Giacino JT, Blumenfeld H. Impaired consciousness in partial seizures is bimodally distributed. Neurology. 2014 May 13; 82(19):1736-44. PMID: 24727311; PMCID: PMC4032205. PubMed
  19. Giacino JT, Fins JJ, Laureys S, Schiff ND. Disorders of consciousness after acquired brain injury: the state of the science. Nat Rev Neurol. 2014 Feb; 10(2):99-114. PMID: 24468878. PubMed
  20. Guller Y, Giacino J. Potential applications of concurrent transcranial magnetic stimulation and functional magnetic resonance imaging in acquired brain injury and disorders of consciousness. Brain Inj. 2014; 28(9):1190-6. PMID: 25099023. PubMed
  21. Edlow BL, Giacino JT, Hirschberg RE, Gerrard J, Wu O, Hochberg LR. Unexpected recovery of function after severe traumatic brain injury: the limits of early neuroimaging-based outcome prediction. Neurocrit Care. 2013 Dec; 19(3):364-75. PMID: 23860665; PMCID: PMC3902071. PubMed
  22. Hicks R, Giacino J, Harrison-Felix C, Manley G, Valadka A, Wilde EA. Progress in developing common data elements for traumatic brain injury research: version two–the end of the beginning. J Neurotrauma. 2013 Nov 15; 30(22):1852-61. PMID: 23725058; PMCID: PMC3814822. PubMed
  23. Edlow BL, Giacino JT, Wu O. Functional MRI and outcome in traumatic coma. Curr Neurol Neurosci Rep. 2013 Sep; 13(9):375. PMID: 23881623; PMCID: PMC3811121. PubMed
  24. Giacino JT, Katz DI, Whyte J. Neurorehabilitation in disorders of consciousness. Semin Neurol. 2013 Apr; 33(2):142-56. PMID: 23888398. PubMed
  25. Nakase-Richardson R, Tran J, Cifu D, Barnett SD, Horn LJ, Greenwald BD, Brunner RC, Whyte J, Hammond FM, Yablon SA, Giacino JT. Do rehospitalization rates differ among injury severity levels in the NIDRR Traumatic Brain Injury Model Systems program? Arch Phys Med Rehabil. 2013 Oct; 94(10):1884-90. PMID: 23770278. PubMed
  26. Whyte J, Nordenbo AM, Kalmar K, Merges B, Bagiella E, Chang H, Yablon S, Cho S, Hammond F, Khademi A, Giacino J. Medical complications during inpatient rehabilitation among patients with traumatic disorders of consciousness. Arch Phys Med Rehabil. 2013 Oct; 94(10):1877-83. PMID: 23735519. PubMed
  27. Whyte J, Nakase-Richardson R, Hammond FM, McNamee S, Giacino JT, Kalmar K, Greenwald BD, Yablon SA, Horn LJ. Functional outcomes in traumatic disorders of consciousness: 5-year outcomes from the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems. Arch Phys Med Rehabil. 2013 Oct; 94(10):1855-60. PMID: 23732164. PubMed
  28. Giacino J, Fins JJ, Machado A, Schiff ND. Central thalamic deep brain stimulation to promote recovery from chronic posttraumatic minimally conscious state: challenges and opportunities. Neuromodulation. 2012 Jul; 15(4):339-49. PMID: 22624587. PubMed
  29. Malec JF, Hammond FM, Giacino JT, Whyte J, Wright J. Structured interview to improve the reliability and psychometric integrity of the Disability Rating Scale. Arch Phys Med Rehabil. 2012 Sep; 93(9):1603-8. PMID: 22510680. PubMed
  30. Giacino JT, Whyte J, Bagiella E, Kalmar K, Childs N, Khademi A, Eifert B, Long D, Katz DI, Cho S, Yablon SA, Luther M, Hammond FM, Nordenbo A, Novak P, Mercer W, Maurer-Karattup P, Sherer M. Placebo-controlled trial of amantadine for severe traumatic brain injury. N Engl J Med. 2012 Mar 01; 366(9):819-26. PMID: 22375973. PubMed
  31. Hirschberg R, Giacino JT. The vegetative and minimally conscious states: diagnosis, prognosis and treatment. Neurol Clin. 2011 Nov; 29(4):773-86. PMID: 22032660. PubMed
  32. Nakase-Richardson R, Whyte J, Giacino JT, Pavawalla S, Barnett SD, Yablon SA, Sherer M, Kalmar K, Hammond FM, Greenwald B, Horn LJ, Seel R, McCarthy M, Tran J, Walker WC. Longitudinal outcome of patients with disordered consciousness in the NIDRR TBI Model Systems Programs. J Neurotrauma. 2012 Jan 01; 29(1):59-65. PMID: 21663544. PubMed
  33. Seel RT, Sherer M, Whyte J, Katz DI, Giacino JT, Rosenbaum AM, Hammond FM, Kalmar K, Pape TL, Zafonte R, Biester RC, Kaelin D, Kean J, Zasler N. Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Arch Phys Med Rehabil. 2010 Dec; 91(12):1795-813. PMID: 21112421. PubMed
  34. Wilde EA, Whiteneck GG, Bogner J, Bushnik T, Cifu DX, Dikmen S, French L, Giacino JT, Hart T, Malec JF, Millis SR, Novack TA, Sherer M, Tulsky DS, Vanderploeg RD, von Steinbuechel N. Recommendations for the use of common outcome measures in traumatic brain injury research. Arch Phys Med Rehabil. 2010 Nov; 91(11):1650-1660.e17. PMID: 21044708. PubMed
  35. Rodriguez Moreno D, Schiff ND, Giacino J, Kalmar K, Hirsch J. A network approach to assessing cognition in disorders of consciousness. Neurology. 2010 Nov 23; 75(21):1871-8. PMID: 20980667; PMCID: PMC2995384. PubMed
  36. Løvstad M, Frøslie KF, Giacino JT, Skandsen T, Anke A, Schanke AK. Reliability and diagnostic characteristics of the JFK coma recovery scale-revised: exploring the influence of rater’s level of experience. J Head Trauma Rehabil. 2010 Sep-Oct; 25(5):349-56. PMID: 20142758. PubMed
  37. Schnakers C, Vanhaudenhuyse A, Giacino J, Ventura M, Boly M, Majerus S, Moonen G, Laureys S. Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol. 2009 Jul 21; 9:35. PMID: 19622138; PMCID: PMC2718857. PubMed
  38. Schiff ND, Giacino JT, Fins JJ. Deep brain stimulation, neuroethics, and the minimally conscious state: moving beyond proof of principle. Arch Neurol. 2009 Jun; 66(6):697-702. PMID: 19506129. PubMed
  39. Whyte J, Gosseries O, Chervoneva I, DiPasquale MC, Giacino J, Kalmar K, Katz DI, Novak P, Long D, Childs N, Mercer W, Maurer P, Eifert B. Predictors of short-term outcome in brain-injured patients with disorders of consciousness. Prog Brain Res. 2009; 177:63-72. PMID: 19818895. PubMed
  40. Giacino JT, Schnakers C, Rodriguez-Moreno D, Kalmar K, Schiff N, Hirsch J. Behavioral assessment in patients with disorders of consciousness: gold standard or fool’s gold? Prog Brain Res. 2009; 177:33-48. PMID: 19818893. PubMed
  41. Schnakers C, Majerus S, Giacino J, Vanhaudenhuyse A, Bruno MA, Boly M, Moonen G, Damas P, Lambermont B, Lamy M, Damas F, Ventura M, Laureys S. A French validation study of the Coma Recovery Scale-Revised (CRS-R). Brain Inj. 2008 Sep; 22(10):786-92. PMID: 18787989. PubMed
  42. Vanhaudenhuyse A, Giacino J, Schnakers C, Kalmar K, Smart C, Bruno MA, Gosseries O, Moonen G, Laureys S. Blink to visual threat does not herald consciousness in the vegetative state. Neurology. 2008 Oct 21; 71(17):1374-5. PMID: 18716237. PubMed
  43. Smart CM, Giacino JT, Cullen T, Moreno DR, Hirsch J, Schiff ND, Gizzi M. A case of locked-in syndrome complicated by central deafness. Nat Clin Pract Neurol. 2008 Aug; 4(8):448-53. PMID: 18506168. PubMed
  44. Kalmar K, Novack TA, Nakase-Richardson R, Sherer M, Frol AB, Gordon WA, Hanks RA, Giacino JT, Ricker JH. Feasibility of a brief neuropsychologic test battery during acute inpatient rehabilitation after traumatic brain injury. Arch Phys Med Rehabil. 2008 May; 89(5):942-9. PMID: 18452744. PubMed
  45. Hanks RA, Millis SR, Ricker JH, Giacino JT, Nakese-Richardson R, Frol AB, Novack TA, Kalmar K, Sherer M, Gordon WA. The predictive validity of a brief inpatient neuropsychologic battery for persons with traumatic brain injury. Arch Phys Med Rehabil. 2008 May; 89(5):950-7. PMID: 18452745. PubMed
  46. Giacino JT, Malone R. The vegetative and minimally conscious states. Handb Clin Neurol. 2008; 90:99-111. PMID: 18631819. PubMed
  47. Giacino JT, Smart CM. Recent advances in behavioral assessment of individuals with disorders of consciousness. Curr Opin Neurol. 2007 Dec; 20(6):614-9. PMID: 17992078. PubMed
  48. Fins JJ, Master MG, Gerber LM, Giacino JT. The minimally conscious state: a diagnosis in search of an epidemiology. Arch Neurol. 2007 Oct; 64(10):1400-5. PMID: 17923624. PubMed
  49. Schiff ND, Giacino JT, Kalmar K, Victor JD, Baker K, Gerber M, Fritz B, Eisenberg B, Biondi T, O’Connor J, Kobylarz EJ, Farris S, Machado A, McCagg C, Plum F, Fins JJ, Rezai AR. Behavioural improvements with thalamic stimulation after severe traumatic brain injury. Nature. 2007 Aug 02; 448(7153):600-3. PMID: 17671503. PubMed
  50. Schnakers C, Giacino J, Kalmar K, Piret S, Lopez E, Boly M, Malone R, Laureys S. Does the FOUR score correctly diagnose the vegetative and minimally conscious states? Ann Neurol. 2006 Dec; 60(6):744-5; author reply 745. PMID: 16847951. PubMed
  51. Giacino JT, Hirsch J, Schiff N, Laureys S. Functional neuroimaging applications for assessment and rehabilitation planning in patients with disorders of consciousness. Arch Phys Med Rehabil. 2006 Dec; 87(12 Suppl 2):S67-76. PMID: 17140882. PubMed
  52. Laureys S, Giacino JT, Schiff ND, Schabus M, Owen AM. How should functional imaging of patients with disorders of consciousness contribute to their clinical rehabilitation needs? Curr Opin Neurol. 2006 Dec; 19(6):520-7. PMID: 17102688; PMCID: PMC2858870. PubMed
  53. Voss HU, Ulug AM, Dyke JP, Watts R, Kobylarz EJ, McCandliss BD, Heier LA, Beattie BJ, Hamacher KA, Vallabhajosula S, Goldsmith SJ, Ballon D, Giacino JT, Schiff ND. Possible axonal regrowth in late recovery from the minimally conscious state. J Clin Invest. 2006 Jul; 116(7):2005-11. PMID: 16823492; PMCID: PMC1483160. PubMed
  54. Cicerone KD, Dahlberg C, Malec JF, Langenbahn DM, Felicetti T, Kneipp S, Ellmo W, Kalmar K, Giacino JT, Harley JP, Laatsch L, Morse PA, Catanese J. Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. Arch Phys Med Rehabil. 2005 Aug; 86(8):1681-92. PMID: 16084827. PubMed
  55. Giacino JT, Kalmar K. Diagnostic and prognostic guidelines for the vegetative and minimally conscious states. Neuropsychol Rehabil. 2005 Jul-Sep; 15(3-4):166-74. PMID: 16350959. PubMed
  56. Kalmar K, Giacino JT. The JFK Coma Recovery Scale–Revised. Neuropsychol Rehabil. 2005 Jul-Sep; 15(3-4):454-60. PMID: 16350986. PubMed
  57. Moussouttas M, Giacino J, Papamitsakis N. Amnestic syndrome of the subcallosal artery: a novel infarct syndrome. Cerebrovasc Dis. 2005; 19(6):410-4. PMID: 15925871. PubMed
  58. Whyte J, Katz D, Long D, DiPasquale MC, Polansky M, Kalmar K, Giacino J, Childs N, Mercer W, Novak P, Maurer P, Eifert B. Predictors of outcome in prolonged posttraumatic disorders of consciousness and assessment of medication effects: A multicenter study. Arch Phys Med Rehabil. 2005 Mar; 86(3):453-62. PMID: 15759228. PubMed
  59. Schiff ND, Rodriguez-Moreno D, Kamal A, Kim KH, Giacino JT, Plum F, Hirsch J. fMRI reveals large-scale network activation in minimally conscious patients. Neurology. 2005 Feb 08; 64(3):514-23. PMID: 15699384. PubMed
  60. Giacino JT. The minimally conscious state: defining the borders of consciousness. Prog Brain Res. 2005; 150:381-95. PMID: 16186037. PubMed
  61. Giacino J, Whyte J. The vegetative and minimally conscious states: current knowledge and remaining questions. J Head Trauma Rehabil. 2005 Jan-Feb; 20(1):30-50. PMID: 15668569. PubMed
  62. Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004 Dec; 85(12):2020-9. PMID: 15605342. PubMed
  63. Giacino JT, Trott CT. Rehabilitative management of patients with disorders of consciousness: grand rounds. J Head Trauma Rehabil. 2004 May-Jun; 19(3):254-65. PMID: 15247847. PubMed
  64. Giacino JT. The vegetative and minimally conscious states: consensus-based criteria for establishing diagnosis and prognosis. NeuroRehabilitation. 2004; 19(4):293-8. PMID: 15671583. PubMed
  65. Giacino JT, Whyte J. Amantadine to improve neurorecovery in traumatic brain injury-associated diffuse axonal injury: a pilot double-blind randomized trial. J Head Trauma Rehabil. 2003 Jan-Feb; 18(1):4-5; author reply 5-6. PMID: 12809123. PubMed
  66. Schiff ND, Ribary U, Moreno DR, Beattie B, Kronberg E, Blasberg R, Giacino J, McCagg C, Fins JJ, Llinás R, Plum F. Residual cerebral activity and behavioural fragments can remain in the persistently vegetative brain. Brain. 2002 Jun; 125(Pt 6):1210-34. PMID: 12023311. PubMed
  67. Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, Kelly JP, Rosenberg JH, Whyte J, Zafonte RD, Zasler ND. The minimally conscious state: definition and diagnostic criteria. Neurology. 2002 Feb 12; 58(3):349-53. PMID: 11839831. PubMed
  68. Cicerone KD, Dahlberg C, Kalmar K, Langenbahn DM, Malec JF, Bergquist TF, Felicetti T, Giacino JT, Harley JP, Harrington DE, Herzog J, Kneipp S, Laatsch L, Morse PA. Evidence-based cognitive rehabilitation: recommendations for clinical practice. Arch Phys Med Rehabil. 2000 Dec; 81(12):1596-615. PMID: 11128897. PubMed
  69. Giacino JT. Re: “The effects of cognitive rehabilitation on outcomes for persons with traumatic brain injury: a systematic review”. J Head Trauma Rehabil. 2000 Feb; 15(1):ix-x. PMID: 10787275. PubMed
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  71. Giacino JT. Disorders of consciousness: differential diagnosis and neuropathologic features. Semin Neurol. 1997 Jun; 17(2):105-11. PMID: 9195652. PubMed
  72. Giacino JT. Sensory stimulation: theoretical perspectives and the evidence for effectiveness. NeuroRehabilitation. 1996; 6(1):69-78. PMID: 24525687. PubMed
  73. Zasler ND, Giacino J, Sandel ME. The persistent vegetative state. N Engl J Med. 1994 Nov 17; 331(20):1381. PMID: 7935718. PubMed
  74. Giacino JT, Kezmarsky MA, DeLuca J, Cicerone KD. Monitoring rate of recovery to predict outcome in minimally responsive patients. Arch Phys Med Rehabil. 1991 Oct; 72(11):897-901. PMID: 1929808. PubMed