ABOUT JOSEPH GIACINO
Joseph Giacino, PhD has been an influential clinical neuropsychologist who has helped to advance our understanding of very special persons who after severe brain injury remain in a prolonged period of low response. Dr. Giacino’s work has over the years resulted in a more precise description and diagnosis of persons in these states.
Dr. Giacino is a neuropsychologist who earned his Ph.D. in clinical/school psychology at Hofstra University in 1986. In addition to maintaining a private practice, Dr. Giacino is currently the associate director of neuropsychology at both the JFK Johnson Rehabilitation Institute and the New Jersey Neuroscience Institute at the JFK Medical Center. He serves as an associate professor and adjunct faculty member at Seton Hall University in the School of Graduate Medical Education and the Department of Neuroscience. He is also a clinical assistant professor at the University of Medicine and Dentistry of New Jersey.
Dr. Giacino is a sought after speaker and has made many professional presentations over the years. Dr. Giacino has authored over 40 peer reviewed publications and 6 book chapters, as well as many letters to the editor, newsletter and magazine articles, test and treatment manuals, and published abstracts. He has four active grants, including "A collaborative study of recovery of consciousness after severe brain injury (McDonnel Foundation)," "An investigation of the effectiveness of functional MRI for detection of conscious awareness and rehabilitation planning in individuals with disorders of consciousness (NIDRR)," "Electrical stimulation of the thalamic intralaminar nuclei for treatment of the minimally conscious state (FDA)," and "A multicenter prospective randomized controlled trial of amantadine hydrochloride to promote recovery of function following severe traumatic brain injury (NIDRR)."
While many have been involved in helping to better identify the needs and care of individuals with disorders of consciousness, Dr. Giacino has provided excellent leadership as well as academic and scientific rigor to our efforts. Dr. Giacino has also provided the drive and passion to a field of investigation that may have gone unnoticed to the clinician in daily practice. The following interview has provided us further insight into the history and ongoing needs of these individuals. I want to express my appreciation and underscore the needed recognition of Dr. Giacino and the very important work through which he has guided us all.
How did you get interested in disorders of consciousness?
In 1982 watching a newsmagazine presentation on television regarding a new sensory stimulation treatment program for persons in a vegetative state I realized that the program was talking about the hospital where I was about to begin my clinical internship. Once there for the year I asked if I might meet the neurosurgical team working on this program. This was well before the sensory stimulation programs were being used and this peaked my interest. The neurosurgeon was welcoming and I began to learn about these conditions. The report of improvement in persons who were diagnosed as in a vegetative state was most interesting and I decided to do my dissertation in this area. They were very willing to have me participate and I undertook exploration of two questions: 1. did patients get better from this treatment and 2. could families comply and keep to the required 11 hours a day of stimulation that was prescribed. This allowed me to see the very basic problems of both the individual being treated and the requirements of the family.
How did the diagnosis of minimally conscious come about?
In the early years it was clearly mentioned and discussed that there was a sub group of patients who were not being correctly identified given the traditional categories being used of comatose and vegetative. These patients were inconsistently responsive with moments of higher level response than what was traditionally known for the person either in a coma or in a vegetative state.
I had the opportunity to participate on an American Congress of Rehabilitation Medicine committee headed by Shelly Berrol, M.D. that was dedicated to the vegetative state. With the untimely passing of Dr. Berrol, I was able to participate in a leadership role having the committee continue its work. I was able to also work with such recognized professionals as Drs. Nathan Zasler, Doug Katz, Ross Zafonte and John Whyte. In the course of our work we began to talk about these patients that were inconsistently responsive. For example their level of response to the environment would vary throughout the day. Staff, therapists and family would report differing responses and this required us to start looking at the way the patient responded not just when we were examining them but how they responded throughout the day. We recognized these patients as a somewhat separate group from the traditional categories. There was no effort to differentiate those who were transitioning through this state of inconsistent responsiveness from those that were to go on to a more persistent state. We now know that MCS is typically a transitional state of reduced responsiveness that usually results in a higher neurocognitive level of functioning. However, for some, this state may be a prolonged or more permanent state of low neurocognitive functioning. Initially these patients were described as being in a "minimally responsive state". I now believe the vast majority are in transition and are capable of a wide range of responses. In time this group of individuals was described as "minimally conscious" to reflect the fact that they showed clear-cut, albeit inconsistent, behavioral signs of consciousness.
From Brain Injury Professional, the official publication of the North American Brain Injury Society, Vol. 6, Issue 1. Copyright 2009. Reprinted with permission of NABIS and HDI Publishers. For more information or to subscribe, visit: www.nabis.org.
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