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Which behaviours are first to emerge during recovery of consciousness after severe brain injury?

Martens, Géraldine; Bodien, Yelena; Sheau, Kristen et al.

2019 • In Annals of Physical and Rehabilitation Medicine

Peer Reviewed verified by ORBi

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https://hdl.handle.net/2268/241654

DOI
10.1016/j.rehab.2019.10.004

PubMed
31783144

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Keywords :

brain injury; vegetative state; minimally conscious state; outcome

Abstract :

[en] Background. Early detection of consciousness after severe brain injury is critical for establishing an accurate prognosis and planning appropriate treatment. Objectives. To determine which behavioral signs of consciousness emerge first and to estimate the time course to recovery of consciousness in patients with severe acquired brain injury. Methods. Retrospective observational study using the Coma Recovery Scale-Revised and days to recovery of consciousness in 79 patients (51 males; 34 with traumatic brain injury; median [IQR] age 48 [26–61] years; median time since injury 26 [20–36] days) who transitioned from coma or unresponsive wakefulness syndrome (UWS)/vegetative state (VS) to the minimally conscious state (MCS) or emerged from MCS during inpatient rehabilitation. Results. Visual pursuit was the most common initial sign of MCS (41% of patients; 95% CI [30–52]), followed by reproducible command-following (25% [16–35]) and automatic movements (24% [15–33]). Ten other behaviors emerged first in less than 16% of cases. Median [IQR] time to recovery of consciousness was 44 [33–59] days. Etiology did not significantly affect time to recovered consciousness. Conclusion. Recovery of consciousness after severe brain injury is most often signaled by reemergence of visual pursuit reproducible command-following and automatic movements. Clinicians should use assessment measures that are sensitive to these behaviors because early detection of consciousness is critical for accurate prognostication and treatment planning.

Disciplines :

Neurology

Author, co-author :

Martens, Géraldine ; Université de Liège - ULiège > Consciousness-Coma Science Group

Bodien, Yelena

Sheau, Kristen

Christoforou, Andrea

Giacino, Joseph

Language :

English

Title :

Which behaviours are first to emerge during recovery of consciousness after severe brain injury?

Publication date :

November 2019

Journal title :

Annals of Physical and Rehabilitation Medicine

ISSN :

1877-0657

eISSN :

1877-0665

Publisher :

Elsevier Masson, Paris, France

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://doi.org/doi:10.1016/j.rehab.2019.10.004

Funders :

NIDILRR - National Institute on Disability, Independent Living, and Rehabilitation Research [US-WA]

Available on ORBi :

since 26 November 2019

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14

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11

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12

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