[en] Objectives: To determine which features of minimally conscious state (MCS) emerge first in patients transitioning from the vegetative state (VS) to MCS following severe traumatic and non-traumatic brain injury.
Design: Retrospective observational study.
Setting: Inpatient Setting with a Specialized Disorders of Consciousness (DoC) program.
Participants: 65 patients who met criteria for MCS for the first time during their inpatient stay (44 male; mean age+/-SD = 43.6+/-19.8; TBI = 31; median time since injury [IQR]: 42 days [32 – 54]).
Interventions: N/A
Main Outcome Measures: MCS behaviors detected on the Coma Recovery Scale-Revised (CRS-R).
Results: At transition from VS to MCS, visual pursuit was the most frequently observed MCS behavior (39% of patients), followed by automatic response (32%), reproducible movement to command (29%), intentional communication (19%) and visual fixation (12%). Each one of the remaining MCS behaviors (i.e., localization to pain, object manipulation, intelligible verbalization, object recognition, object localization and consistent movement to command) was present in less than 5% of the patients. In patients who showed only one behavioral sign of consciousness at emergence from VS (71% of sample), visual pursuit was most prevalent, occurring in 41% of cases. In patients who demonstrated two MCS behaviors concurrently at time of emergence (9% of sample), transitional features involved visual and motor functions in 44% of cases. Only 2% of patients demonstrated MCS behaviors across all 5 CRS-R subscales that include MCS features.
Conclusions: Patients with DoC transitioning from VS to MCS typically recover cognitively-mediated visual and motor behaviors. Most patients initially demonstrate only one behavioral sign of consciousness, highlighting the importance of performing comprehensive serial assessments in this population.
Disciplines :
Neurology
Author, co-author :
Martens, Géraldine ; Université de Liège - ULiège > Consciousness-Coma Science Group
Bodien, Yelena; Harvard Medical School > Physical Medicine and Rehabilitation
Sheau, Kristen; Harvard Medical School > Physical Medicine and Rehabilitation
Christoforou, Andrea; Harvard Medical School > Physical Medicine and Rehabilitation
Giacino, Joseph; Harvard Medical School > Department of Physical Medicine and Rehabilitation
Language :
English
Title :
Behavioral signs associated with recovery of consciousness after severe brain injury
Publication date :
2018
Event name :
American Congress of Rehabilitation Medicine 95th Conference
Event place :
Dallas, TX, United States
Event date :
from 1-10-2018 to 3-10-2018
Audience :
International
Journal title :
Archives of Physical Medicine and Rehabilitation
ISSN :
0003-9993
eISSN :
1532-821X
Publisher :
W.B. Saunders, Philadelphia, United States - Pennsylvania
Volume :
99
Issue :
10
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
NIDILRR - National Institute on Disability, Independent Living, and Rehabilitation Research
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