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Practice Guideline Update Recommendations Summary: Disorders of Consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research
Giacino, J. T.; Katz, D. I.; Schiff, N. D. et al.
2018In Archives of Physical Medicine and Rehabilitation, 99 (9), p. 1699-1709
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Abstract :
[en] Objective: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition on minimally conscious state (MCS) and provide care recommendations for patients with prolonged disorders of consciousness (DoC). Methods: Recommendations were based on systematic review evidence, related evidence, care principles, and inferences using a modified Delphi consensus process according to the AAN 2011 process manual, as amended. Recommendations: Clinicians should identify and treat confounding conditions, optimize arousal, and perform serial standardized assessments to improve diagnostic accuracy in adults and children with prolonged DoC (Level B). Clinicians should counsel families that for adults, MCS (vs vegetative state [VS]/ unresponsive wakefulness syndrome [UWS]) and traumatic (vs nontraumatic) etiology are associated with more favorable outcomes (Level B). When prognosis is poor, long-term care must be discussed (Level A), acknowledging that prognosis is not universally poor (Level B). Structural MRI, SPECT, and the Coma Recovery Scale–Revised can assist prognostication in adults (Level B); no tests are shown to improve prognostic accuracy in children. Pain always should be assessed and treated (Level B) and evidence supporting treatment approaches discussed (Level B). Clinicians should prescribe amantadine (100–200 mg bid) for adults with traumatic VS/UWS or MCS (4–16 weeks post injury) to hasten functional recovery and reduce disability early in recovery (Level B). Family counseling concerning children should acknowledge that natural history of recovery, prognosis, and treatment are not established (Level B). Recent evidence indicates that the term chronic VS/UWS should replace permanent VS, with duration specified (Level B). Additional recommendations are included.
Disciplines :
Neurology
Author, co-author :
Giacino, J. T.;  Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA, United States, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
Katz, D. I.;  Department of Neurology, Boston University School of Medicine, Boston, MA, United States, Braintree Rehabilitation HospitalMA, United States
Schiff, N. D.;  Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, NY, United States
Whyte, J.;  Moss Rehabilitation Research Institute, Elkins Park, PA, United States
Ashman, E. J.;  Bronson Neuroscience Center, Bronson Methodist Hospital, Kalamazoo, MI, United States
Ashwal, S.;  Department of Pediatrics, Division of Child Neurology, Loma Linda University School of MedicineCA, United States
Barbano, R.;  Department of Neurology, University of Rochester Medical CenterNY, United States
Hammond, F. M.;  Indiana University Department of Physical Medicine & Rehabilitation, University of Indiana School of Medicine, Indianapolis, United States
Laureys, Steven  ;  Université de Liège - ULiège > GIGA : Coma Group
Ling, G. S. F.;  Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, United States, Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
Nakase-Richardson, R.;  James A. Haley Veterans’ Hospital, US Department of Veterans Affairs, Tampa, FL, United States
Seel, R. T.;  Crawford Research Institute, Shepherd Center, Atlanta, GA, United States, Center for Rehabilitation Science and Engineering, Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, United States
Yablon, S.;  Division of Physical Medicine & Rehabilitation, University of Mississippi School of Medicine, Jackson, MS, United States, Brain Injury Program, Methodist Rehabilitation Center, Jackson, MS, United States
Getchius, T. S. D.;  Heart Rhythm Society, Washington, DC, United States
Gronseth, G. S.;  Department of Neurology, University of Kansas Medical Center, Kansas City, United States
Armstrong, M. J.;  Department of Neurology, University of Florida College of Medicine, Gainesville, United States
More authors (6 more) Less
Language :
English
Title :
Practice Guideline Update Recommendations Summary: Disorders of Consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research
Publication date :
2018
Event name :
American Congress of Rehabilitation Medicine
Event date :
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 :
9
Pages :
1699-1709
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
ACRM - American Congress of Rehabilitation Medicine [US-IN] [US-IN]
AAN - American Academy of Neurology [US-MN] [US-MN]
NIDILRR - National Institute on Disability, Independent Living, and Rehabilitation Research [US-WA] [US-WA]
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