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.; Whyte, J.; Ashman, E. J.; Ashwal, S.; Barbano, R.; Hammond, F. M.; Laureys, Steven; Ling, G. S. F.; Nakase-Richardson, R.; Seel, R. T.; Yablon, S.; Getchius, T. S. D.; Gronseth, G. S.; Armstrong, M. J.

doi:10.1016/j.apmr.2018.07.001

Paper published in a journal (Scientific congresses and symposiums)

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.

2018 • In Archives of Physical Medicine and Rehabilitation, 99 (9), p. 1699-1709

Peer Reviewed verified by ORBi

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https://hdl.handle.net/2268/249255

DOI
10.1016/j.apmr.2018.07.001

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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

More authors (6 more)

Language :

English

Title :

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 :

Issue :

Pages :

1699-1709

Peer reviewed :

Peer Reviewed verified by ORBi

Funders :

ACRM - American Congress of Rehabilitation Medicine
AAN - American Academy of Neurology
NIDILRR - National Institute on Disability, Independent Living, and Rehabilitation Research

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the American Congress of Rehabilitation Medicine
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