Brain injury; Coma recovery scale revised; Disorders of consciousness; Minimally conscious state; Unresponsive wakefulness syndrome; Vegetative state; Coma; Consciousness Disorders/etiology; Humans; Recovery of Function/physiology; Retrospective Studies; Syndrome; Wakefulness; Brain Injuries/complications; Brain Injuries/rehabilitation; Persistent Vegetative State/diagnosis; Brain Injuries; Consciousness Disorders; Persistent Vegetative State; Recovery of Function; Orthopedics and Sports Medicine; Rehabilitation
Abstract :
[en] Precise description of behavioral signs denoting transition from unresponsive wakefulness syndrome/vegetative state (UWS/VS) to minimally conscious state (MCS) or emergence from MCS after severe brain injury is crucial for prognostic purposes. A few studies have attempted this goal but involved either non-standardized instruments, limited temporal accuracy or samples, or focused on (sub)acute patients. The objective of this study was to describe the behavioral signs that led to a change of diagnosis, as well as the factors influencing this transition, in a large sample of patients with chronic disorders of consciousness after severe brain injury. In this retrospective cohort study, 185 patients in UWS/VS or MCS were assessed with the Coma Recovery Scale Revised (CRS-R) five times within the two weeks following their admission to a neurorehabilitation center and then weekly until emergence from MCS, discharge or death. Of these 185 patients, 33 patients in UWS/VS and 45 patients in MCS transitioned to another state. Transition to MCS was mostly denoted by one behavioral sign (72%), predominantly visual fixation (57%), followed by localization to noxious stimulation (27%), visual pursuit (21%) and object manipulation (12%), and could be predicted by etiology, time post-injury and age. Emergence from MCS was characterized by one sign in 64% of patients and by two signs (functional communication and objects use) in the remaining cases, and could be predicted by time post-injury and number of behavioral signs at admission. Clinicians should be therefore advised to pay particular attention to visual and motor subscales of the CRS-R to detect behavioral recovery.
Disciplines :
Neurosciences & behavior
Author, co-author :
Carrière, Manon ; Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège, Liège, Belgium, Centre du Cerveau, University Hospital of Liège, Liège, Belgium
Llorens, Roberto; NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, València, Spain, Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, València, Spain
Navarro, María Dolores; NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, València, Spain
Olaya, José; NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, València, Spain
Ferri, Joan; NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, València, Spain
Noé, Enrique; NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, València, Spain. Electronic address: quique@neurorhb.com
Language :
English
Title :
Behavioral signs of recovery from unresponsive wakefulness syndrome to emergence of minimally conscious state after severe brain injury.
EC - European Commission [BE] Generalitat Valenciana Conselleria d' Educacio Investigacio Cultura i Esport
Funding text :
This work was supported by the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie (Grant Agreement No. 778234 ) and by Conselleria de Educación, Investigación, Cultura y Deporte of Generalitat Valenciana (Project SEJI/2019/017 ).
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