Study tracked the behavioral and functional recovery of patients with prolonged traumatic disorders of consciousness (DoC) following discharge from the acute care setting. Standardized behavioral data were acquired from 95 patients in a minimally conscious (MCS) or vegetative state (VS) recruited from 11 clinic sites and randomly assigned to the placebo arm of a previously completed prospective clinical trial. Patients were followed for 6 weeks by blinded observers to determine frequency of recovery of six target behaviors associated with functional status: consistent command following, object recognition, functional object use, intelligible verbalization, reliable communication, and sustained attention. The Coma Recovery Scale-Revised and Disability Rating Scale were used to track reemergence of target behaviors and assess degree of functional disability, respectively. Twenty percent of participants recovered all six target behaviors within the 6-week observation period. The odds of recovering a specific target behavior were 3.2 to 7.8 times higher for patients in MCS than for those in VS. Patients with preserved language function recovered the most behaviors and had the least disability at follow-up. These findings suggest that recovery of high-level behaviors underpinning functional independence is common in patients with prolonged traumatic DoC. Clinicians involved in early prognostic counseling should recognize that failure to emerge from traumatic DoC before 28 days does not necessarily portend unfavorable outcome.
Author(s):
Giacino, Joseph T. |Sherer, Mark |Christoforou, Andrea |Maurer-Karattup, Petra |Hammond, Flora M. |Long, David |Bagiella, Emilia|
