Model System:

TBI

Reference Type:

Journal

Accession No.:

Journal:

Annals of Physical and Rehabilitation Medicine

Year, Volume, Issue, Page(s):

, 63, 4, 263-269

Abstract:

Background: Early detection of consciousness after severe brain injury is critical for establishing an accurate prognosis and planning appropriate treatment.

Objectives: To determine which behavioural signs of consciousness emerge first and to estimate the time course to recovery of consciousness in patients with severe acquired brain injury.

Methods: Retrospective observational study using the Coma Recovery Scale-Revised and days to recovery of consciousness in 79 patients (51 males; 34 with traumatic brain injury; median [IQR] age 48 [26–61] years; median time since injury 26 [20–36] days) who transitioned from coma or unresponsive wakefulness syndrome (UWS)/vegetative state (VS) to the minimally conscious state (MCS) or emerged from MCS during inpatient rehabilitation.

Results: Visual pursuit was the most common initial sign of MCS (41% of patients; 95% CI [30–52]), followed by reproducible command-following (25% [16–35]) and automatic movements (24% [15–33]). Ten other behaviours emerged first in less than 16% of cases. Median [IQR] time to recovery of consciousness was 44 [33–59] days. Etiology did not significantly affect time to recovered consciousness.

Conclusion: Recovery of consciousness after severe brain injury is most often signalled by reemergence of visual pursuit, reproducible command-following and automatic movements. Clinicians should use assessment measures that are sensitive to these behaviours because early detection of consciousness is critical for accurate prognostication and treatment planning.

Author(s):

GeraldineMartens, YelenaBodien, KristenSheau, Andrea Christoforou, Joseph T. Giacino