Revisiting the diagnostic criteria for emergence from the minimally conscious state: An empirical investigation

Objective: To determine whether consistent command-following (CCF) should be added to the diagnostic criteria for emergence from the minimally conscious state (MCS) Design: Retrospective cohort study Setting: Inpatient rehabilitation hospital Participants: Patients with severe acquired brain injury and disorders of consciousness (DoC) admitted to a specialized rehabilitation program Main Outcome Measure: Difference between time to recovery of CCF and time to recovery of functional object use [FOU] or functional communication [FC] (the two existing criteria for emergence from MCS) as measured by the Coma Recovery Scale-Revised [CRS-R]). Results: Of 214 patients (median [interquartile range] age: 53 [34, 66] years, male: 134 (62.6%), traumatic etiology: 115 (53.7%), admission CRS-R total score: 10 [7, 13]) admitted to rehabilitation without CCF, FO, or FC, 162 (75.7%) recovered CCF and FOU or FC during the eight-week observation period. On average, recovery of CCF, FOU, and FC was observed within one day of one another, approximately 46 [38.25, 58] days post-injury. One hundred and sixteen patients (71.6%) recovered FOU or FC prior to or at the same time as CCF. Conclusions: In patients recovering from DoC, CCF reemerges around the same time as FOU and FC. This finding likely reflects the shared dependency of these behaviors on cognitive procecess (e.g., language comprehension, attention, motor control) that are essential for effective interpersonal interaction and social participation. Our results support the addition of CCF to the existing diagnostic criteria for emergence from MCS.

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When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Neurobehavioral Progress

Brain Sciences ◽

10.3390/brainsci11010126 ◽

2021 ◽

Vol 11 (1) ◽

pp. 126

Author(s):

Enrique Noé ◽

Joan Ferri ◽

José Olaya ◽

María Dolores Navarro ◽

Myrtha O’Valle ◽

...

Keyword(s):

Clinical Decision Making ◽

Minimally Conscious State ◽

Clinical Decision ◽

Total Sample ◽

Conscious State ◽

Accurate Estimation ◽

Functional Communication ◽

Unresponsive Wakefulness Syndrome ◽

Object Use ◽

Minimally Conscious

Accurate estimation of the neurobehavioral progress of patients with unresponsive wakefulness syndrome (UWS) is essential to anticipate their most likely clinical course and guide clinical decision making. Although different studies have described this progress and possible predictors of neurobehavioral improvement in these patients, they have methodological limitations that could restrict the validity and generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the prognostic factors of changes in their neurobehavioral condition. Our results showed that, during the analyzed period, 34% of the patients were able to progress from UWS to minimally conscious state (MCS), 12% of the total sample (near one third from those who progressed to MCS) were able to emerge from MCS, and 10% of the patients died. Transition to MCS was mostly denoted by visual signs, which appeared either alone or in combination with motor signs, and was predicted by etiology and the score on the Coma Recovery Scale-Revised at admission with an accuracy of 75%. Emergence from MCS was denoted in the same proportion by functional communication and object use. Predictive models of emergence from MCS and mortality were not valid and the identified predictors could not be accounted for.

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