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Clin Rehabil. 2015 Aug;29(8):803-8. doi: 10.1177/0269215514556002. Epub 2014 Nov 7.

A multicentre study of intentional behavioural responses measured using the Coma Recovery Scale-Revised in patients with minimally conscious state.

Author information

1
Lab. for the study of Disorders of Consciousness, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy anna.estraneo@fsm.it.
2
Lab. for the study of Disorders of Consciousness, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy.
3
Department of Rehabilitation, Cardinal Ferrari Hospital Fontanellato-Parma, Italy.
4
Rehabilitation Medicine Unit, Ravenna Hospital, Ravenna, Italy.
5
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
6
Lab. for the study of Disorders of Consciousness, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy Neuropsychology Lab, Department of Psychology, Second University of Naples, Caserta, Italy.

Abstract

OBJECTIVE:

To investigate which conscious behaviour is most frequently detected using the Coma Recovery Scale-Revised in patients with minimally conscious state.

DESIGN:

Multicentre, cross-sectional study.

SETTING:

One intensive care unit, 8 post-acute rehabilitation centres and 2 long-term facilities.

SUBJECTS:

Fifty-two patients with established diagnosis of minimally conscious state of different aetiology.

MAIN MEASURES:

All patients were assessed by the Coma Recovery Scale-Revised.

RESULTS:

In most patients (34/52) non-reflexive responses were identified by two or more subscales of the Coma Recovery Scale-Revised, whereas in 14 patients only the visual subscale could identify cortically-mediated behaviours, and in the remaining 4 patients only the motor subscale did so.The clinical signs of intentional behaviour were most often detected by the visual subscale (43/52 patients) and by the motor subscale (31/52), and least frequently by the oromotor/verbal subscale (3/52) of the Coma Recovery Scale-Revised. This clinical pattern was observed independently from time post-onset and aetiology.

CONCLUSIONS:

Non-reflexive visual behaviour, identified by the visual subscale of Coma Recovery Scale-Revised, is the most frequently detected intentional sign consistent with the diagnosis of minimally conscious state, independently from aetiology and time post-onset.

KEYWORDS:

Coma Recovery Scale-Revised; Minimally conscious state; brain injury; intentional behaviours; rehabilitation

PMID:
25381347
DOI:
10.1177/0269215514556002
[Indexed for MEDLINE]

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