Which behaviours are first to emerge during recovery of consciousness after severe brain injury?

被引:27
作者
Martens, Geraldine [1 ,2 ,3 ,4 ]
Bodien, Yelena [1 ,2 ,5 ]
Sheau, Kristen [1 ,6 ]
Christoforou, Andrea [1 ,2 ]
Giacino, Joseph T. [1 ,2 ]
机构
[1] Spaulding Rehabil Hosp, Dept Phys Med & Rehabil, Charlestown, MA 02129 USA
[2] Harvard Med Sch, Dept Phys Med & Rehabil, Boston, MA 02115 USA
[3] Univ Liege, Coma Sci Grp, GIGA Res, GIGA Consciousness, 11 Ave Hop, B-4000 Liege, Sart Tilman, Belgium
[4] Univ Hosp Liege, Ctr Integre Pluridisciplinaire Etud Cerveau Cogn, Ctr Cerveau2, Liege, Belgium
[5] Massachusetts Gen Hosp, Lab Neuroimaging Coma & Consciousness, Boston, MA 02114 USA
[6] Massachusetts Gen Hosp, Inst Hlth Profess, Boston, MA 02114 USA
关键词
Brain injury; Vegetative state; Minimally conscious state; Outcome; VISUAL PURSUIT; VEGETATIVE STATE; DISORDERS; SCALE; COMA; DIAGNOSIS; CHILDREN; SIGNS;
D O I
10.1016/j.rehab.2019.10.004
中图分类号
R49 [康复医学];
学科分类号
100215 ;
摘要
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. (C) 2019 Elsevier Masson SAS. All rights reserved.
引用
收藏
页码:263 / 269
页数:7
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