List of abbreviations:AAN (American Academy of Neurology), ACRM (American Congress of Rehabilitation Medicine), CI (confidence interval), CRS-R (Coma Recovery Scale–Revised), DoC (disorders of consciousness), DRS (Disability Rating Scale), FDG (fluorodeoxyglucose), MCS (minimally conscious state), TBI (traumatic brain injury), UWS (unresponsive wakefulness syndrome), VS (vegetative state)
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Giacino JT, Katz DI, Schiff ND, et al; for the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Comprehensive systematic review update summary: disorders of consciousness: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Neurology Epub 2018 Aug 8.
- Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit.BMJ. 1996; 313: 13-16
- Reliability and diagnostic characteristics of the JFK Coma Recovery Scale–revised: exploring the influence of rater’s level of experience.J Head Trauma Rehabil. 2010; 25: 349-356
- Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study.CMAJ. 2011; 183: 1581-1588
- Medical complications during inpatient rehabilitation among patients with traumatic disorders of consciousness.Arch Phys Med Rehabil. 2013; 94: 1877-1883
- Long-term survival of adult trauma patients.JAMA. 2011; 305: 1001-1007
- Coma Recovery Scale–R: variability in the disorder of consciousness.BMC Neurol. 2015; 15: 186
- Visual pursuit: within-day variability in the severe disorder of consciousness.J Neurotrauma. 2011; 28: 2013-2017
- Dissociations between behavioural and functional magnetic resonance imaging-based evaluations of cognitive function after brain injury.Brain. 2011; 134: 769-782
- Assessment and management of pain in patients with disorders of consciousness.PM R. 2015; 7: S270-S277
- Behavioral evaluation of consciousness in severe brain damage.Prog Brain Res. 2005; 150: 397-413
- Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment.BMC Neurol. 2009; 9: 35
- Accuracy of diagnosis of persistent vegetative state.Neurology. 1993; 43: 1465-1467
- A case of locked-in syndrome complicated by central deafness.Nat Clin Pract Neurol. 2008; 4: 448-453
- The locked-in syndrome: what is it like to be conscious but paralyzed and voiceless?.Prog Brain Res. 2005; 150: 495-511
- The JFK Coma Recovery Scale–Revised: measurement characteristics and diagnostic utility.Arch Phys Med Rehabil. 2004; 85: 2020-2029
- Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research.Arch Phys Med Rehabil. 2010; 91: 1795-1813
- Assessment of command-following in minimally conscious brain injured patients.Arch Phys Med Rehabil. 1999; 80: 653-660
- The Wessex Head Injury Matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury.Clin Rehabil. 2000; 14: 408-416
- The Sensory Modality Assessment Rehabilitation Technique (SMART): a valid and reliable assessment for the vegetative and minimally conscious state patient.Brain Inj. 2004; 18: 1255-1269
- The Western Neuro Sensory Stimulation Profile: a tool for assessing slow-to-recover head-injured patients.Arch Phys Med Rehabil. 1989; 70: 104-108
- A measure of neurobehavioral functioning after coma. Part I: theory, reliability, and validity of Disorders of Consciousness Scale.J Rehabil Res Dev. 2005; 42: 1-17
- The Sensory Stimulation Assessment Measure (SSAM): a tool for early evaluation of severely brain-injured patients.Brain Inj. 1994; 8: 309-321
- Thalamofrontal connectivity mediates top-down cognitive functions in disorders of consciousness.Neurology. 2015; 84: 167-173
- True or false? Activations of language-related areas in patients with disorders of consciousness.Curr Pharm Des. 2014; 20: 4239-4247
- Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study.Lancet. 2014; 384: 514-522
- Large scale screening of neural signatures of consciousness in patients in a vegetative or minimally conscious state.Brain. 2014; 137: 2258-2270
- Longitudinal outcome of patients with disordered consciousness in the NIDRR TBI Model Systems Programs.J Neurotrauma. 2012; 29: 59-65
- Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1–4 year follow-up.Prog Brain Res. 2009; 177: 73-88
- The autonomic system functional state predicts responsiveness in disorder of consciousness.J Neurotrauma. 2015; 32: 1071-1077
- Medical aspects of the persistent vegetative state: (First of two parts).N Engl J Med. 1994; 330: 1499-1508
- Brief report: late improvement in consciousness after posttraumatic vegetative state.N Engl J Med. 1996; 334: 24-25
- The National Traumatic Coma Data Bank: part 1: design, purpose, goals, and results.J Neurosurg. 1983; 59: 276-284
- Long-term outcomes of chronic minimally conscious and vegetative states.Neurology. 2010; 75: 246-252
- Predictors of recovery of responsiveness in prolonged anoxic vegetative state.Neurology. 2013; 80: 464-470
- Late recovery after traumatic, anoxic, or hemorrhagic long-lasting vegetative state.Neurology. 2010; 75: 239-245
- Disorders of consciousness: outcomes, comorbidities, and care needs.Arch Phys Med Rehabil. 2013; 94: 1851-1854
- The vegetative and minimally conscious states: a comparison of clinical features and functional outcome.J Head Trauma Rehabil. 1997; 12: 36-51
- Medical comorbidities in disorders of consciousness patients and their association with functional outcomes.Arch Phys Med Rehabil. 2013; 94: 1899-1907
- Descriptive characteristics and rehabilitation outcomes in active duty military personnel and veterans with disorders of consciousness with combat- and noncombat-related brain injury.Arch Phys Med Rehabil. 2013; 94: 1861-1869
Correspondence American Academy of Neurology [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
This research was supported through a memorandum of understanding between the American Academy of Neurology, the American Congress of Rehabilitation Medicine, and the National Institute on Disability and Rehabilitation Research (NIDRR). In 2014, NIDRR was moved from the US Department of Education to the Administration for Community Living of the US Department of Health and Human Services, and was renamed the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). This article does not reflect the official policy or opinions of NIDILRR or HHS and does not constitute an endorsement by NIDILRR, HHS, or other components of the federal government.
Approved by the AAN Guideline Development, Dissemination, and Implementation Subcommittee on October 21,2017; by the AAN Practice Committee on April 9, 2018; by the American Congress of Rehabilitation Medicine Board of Governors on April 30, 2018; by the National Institute on Disability, Independent Living, and Rehabilitation Research Review Committee on April 5, 2018; and by the AAN Institute Board of Directors on May 2, 2018.
This practice guideline was endorsed by the American Academy of Physical Medicine and Rehabilitation on April 4, 2018; by the American College of Surgeons Committee on Trauma on July 3, 2018; and by the Child Neurology Society on April 17, 2018.
This special article is published simultaneously in Neurology® and the Archives of Physical Medical Rehabilitation. Neurology was responsible for peer review of this article.
This guideline is in the public domain: it may be copied, published, or shared without permission from the AAN, ACRM, or NIDILRR. Please use the following attribution when republishing it: This guideline was developed by the AAN, ACRM, and NIDILRR and was published online in Neurology and Archives of Physical Medicine and Rehabilitation on August 8, 2018.