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Temporal Profile of Recovery of Communication in Patients With Disorders of Consciousness After Severe Brain Injury

  • Author Footnotes
    ∗ Martens and Bodien contributed equally to this work.
    Géraldine Martens
    Correspondence
    Corresponding author Géraldine Martens, MSc, Coma Science Group, GIGA Research, GIGA-Consciousness, University of Liège, 11 Avenue de l’Hopital, 4000 Liège (Sart Tilman), Belgium.
    Footnotes
    ∗ Martens and Bodien contributed equally to this work.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA

    Coma Science Group, GIGA Research, GIGA-Consciousness, University of Liège, Liège, Belgium

    Centre du Cerveau2, Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
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  • Author Footnotes
    ∗ Martens and Bodien contributed equally to this work.
    Yelena Bodien
    Footnotes
    ∗ Martens and Bodien contributed equally to this work.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA

    Laboratory for Neuroimaging in Coma and Consciousness, Massachusetts General Hospital, Boston, MA
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  • Amber Thomas
    Affiliations
    Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
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  • Joseph Giacino
    Affiliations
    Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
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  • Author Footnotes
    ∗ Martens and Bodien contributed equally to this work.
Published:February 27, 2020DOI:https://doi.org/10.1016/j.apmr.2020.01.015

      Highlights

      • Recovery of communication after severe acquired brain injury was investigated in an inpatient rehabilitation setting.
      • Half of patients recover functional communication within 7 weeks postinjury.
      • Referral to rehabilitation in severe acute cases should be encouraged because late recovery of communication is possible.

      Abstract

      Objective

      Characterize the temporal profile of recovery of communication after severe brain injury.

      Design

      Retrospective cohort study.

      Setting

      Inpatient rehabilitation hospital.

      Participants

      Patients with severe acquired brain injury and no evidence of communication on the Coma Recovery Scale-Revised (CRS-R) (N=175).

      Main Outcome Measures

      Time from injury to recovery of intentional communication (IC, inconsistent yes/no responses) and functional communication (FC, consistent and accurate yes/no responses) on the CRS-R Communication subscale.

      Results

      Patients (N=175) were included in the primary observation period of the first 8 weeks of inpatient rehabilitation (median [interquartile range, IQR]: 48 [27-61] years old, 105 men, 28 [21-38] days postinjury, 100 traumatic etiology). Fifty-four patients (31%) did not recover IC or FC. Thirty patients (17%) recovered IC only (median [IQR] days from injury to IC= 40 [34-54]), 72 patients (41%) recovered IC followed by FC (days from injury to FC=50 [42-61]), and 19 patients (11%) recovered FC without first recovering IC (43 [32-63]). The patients who recovered neither IC nor FC within 8 weeks of admission were admitted to rehabilitation later than those who recovered IC and/or FC (P<.01). Sixteen patients who did not recover communication within 8 weeks of admission to rehabilitation subsequently recovered FC prior to discharge.

      Conclusions

      In patients with severe brain injury receiving inpatient rehabilitation, discernible yes-no responses emerged approximately 6 weeks postinjury and became reliable 1 week later. Approximately 1 in 3 patients did not demonstrate IC or FC within 8 weeks of admission to rehabilitation, although 33% of these individuals recovered communication prior to discharge. In total, 61% of patients recovered FC prior to discharge from rehabilitation.

      Keywords

      List of abbreviations:

      CRS-R (Coma Recovery Scale-Revised), DoC (disorders of consciousness), FC (functional communication), IC (intentional communication), IQR (interquartile range)
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