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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 27, 2020
Footnotes
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (grant no. 90DPTB0011), which is a Center within the Administration for Community Living, Department of Health and Human Services, University of Liège (LEAR Foundation), the Wallonia-Brussels Federation, Wallonie-Bruxelles International (WBI.World), Tiny Blue Dot Foundation, and the James S. McDonnell Foundation.
Disclosures: none
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
