Highlights
- •Criteria for emergence for the minimally conscious state are consensus-based.
- •Consistent command following recovers with functional object use and communication.
- •Consistent command following suggests emergence from the minimally conscious state.
Abstract
Objective
To determine whether consistent command-following (CCF) should be added to the diagnostic
criteria for emergence from the minimally conscious state (eMCS).
Design
Retrospective cohort study.
Setting
Inpatient rehabilitation hospital.
Participants
Patients (N=214) with acquired brain injury resulting in disorders of consciousness
(DoC) admitted to a specialized rehabilitation program.
Main Outcome Measures
Difference between time to recovery of CCF and time to recovery of functional object
use (FOU) or functional communication (FC), the 2 existing criteria for eMCS as measured
by the Coma Recovery Scale–Revised (CRS-R).
Results
Of 214 patients (median age, 53 years [interquartile range {IQR}, 34-66 years], male:
134 [62.6%], traumatic etiology: 115 [53.7%], admission CRS-R total score: 10 [IQR,
7-13]) admitted to rehabilitation without CCF, FOU, or FC, 162 (75.7%) recovered CCF
and FOU or FC during the 8-week observation period. On average, recovery of CCF, FOU,
and FC was observed within 1 day of one another, approximately 46 days (IQR, 38.25-58
days) post injury. One hundred and sixteen patients (71.6%) recovered FOU or FC prior
to or at the same time as CCF.
Conclusions
In patients recovering from DoC, CCF reemerges around the same time as FOU and FC.
This finding may reflect the shared dependency of these behaviors on cognitive processes
(eg, language comprehension, attention, motor control) that are essential for effective
interpersonal interaction and social participation. Our results support the addition
of CCF to the existing diagnostic criteria for eMCS, but further validation in an
independent sample should be conducted.
Keywords
List of abbreviations:
CCF (consistent command-following), CRS-R (Coma Recovery Scale–Revised), DoC (disorders of consciousness), eMCS (emergence from minimally conscious state), FC (functional communication), FOU (functional object use), IQR (Interquartile Range), MCS (minimally conscious state)To read this article in full you will need to make a payment
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References
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Article info
Publication history
Published online: April 06, 2022
Accepted:
March 20,
2022
Received in revised form:
March 15,
2022
Received:
December 19,
2021
Footnotes
This reference is for a published abstract in Arch Phys Med Rehab. The presentation was sponsored by the American Congress for Rehabilitation Medicine in 2009
Developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (90DPTB0011), which is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS), Tiny Blue Dot Foundation, and the James S. McDonnell Foundation.
Disclosures: none.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
