BRIEF REPORT| Volume 103, ISSUE 9, P1870-1873, September 2022

Should Consistent Command-Following Be Added to the Criteria for Emergence From the Minimally Conscious State?

Published:April 06, 2022DOI:


      • 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.



      To determine whether consistent command-following (CCF) should be added to the diagnostic criteria for emergence from the minimally conscious state (eMCS).


      Retrospective cohort study.


      Inpatient rehabilitation hospital.


      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).


      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.


      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.


      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)
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