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. 2022 Sep;103(9):1870-1873.
doi: 10.1016/j.apmr.2022.03.010. Epub 2022 Apr 6.

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

Katherine Golden  1 , Kimberly S Erler  1 , John Wong  1 , Joseph T Giacino  2 , Yelena G Bodien  3
Affiliations

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

Katherine Golden et al. Arch Phys Med Rehabil. 2022 Sep.

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: Brain Injury; Consciousness; Diagnosis; Rehabilitation.

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Figures

Fig 1
Fig 1
(A) Temporal association between recovery of CCF and FOU/FC. On the x-axis, day 0 represents day of recovery of FOU/FC. Sixty patients recovered CCF on the same day as FOU/FC. Patients left of day 0 recovered CCF before FOU/FC; patients to the right of day 0 recovered CCF after eMCS. (B) Timeline of recovery of CCF and eMCS (ie, FOU/FC). Days are reported using medians. During the observation period, Group1CCF+FOU/FC recovered CCF and FOU/FC on same assessment day, Group2CCF→FOU/FC recovered CCF before FOU/FC, and Group3FOU/FC→CCF recovered FOU/FC before CCF.
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