title: Clinical and neuropsychological long-term outcomes after late recovery of responsiveness: a case series.
abstract: OBJECTIVE
  To report clinical conditions and neuropsychological functioning of patients with late recovery of responsiveness at least 5 years after injury.
  
  
  METHODS
  Patient series.
  
  
  METHODS
  Patients discharged from an inpatient rehabilitation unit.
  
  
  METHODS
  Patients (N=13) who recovered from a vegetative state 1 year after severe traumatic brain injury or 6 months after nontraumatic brain injury.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Coma Recovery Scale-Revised, Disability Rating Scale, and FIM. For patients who recovered full consciousness, neuropsychological tests specifically adapted for patients with very severe disabilities were used.
  
  
  RESULTS
  After regaining responsiveness, 2 patients died because of severe clinical complications. Among the remaining 11 patients, 5 were still in a minimally conscious state at their last assessment, but 4 of them had recovered some complex behavioral responses to the environment (eg, they could follow simple commands, albeit inconsistently). Six patients had emerged from a minimally conscious state at the last evaluation. Severe functional disability was present in both patients who were conscious and patients who were minimally conscious. No patient was autonomous in common daily life activities or in transfers. All patients who were conscious showed variable cognitive impairments, and some of them also developed behavioral and psychological symptoms. However, such disturbances did not impede the patients' interaction with relatives and caregivers.
  
  
  CONCLUSIONS
  This study provides systematic data about the course of the disease in a cohort of patients that was previously considered as exceptional. Patients with late recovery show a variable degree of functional recovery, although they experience marked residual motor and cognitive disabilities. The present findings contribute to enhance the understanding of the course of the disease in patients with late recovery and might help clinicians optimize the levels of care and provide the patients' families with correct information.
authors.affiliation: Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme, Telese Terme, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Estraneo
authors.affiliation: Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme, Telese Terme, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Moretta
authors.affiliation: Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme, Telese Terme, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Loreto
authors.affiliation: Department of Neurological Sciences, Federico II University, Naples, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Santoro
authors.affiliation: Neuropsychology Laboratory, Department of Psychology, Second University of Naples, Caserta, Italy. Electronic address: luigi.trojano@unina2.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Trojano
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000534:rehabilitation; D002648:Child; D003072:Cognition Disorders / Q000209:etiology; D003243:Consciousness; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D018458:Persistent Vegetative State / Q000150:complications* / Q000534:rehabilitation; D011782:Quadriplegia / Q000209:etiology; D020127:Recovery of Function; D013997:Time Factors; D055815:Young Adult
keywords: Outcome assessment (health care); Persistent vegetative state; Rehabilitation