title: Impact of aphasia on consciousness assessment: a cross-sectional study.
abstract: BACKGROUND
  Previous findings suggest that language disorders may occur in severely brain-injured patients and could interfere with behavioral assessments of consciousness. However, no study investigated to what extent language impairment could affect patients' behavioral responses. Objective. To estimate the impact of receptive and/or productive language impairments on consciousness assessment.
  
  
  METHODS
  Twenty-four acute and subacute stroke patients with different types of aphasia (global, n = 11; Broca, n = 4; Wernicke, n = 3; anomic, n = 4; mixed, n = 2) were recruited in neurology and neurosurgery units as well as in rehabilitation centers. The Coma Recovery Scale-Revised (CRS-R) was administered.
  
  
  RESULTS
  We observed that 25% (6 out of 24) of stroke patients with a diagnosis of aphasia and 54% (6 out of 11) of patients with a diagnosis of global aphasia did not reach the maximal CRS-R total score of 23. An underestimation of the consciousness level was observed in 3 patients with global aphasia who could have been misdiagnosed as being in a minimally conscious state, even in the absence of any documented period of coma. More precisely, lower subscores were observed on the communication, motor, oromotor, and arousal subscales.
  
  
  CONCLUSIONS
  Consciousness assessment may be complicated by the co-occurrence of severe language deficits. This stresses the importance of developing new tools or identifying items in existing scales, which may allow the detection of language impairment in severely brain-injured patients.
authors.affiliation: University of Liège, Liege, Belgium University Hospital of Liege, Liege, Belgium c.schnakers@gmail.com.
authors.forename: Caroline
authors.initials: C
authors.lastname: Schnakers
authors.affiliation: University of Liège, Liege, Belgium.
authors.forename: Helene
authors.initials: H
authors.lastname: Bessou
authors.affiliation: Rehanova Neurorehabilitation Center, Cologne-Merheim, Germany.
authors.forename: Ilona
authors.initials: I
authors.lastname: Rubi-Fessen
authors.affiliation: Rehanova Neurorehabilitation Center, Cologne-Merheim, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hartmann
authors.affiliation: University Hospital of Cologne, Cologne, Germany Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich, Germany.
authors.forename: Gereon R
authors.initials: GR
authors.lastname: Fink
authors.affiliation: University Hospital of Cologne, Cologne, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Meister
authors.affiliation: Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Giacino
authors.affiliation: University of Liège, Liege, Belgium University Hospital of Liege, Liege, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
authors.affiliation: University of Liège, Liege, Belgium.
authors.forename: Steve
authors.initials: S
authors.lastname: Majerus
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001037:Aphasia / Q000145:classification / Q000209:etiology* / Q000534:rehabilitation; D003243:Consciousness / Q000502:physiology*; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications* / Q000523:psychology; D016138:Walking
keywords: aphasia; consciousness; scales; stroke