A multicentre study of intentional behavioural responses measured using the Coma Recovery Scale-Revised in patients with minimally conscious state.
OBJECTIVE
To investigate which conscious behaviour is most frequently detected using the Coma Recovery Scale-Revised in patients with minimally conscious state.


METHODS
Multicentre, cross-sectional study.


METHODS
One intensive care unit, 8 post-acute rehabilitation centres and 2 long-term facilities.


METHODS
Fifty-two patients with established diagnosis of minimally conscious state of different aetiology.


METHODS
All patients were assessed by the Coma Recovery Scale-Revised.


RESULTS
In most patients (34/52) non-reflexive responses were identified by two or more subscales of the Coma Recovery Scale-Revised, whereas in 14 patients only the visual subscale could identify cortically-mediated behaviours, and in the remaining 4 patients only the motor subscale did so.The clinical signs of intentional behaviour were most often detected by the visual subscale (43/52 patients) and by the motor subscale (31/52), and least frequently by the oromotor/verbal subscale (3/52) of the Coma Recovery Scale-Revised. This clinical pattern was observed independently from time post-onset and aetiology.


CONCLUSIONS
Non-reflexive visual behaviour, identified by the visual subscale of Coma Recovery Scale-Revised, is the most frequently detected intentional sign consistent with the diagnosis of minimally conscious state, independently from aetiology and time post-onset.
Lab. for the study of Disorders of Consciousness, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy anna.estraneo@fsm.it.
Anna
A
Estraneo
Lab. for the study of Disorders of Consciousness, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy.
Pasquale
P
Moretta
Lab. for the study of Disorders of Consciousness, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy.
Viviana
V
Cardinale
Department of Rehabilitation, Cardinal Ferrari Hospital Fontanellato-Parma, Italy.
Antonio
A
De Tanti
Rehabilitation Medicine Unit, Ravenna Hospital, Ravenna, Italy.
Giordano
G
Gatta
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
Joseph T
JT
Giacino
Lab. for the study of Disorders of Consciousness, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy Neuropsychology Lab, Department of Psychology, Second University of Naples, Caserta, Italy.
Luigi
L
Trojano
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D005133:Eye Movements; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000503:physiopathology* / Q000523:psychology* / Q000534:rehabilitation; D011597:Psychomotor Performance / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology*; D015203:Reproducibility of Results; D055815:Young Adult
Coma Recovery Scale-Revised; Minimally conscious state; brain injury; intentional behaviours; rehabilitation