Behavioral Recovery in Disorders of Consciousness: A Prospective Study With the Spanish Version of the Coma Recovery Scale–Revised

Noé, Enrique; Olaya, José; Navarro, María Dolores; Noguera, Paloma; Colomer, Carolina; García-Panach, Javier; Rivero, Sandra G. M.; Moliner, B.; Ferri, J.

doi:10.1016/j.apmr.2011.08.048

Cited by 60 publications

(52 citation statements)

References 26 publications

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“…Each nursing staff member filled a median of 4 [1-12] evaluations. Median delay between the first and the last individual rating was 6 days [5-9]. No statistical differences were found between UWS and MCS in terms of number of DoC-feeling ratings per patient, number of rater per patient or in terms of number of ratings per rater.…”

Section: Resultsmentioning

confidence: 99%

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“DoC-feeling”: a new behavioural tool to help diagnose the Minimally Conscious State

Hermann

Goudard

Courcoux

et al. 2018

Preprint

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ObjectivesThe clinical distinction between vegetative state/unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) is a key step to elaborate a prognosis and formulate an appropriate medical plan for any patient suffering from disorders of consciousness (DoC). However, this assessment is often challenging and may require specialized expertise. In this study, we hypothesized that pooling subjective reports of the level of consciousness of a given patient across several nursing staff members can be used to clinically detect MCS.Setting and ParticipantsPatients referred for consciousness assessment were prospectively screened. MCS (target condition) was defined according to the best Coma Recovery Scale-Revised score (CRS-R) obtained from expert physicians (reference standard). “DoC-feeling” score consisted in the median value of multiple ratings of patient’s behavior observation pooled from multiple staff members during a week of hospitalisation (index test). Individual ratings were collected at the end of each shift using a 100mm visual analog scale, blinded from the reference standard. Diagnostic accuracy was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity and specificity metrics.Results692 ratings performed by 83 nursing staff members were collected from 47 patients. Twenty patients were in a UWS and 27 in a MCS. DoC-feeling scores obtained by pooling all individual ratings obtained for a given patient were significantly greater in MCS than in UWS patients (59.2 mm [IQR: 27.3-77.3] vs. 7.2 mm [IQR: 2.4-11.4]; p<0.001) yielding an AUC of 0.92 (95%CI: 0.84-0.99).ConclusionsDoC-feeling capitalizes on the expertise of nursing staff to evaluate patients’ consciousness. Together with the CRS-R as well as with brain imaging, DoC-feeling might improve diagnostic and prognostic accuracy of DoC patients.Strengths and limitations of this studyWe designed a new behavioural tool called “DoC-feeling” to help face the clinical challenge of the detection of Minimally Conscious State in patients suffering from disorders of consciousness (DoC)“DoC-feeling score” quantifies nursing staff’s subjective perception of patient’s consciousness by pooling multiple assessments obtained from multiple caregivers (“wisdom of the crowds”)This score which requires no particular training showed a very good accuracy when compared to the gold standard (repeated expert clinical assessment using the Coma Recovery Scale – Revised (CRS-R))A validation in a separate cohort would help to determine its place in consciousness assessmentThis score should be tested not only against the CRS-R but also against brain-imaging techniques to test for its capacity to detect covert signs of consciousness

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Section: Resultsmentioning

confidence: 99%

“…Overall, patients underwent 12 [9-19] DoC-feeling individual ratings performed by 7 [5-10] different raters. All DoC-feeling ratings obtained for a given patient were summarized using the median to obtain a pooled metric called DoC-feeling score (index test, Figure 4 a).…”

Section: Resultsmentioning

confidence: 99%

“DoC-feeling”: a new behavioural tool to help diagnose the Minimally Conscious State

Hermann

Goudard

Courcoux

et al. 2018

Preprint

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“…In this situation, indirect cues collected through functional brain-imaging methods such as neurophysiological tolls we presented above can be very helpful. Indeed, the distinction between VS and MCS patient has an important impact on the prognosis of consciousness recovery (80,81).…”

Section: Discussionmentioning

confidence: 99%

Disentangling conscious from unconscious cognitive processing with event-related EEG potentials

Rohaut¹,

Naccache

2017

Revue Neurologique

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By looking for properties of consciousness, cognitive neuroscience studies have dramatically enlarged the scope of unconscious cognitive processing. This emerging knowledge inspired the development of new approaches allowing clinicians to probe and disentangle conscious from unconscious cognitive processes in non-communicating brain-injured patients both in terms of behaviour and brain activity. This information is extremely valuable in order to improve diagnosis and prognosis in such patients both at acute and chronic settings. Reciprocally, the growing observations coming from such patients suffering from disorders of consciousness provide valuable constraints to theoretical models of consciousness. In this review we chose to illustrate these recent developments by focusing on brain signals recorded with EEG at bedside in response to auditory stimuli. More precisely, we present the respective EEG markers of unconscious and conscious processing of two classes of auditory stimuli (sounds and words). We show that in both cases, conscious access to the corresponding representation (e.g.: auditory regularity and verbal semantic content) share a similar neural signature (P3b and P600/LPC) that can be distinguished from unconscious processing occurring during an earlier stage (MMN and N400). We propose a two-stage serial model of processing and discuss how unconscious and conscious signatures can be measured at bedside providing relevant informations for both diagnosis and prognosis of consciousness recovery. These two examples emphasize how fruitful can be the bidirectional approach exploring cognition in healthy subjects and in brain-damaged patients.

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“…A third group of people show levels of recovery falling somewhere between the aforementioned two extremes (Bekinschtein et al, 2005;Laureys & Schiff, 2012;Noé et al, 2012;Pistoia, Mura, Govoni, Fini, & Sarà, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…This last group includes, among others, persons who have emerged from a minimally conscious state but present with extensive neuro-motor impairment and lack of or minimal verbal skills that reduce their opportunities of engagement and communication (Cavinato et al, 2009;Katz et al, 2009;Leisman & Kock, 2009;Noé et al, 2012;Rispoli, Machalicek, & Lang, 2010;Wallace & Bradshaw, 2011). Intervention programs for these persons would need to (a) support/facilitate their occupation and communication and (b) resort to the use of assistive technology solutions to bypass or reduce the negative impact of their disabilities (Bauer, Elsaesser, & Arthanat, 2011;Borg, Larson, &Östergren, 2011;Chantry & Dunford, 2010;De Joode, Van Boxtel, Verhey, & Van Heugten, 2012;Lancioni, O'Reilly, Singh, Sigafoos, Buonocunto et al, 2011;Lancioni, Singh, O'Reilly, Sigafoos, Colonna et al, 2012;Lancioni, Singh, O'Reilly, Sigafoos, Ricci et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Post-coma persons with multiple disabilities use assistive technology for their leisure engagement and communication

Lancioni

Singh

O’Reilly

et al. 2014

NRE

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BACKGROUND: Interventions for post-coma persons, who have emerged from a minimally conscious state but present with extensive neuro-motor impairment and lack of or minimal verbal skills, need to promote occupation and communication through the use of assistive technology. OBJIECTIVE: These two studies were aimed at assessing two technology-aided programs to promote leisure engagement and communication for three post-coma participants with multiple disabilities. METHODS: Study I assessed a program to allow a woman and a man with extensive neuro-motor impairment and lack of speech to switch on music and videos, make requests to caregivers, and send messages to (communicate with) relevant partners and receive messages from those partners. Study II assessed a program to allow a post-coma woman with extensive motor impairment and reduced verbal behavior to activate music, videos and requests, send and receive messages, and make telephone calls. RESULTS: Data showed that both programs were successful. The participants of Study I managed leisure engagement, requests, as well as text messaging. The participant of Study II showed consistent leisure engagement, text messaging, and telephone calls. CONCLUSIONS: Assistive technology can be profitably used to provide post-coma persons with multiple disabilities relevant leisure and communication opportunities.

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Behavioral Recovery in Disorders of Consciousness: A Prospective Study With the Spanish Version of the Coma Recovery Scale–Revised

Cited by 60 publications

References 26 publications

“DoC-feeling”: a new behavioural tool to help diagnose the Minimally Conscious State

“DoC-feeling”: a new behavioural tool to help diagnose the Minimally Conscious State

Disentangling conscious from unconscious cognitive processing with event-related EEG potentials

Post-coma persons with multiple disabilities use assistive technology for their leisure engagement and communication

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