Behavioral scales variability in patients with prolonged disorders of consciousness

Abstract

Background The principal conditions differentiating disorders of consciousness (DOC) patients are the unresponsive wakefulness syndrome/vegetative state (UWS/VS) and the minimally conscious state (MCS). Many individuals who suffer from sudden-onset severe brain injury move through stages of UWS/VS and MCS before regaining full awareness. In some patients, the DOC condition is protracted for years (PDOC). In this study, we observed PDOC patients for 6 months to assess possible changes in their level of consciousness. Methods We enrolled 40 PDOC patients, 23 UWS/VS and 17 MCS hosted in a dedicated unit for long-term brain injury care. The time from injury was 472 ± 533 days for UWS/VS and 1090 ± 1079 days for MCS. The Wessex Head Injury Matrix (WHIM), Coma Recovery Scale-R (CRS-R), and Nociception Coma Scale were administered monthly for 6 months. Results During the period of assessment, the percentage of UWS/VS shifted from 58 to 45%, while for the MCS, from 42 to 55%. A positive correlation was found for the UWS/VS patients between the months of observation with the CRS-R total score and WHIM total numbers of behaviors (TNB). In the UWS/VS group, the CRS-R auditive and visual subscales correlated positively with the observation time. During the whole period of observation, 8 patients had constant CRS-R total scores while the WHIM TNB changed in 7 of them. Conclusion Our findings demonstrated that the monthly assessment of PDOC by means of the CRS-R and WHIM was able to detect also subtle changes in consciousness level.

Wessex Head Injury Matrix in Patients with Prolonged Disorders of Consciousness: A Reliability Study

“…However, this does not necessarily denote greater overall sensitivity, and careful consideration is needed when comparing these tools due to their differing measurement factors and the inherent complexities in diagnosing disorders of consciousness [16,24].…”

“…WHIM is among the scales recommended for clinical use [3,8]. It has been shown to be promising in assessing and monitoring the recovery of patients with severe head injuries and PDOC, and provides a standardized approach to evaluate cognitive and functional changes over time [16].…”

Stimulation of vagus nerve for patients with disorders of consciousness: a systematic review

“…Disorders of consciousness (DOCs) refer to prolonged periods of impaired awareness following severe brain injuries or neurological impairments, such as traumatic brain injury (TBI), stroke, hypoxic-ischemic encephalopathy (HIE) and other related conditions (Dostovic et al, 2012;Eapen et al, 2017;Malone et al, 2019). The DOCs can be classified into four categories based on their neurobehavioral function: coma, vegetative state/unresponsive wakefulness state Dong et al 10.3389/fnins.2023.1257378 Frontiers in Neuroscience 02 frontiersin.org (VS/UWS), minimally conscious state (MCS), and the emergence from MCS to higher consciousness level, namely eMCS (Cortese et al, 2023;Li et al, 2023). Comas are states of unconsciousness characterized by a lack of arousal and consciousness.…”