Recovery in cognitive motor dissociation after severe brain injury: A cohort study

Abstract

Objective To investigate the functional and cognitive outcomes during early intensive neurorehabilitation and to compare the recovery patterns of patients presenting with cognitive motor dissociation (CMD), disorders of consciousness (DOC) and non-DOC. Methods We conducted a single center observational cohort study of 141 patients with severe acquired brain injury, consecutively admitted to an acute neurorehabilitation unit. We divided patients into three groups according to initial neurobehavioral diagnosis at admission using the Coma Recovery Scale-Revised (CRS-R) and the Motor Behavior Tool (MBT): potential clinical CMD, [N = 105]; DOC [N = 19]; non-DOC [N = 17]). Functional and cognitive outcomes were assessed at admission and discharge using the Glasgow Outcome Scale, the Early Rehabilitation Barthel Index, the Disability Rating Scale, the Rancho Los Amigos Levels of Cognitive Functioning, the Functional Ambulation Classification Scale and the modified Rankin Scale. Confirmed recovery of conscious awareness was based on CRS-R criteria. Results CMD patients were significantly associated with better functional outcomes and potential for improvement than DOC. Furthermore, outcomes of CMD patients did not differ significantly from those of non-DOC. Using the CRS-R scale only; approximatively 30% of CMD patients did not recover consciousness at discharge. Interpretation Our findings support the fact that patients presenting with CMD condition constitute a separate category, with different potential for improvement and functional outcomes than patients suffering from DOC. This reinforces the need for CMD to be urgently recognized, as it may directly affect patient care, influencing life-or-death decisions.

Early discrimination of cognitive motor dissociation from disorders of consciousness: pitfalls and clues

“…Imaging (MRI or CT)-dominant sided parietalfronto-temporal lesions clinical CMD from those with true DOC [7,8,28]. The MBT was reported to detect residual cognition at very early stages after brain injury [7,8] and the present study showed consistent findings despite the presence of pitfalls.…”

Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies

“…A new behavioural assessment tool, the Motor Behaviour Tool — Revised (MBT‐r) 202 , has also been developed to complement the CRS-R by identifying subtle motor behaviours that reveal residual cognition. Evidence from a sample of 141 patients receiving inpatient rehabilitative care for severe brain injuries suggests that the MBT-r used in conjunction with the CRS-R detects consciousness with a greater sensitivity than the CRS-R alone 203 . Moreover, behavioural diagnoses derived from the MBT-r predicted functional recovery at discharge from the inpatient rehabilitation centre 203 .…”

Applied potential of task-free event-related paradigms for assessing neurocognitive functions in disorders of consciousness

“…These patients are referred to as patients with cognitive motor dissociation (CMD; Schiff, 2015 ). With the current assessment tools, patients with CMD are easily confused with patients with UWS or in MCS− ( Schiff, 2015 ; Edlow et al , 2017 ), however; it is crucial to be able to differentiate the groups, as patients with CMD are likely to have better functional outcomes ( Jöhr et al , 2020 ). Whether to regard CMD as a clinical dimension within DoC or as a patient category of its own is still a matter of some debate ( Schiff, 2015 ; Noel et al , 2019 ; Pincherle et al , 2019 ; Jöhr et al , 2020 ), but the importance of being able to recognize patients with CMD is undisputed.…”

“…With the current assessment tools, patients with CMD are easily confused with patients with UWS or in MCS− ( Schiff, 2015 ; Edlow et al , 2017 ), however; it is crucial to be able to differentiate the groups, as patients with CMD are likely to have better functional outcomes ( Jöhr et al , 2020 ). Whether to regard CMD as a clinical dimension within DoC or as a patient category of its own is still a matter of some debate ( Schiff, 2015 ; Noel et al , 2019 ; Pincherle et al , 2019 ; Jöhr et al , 2020 ), but the importance of being able to recognize patients with CMD is undisputed. The revised Motor Behaviour Tool has been suggested to help detect even very subtle signs of motor behaviour and thereby better differentiate patients with CMD from other patient categories ( Pignat et al , 2016 ; Pincherle et al , 2019 ).…”