Department of Clinical Neurosciences, Neurology Service, Acute Neurorehabilitation Unit, University Hospital Lausanne, Lausanne, Switzerland.
Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland.
PLoS One. 2020 Feb 5;15(2):e0228474. doi: 10.1371/journal.pone.0228474. eCollection 2020.
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.
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.
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.
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.
探讨早期强化神经康复期间的功能和认知结果，并比较表现出认知运动分离（CMD）、意识障碍（DOC）和非-DOC 的患者的恢复模式。
我们对 141 例连续入住急性神经康复病房的严重获得性脑损伤患者进行了一项单中心观察性队列研究。我们根据入院时使用昏迷恢复量表修订版（CRS-R）和运动行为工具（MBT）的初始神经行为诊断，将患者分为三组：潜在临床 CMD，[N = 105]；DOC [N = 19]；非-DOC [N = 17]）。使用格拉斯哥结局量表、早期康复巴氏量表、残疾评定量表、拉霍亚认知功能水平量表、功能步行分类量表和改良 Rankin 量表在入院和出院时评估功能和认知结果。有意识意识恢复的确认基于 CRS-R 标准。
CMD 患者的功能结局和改善潜力明显优于 DOC。此外，CMD 患者的结局与非-DOC 患者的结局无显著差异。仅使用 CRS-R 量表；大约 30%的 CMD 患者在出院时没有恢复意识。
我们的发现支持这样一个事实，即表现出 CMD 状态的患者构成一个单独的类别，与 DOC 患者相比，他们具有不同的改善潜力和功能结局。这再次强调了急需识别 CMD 的必要性，因为它可能直接影响患者的护理，影响生死攸关的决策。
