Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Coma Science Group, GIGA Research, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium.
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging in Coma and Consciousness, Massachusetts General Hospital, Boston, MA.
Arch Phys Med Rehabil. 2020 Jul;101(7):1260-1264. doi: 10.1016/j.apmr.2020.01.015. Epub 2020 Feb 28.
Characterize the temporal profile of recovery of communication after severe brain injury.
Retrospective cohort study.
Inpatient rehabilitation hospital.
Patients with severe acquired brain injury and no evidence of communication on the Coma Recovery Scale-Revised (CRS-R) (N=175).
Time from injury to recovery of intentional communication (IC, inconsistent yes/no responses) and functional communication (FC, consistent and accurate yes/no responses) on the CRS-R Communication subscale.
Patients (N=175) were included in the primary observation period of the first 8 weeks of inpatient rehabilitation (median [interquartile range, IQR]: 48 [27-61] years old, 105 men, 28 [21-38] days postinjury, 100 traumatic etiology). Fifty-four patients (31%) did not recover IC or FC. Thirty patients (17%) recovered IC only (median [IQR] days from injury to IC= 40 [34-54]), 72 patients (41%) recovered IC followed by FC (days from injury to FC=50 [42-61]), and 19 patients (11%) recovered FC without first recovering IC (43 [32-63]). The patients who recovered neither IC nor FC within 8 weeks of admission were admitted to rehabilitation later than those who recovered IC and/or FC (P<.01). Sixteen patients who did not recover communication within 8 weeks of admission to rehabilitation subsequently recovered FC prior to discharge.
In patients with severe brain injury receiving inpatient rehabilitation, discernible yes-no responses emerged approximately 6 weeks postinjury and became reliable 1 week later. Approximately 1 in 3 patients did not demonstrate IC or FC within 8 weeks of admission to rehabilitation, although 33% of these individuals recovered communication prior to discharge. In total, 61% of patients recovered FC prior to discharge from rehabilitation.
描述严重脑损伤后沟通恢复的时间进程。
回顾性队列研究。
住院康复医院。
严重获得性脑损伤且昏迷恢复量表修订版（CRS-R）无沟通迹象的患者（N=175）。
从损伤到 CRS-R 沟通分量表上的意向性沟通（IC，不一致的是/否反应）和功能性沟通（FC，一致且准确的是/否反应）恢复的时间。
175 例患者纳入住院康复的前 8 周主要观察期（中位数[四分位距，IQR]：48[27-61]岁，105 例男性，损伤后 28[21-38]天，100 例创伤性病因）。54 例（31%）患者未恢复 IC 或 FC。30 例（17%）仅恢复 IC（从损伤到 IC 的中位数[IQR]天数=40[34-54]），72 例（41%）恢复 IC 后恢复 FC（从损伤到 FC 的中位数[IQR]天数=50[42-61]），19 例（11%）恢复 FC 而未先恢复 IC（43[32-63]）。在 8 周内未恢复 IC 和/或 FC 的患者入院时间晚于恢复 IC 和/或 FC 的患者（P<.01）。16 例在入院后 8 周内未恢复沟通的患者在出院前恢复了 FC。
在接受住院康复的严重脑损伤患者中，大约在损伤后 6 周出现可识别的是/否反应，大约 1 周后变得可靠。在 8 周内入院康复的患者中，约有 1/3 患者未出现 IC 或 FC，但其中 33%的患者在出院前恢复了沟通。总的来说，61%的患者在康复出院前恢复了 FC。
