Department of Occupational Therapy, Massachusetts General Hospital, Institute of Health Professions, Boston, MA, USA.
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA.
Arch Phys Med Rehabil. 2022 Sep;103(9):1870-1873. doi: 10.1016/j.apmr.2022.03.010. Epub 2022 Apr 6.
To determine whether consistent command-following (CCF) should be added to the diagnostic criteria for emergence from the minimally conscious state (eMCS).
Retrospective cohort study.
Inpatient rehabilitation hospital.
Patients (N=214) with acquired brain injury resulting in disorders of consciousness (DoC) admitted to a specialized rehabilitation program.
Difference between time to recovery of CCF and time to recovery of functional object use (FOU) or functional communication (FC), the 2 existing criteria for eMCS as measured by the Coma Recovery Scale-Revised (CRS-R).
Of 214 patients (median age, 53 years [interquartile range {IQR}, 34-66 years], male: 134 [62.6%], traumatic etiology: 115 [53.7%], admission CRS-R total score: 10 [IQR, 7-13]) admitted to rehabilitation without CCF, FOU, or FC, 162 (75.7%) recovered CCF and FOU or FC during the 8-week observation period. On average, recovery of CCF, FOU, and FC was observed within 1 day of one another, approximately 46 days (IQR, 38.25-58 days) post injury. One hundred and sixteen patients (71.6%) recovered FOU or FC prior to or at the same time as CCF.
In patients recovering from DoC, CCF reemerges around the same time as FOU and FC. This finding may reflect the shared dependency of these behaviors on cognitive processes (eg, language comprehension, attention, motor control) that are essential for effective interpersonal interaction and social participation. Our results support the addition of CCF to the existing diagnostic criteria for eMCS, but further validation in an independent sample should be conducted.
确定在最小意识状态（eMCS）的诊断标准中是否应加入一致的命令遵循（CCF）。
回顾性队列研究。
住院康复医院。
患有导致意识障碍（DoC）的获得性脑损伤并被专门康复计划收治的患者（N=214）。
通过修订后的昏迷恢复量表（CRS-R）测量的 CCF 恢复时间与功能性物体使用（FOU）或功能性交流（FC）恢复时间之间的差异，这是 eMCS 的两个现有标准。
在 214 名（中位年龄，53 岁[四分位距{IQR}，34-66 岁]，男性：134[62.6%]，创伤性病因：115[53.7%]，入院 CRS-R 总分：10[IQR，7-13]）未出现 CCF、FOU 或 FC 的患者中，有 162 名（75.7%）在 8 周观察期内恢复了 CCF 和 FOU 或 FC。平均而言，CCF、FOU 和 FC 的恢复在彼此之间的 1 天内发生，大约在损伤后 46 天（IQR，38.25-58 天）。有 116 名（71.6%）患者在 CCF 之前或同时恢复了 FOU 或 FC。
在从 DoC 中恢复的患者中，CCF 与 FOU 和 FC 同时重新出现。这一发现可能反映了这些行为共同依赖于认知过程（例如，语言理解、注意力、运动控制），这些过程对于有效的人际互动和社会参与至关重要。我们的结果支持将 CCF 添加到现有的 eMCS 诊断标准中，但应在独立样本中进一步验证。
