Neurorehabilitation issues in states of disordered consciousness following traumatic brain injury

Multidisciplinary assessment measure for individuals with disorders of consciousness

OBJECTIVE

This study introduces the Comprehensive Assessment Measure for the Minimally Responsive Individual (CAMMRI) and reports on its development, inter-rater reliability, construct validity and clinical value.

METHODS

A multidisciplinary team of therapists developed this measure, which comprises 12 sub-tests that examine three main areas: Response to the Environment, Motor Control and Communication and Swallowing. The sub-tests are scored using a 7-point scale; sub-tests can also be administered individually. The measure was administered during a pilot project and then 1 year later to 12 adult clients with severe acquired brain injury at a long-term rehabilitation programme. The age range of the participants was 18-65 years; individuals were 1.5-10 years post-injury.

RESULTS

Comparison measures included the Western Neuro Sensory Stimulation Profile (WNSSP), the Coma Recovery Scale-Revised (CRS-R) and the Chedoke McMaster Impairment Inventory (CMII). Inter-rater reliability of each sub-test ranged from 0.87-1.0, with an average of 0.90 in the first year of the assessments.

CONCLUSION

Validity data supported the use of the CAMMRI for minimally conscious adults with ABI to measure behavioural changes and plan treatment for this population. Future research should focus on using this measure with other neurological populations.

Surrogate expectations in severe brain injury

OBJECTIVE

To understand what influences surrogate decision-makers' expectation that a patient with a disorder of consciousness (DOC; those in a coma, the vegetative state or the minimally conscious state) will recover.

SUBJECTS

Forty-one surrogates representing 37 DOC patients completed a survey about their experiences in having a family member with a DOC.

METHODS

A quantitative questionnaire assessed surrogate and patient's demographic, medical and psychosocial features that may explain surrogate's expectation of patient recovery.

RESULTS

Surrogates who were more relationally enmeshed with the patient thought the patient could communicate better and thought technology would improve treatment of patients with brain injury had greater expectations of recovery. Source of injury and patient's current diagnosis did not explain expectations.

CONCLUSION

Relational factors between the patient and the surrogate may explain the surrogate's expectation that the patient will recover more than factors that matter to clinicians such as the source of injury or the patient's diagnosis.