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Binder M, Papiernik J, Griskova-Bulanova I, Frycz S, Chojnacki B, Górska-Klimowska U. Diagnosing awareness in disorders of consciousness with gamma-band auditory responses. Front Hum Neurosci 2024; 17:1243051. [PMID: 38249572 PMCID: PMC10796678 DOI: 10.3389/fnhum.2023.1243051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/28/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction The prolonged disorders of consciousness (pDOC) describe a group of neurological conditions characterized by severe impairment of consciousness resulting from the injury of the central nervous system. As the behavioral diagnosis of pDOC remains challenging, the methods based on observing brain activity appear as promising alternatives. One of these methods is electroencephalography, which allows for noninvasive assessment of brain function. Methods In this study, we evaluated evoked auditory responses to the chirp-modulated auditory stimulation as a potential biomarker of awareness in pDOC. Chirp-modulated stimulation is based on the repetitive presentation of auditory stimuli with a changing frequency over time. Two protocols were tested: amplitude-modulated narrow-band chirps (frequency range 25-55 Hz) and click-based wide-band chirps (30-100 Hz). The studied pDOC patient group included 62 patients (19 females and 43 males, mean age 40.72 years) diagnosed with Coma Recovery Scale-Revised. Envelope-following responses to stimulation were examined using the intertrial phase clustering coefficient. Results For both types of stimulation, the strength of the response in the low-gamma range (around 40 Hz) was related to the diagnosis of pDOC. Patients diagnosed with unresponsive wakefulness syndrome exhibited diminished responses, while more favorable diagnoses, suggesting awareness (minimally conscious state or emergence from the minimally conscious state), showed elevated responses. The variations in the integrity of the auditory pathway and the etiology of brain injury altered the observed response strength. Narrow-band stimulation yielded a more systematic relationship between low-gamma response and pDOC diagnosis. Discussion The results suggest the potential role of low gamma-band responses to chirp-modulated stimulation as the supportive diagnostic tool to detect awareness in the pDOC patient group.
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Affiliation(s)
- Marek Binder
- Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Julia Papiernik
- Institute of Psychology, Jagiellonian University, Kraków, Poland
- Doctoral School in the Social Sciences, Jagiellonian University, Kraków, Poland
| | | | - Sandra Frycz
- Institute of Psychology, Jagiellonian University, Kraków, Poland
- Doctoral School in the Social Sciences, Jagiellonian University, Kraków, Poland
| | - Bartłomiej Chojnacki
- Department of Mechanics and Vibroacoustics, Faculty of Mechanical Engineering and Robotics, AGH University of Krakow, Kraków, Poland
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Jang S, Choi E. Relationship between Coma Recovery Scale-Revised and the Thalamocortical Tract of Ascending Reticular Activating System in Hypoxic-Ischemic Brain Injury: A Pilot Study. Healthcare (Basel) 2023; 11:healthcare11081148. [PMID: 37107982 PMCID: PMC10137777 DOI: 10.3390/healthcare11081148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND This pilot study examined the relationship between the Coma Recovery Scale-Revised (CRS-R) and the five subparts of the thalamocortical tract in chronic patients with hypoxic-ischemic brain injury by diffusion tensor tractography (DTT). METHODS Seventeen consecutive chronic patients with hypoxic-ischemic brain injury were recruited. The consciousness state was evaluated using CRS-R. The five subparts of the thalamocortical tract (the prefrontal cortex, the premotor cortex, the primary motor cortex, the primary somatosensory cortex, and the posterior parietal cortex) were reconstructed using DTT. Fractional anisotropy and the tract volume of each subpart of the thalamocortical tract were estimated. RESULTS The CRS-R score showed a moderate positive correlation with the tract volume of the prefrontal cortex part of the thalamocortical tract (p < 0.05). In addition, the tract volume of the prefrontal cortex component of the thalamocortical tract could explain the variability in the CRS-R score (p < 0.05). CONCLUSION The prefrontal cortex part was closely related to the CRS-R score in chronic patients with hypoxic-ischemic brain injury. In addition, the change in the remaining number of neural fibers of the prefrontal cortex part appeared to be related to the change in conscious state.
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Affiliation(s)
- Sungho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Eunbi Choi
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
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Zhou YF, Kang JW, Xiong Q, Feng Z, Dong XY. Transauricular vagus nerve stimulation for patients with disorders of consciousness: A randomized controlled clinical trial. Front Neurol 2023; 14:1133893. [PMID: 36937511 PMCID: PMC10017768 DOI: 10.3389/fneur.2023.1133893] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Disorders of consciousness (DoCs) are a frequent complication of brain injury disease, and effective treatments are currently lacking. Transauricular vagus nerve stimulation (tVNS) has been proposed as a promising therapeutic method for neurological disorders such as epilepsy and depression. In our previous study, we demonstrated that vagus nerve stimulation promoted recovery in rats with DoCs caused by traumatic brain injury. However, the clinical effect of vagus nerve stimulation on consciousness disorders is unclear. We aimed to investigate the therapeutic efficacy and safety of tVNS in patients with DoCs. Methods We conducted a randomized, double-blinded, sham-controlled trial. Patients (N = 60) with DoCs, including minimally conscious state (MCS) and vegetative state/unresponsive wakefulness syndrome, were enrolled and randomized to groups receiving either active or sham tVNS. A frequency of 20 Hz and pulse wave of 200 us was used in the active-tVNS protocol, which was performed in the auricular branch of the vagus nerve in the left outer ear. The sham-tVNS protocol was the same as the active-tVNS protocol although without current input. Both groups of patients also received conventional treatments. Consciousness was evaluated according to the Coma Recovery Scale-Revised before and after the 4-week intervention. We also recorded the type and number of behavioral responses. Safety was primarily assessed according to the incidence of treatment-emergent adverse events. Each patient's heart rate and blood pressure were monitored during all treatment sessions. Results Ultimately, 57 patients completed the study: 28 patients underwent active tVNS and 29 patients underwent sham tVNS. No significant differences were observed in Coma Recovery Scale-Revised scores between the active- and sham-tVNS groups before the tVNS sessions. Compared with patients in the sham-tVNS group (9.28 ± 4.38), patients with DoCs treated with active tVNS showed improved consciousness (10.93 ± 4.99), although not statistically significant. Further analysis revealed obvious differences between patients with MCS receiving active and sham tVNS, but no significant difference in patients with vegetative state/unresponsive wakefulness syndrome in both groups. All side effects were considered common medical conditions with no obvious correlation to tVNS. Conclusion These preliminary data provide early evidence that tVNS may be an effective and safe approach for promoting the recovery of consciousness, especially in patients with MCS. Clinical trial registration https://www.chictr.org.cn/edit.aspx?pid=175938&htm=4, identifier: ChiCTR2200066629.
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Halbmayer LM, Kofler M, Hitzenberger G, Matzak H, Fava E, Genelin E, Werkmann M, Saltuari L, Versace V, Dobesberger J, Pucks-Faes E. On the recovery of disorders of consciousness under intrathecal baclofen administration for severe spasticity-An observational study. Brain Behav 2022; 12:e2566. [PMID: 35398998 PMCID: PMC9120732 DOI: 10.1002/brb3.2566] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/30/2022] [Accepted: 03/05/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Occasionally, patients show dramatic recovery from disorders of consciousness (DOC) under intrathecal baclofen (ITB), an established treatment option for severe supraspinal spasticity. Anecdotal explanations for ITB-related recovery of cognition include modulation of afferent impulses at the spinal level, thereby reducing spasticity-related proprioceptive information overload within cortico-thalamo-cortical connections. OBJECTIVE In this retrospective patient chart analysis, we assessed whether a reduction in spasticity would be associated with an increase in Coma Recovery Scale revised (CRS-R) scores in a larger sample of patients than previously published. METHODS From a hospital-based ITB treatment register, we extracted data from 26 patients with DOC and severe supraspinal spasticity who improved by >2 points on the Coma Recovery Scale revised (CRS-R) within 6 months after ITB treatment initiation. We assessed Modified Ashworth scale (MAS) scores and CRS-R scores on admission (PRE) and 3 and 6 months after initiation of ITB treatment (3M, 6M). We performed correlation analysis of the scores and their respective changes (PRE to 3M, 3M to 6M). We also correlated the time from acute event until ITB initiation to CRS-R scores at 3M and 6M. RESULTS ITB led to significant improvement in spasticity based on MAS scores, which did not correlate to the improvements seen in CRS-R total and subscale scores. Daily ITB dose did neither correlate to MAS scores nor to CRS-total scores in the whole patient group, but after 3 months, ITB dose correlated to some CRS-R subscale scores in some patient subgroups. Time until ITB treatment did not correlate to CRS-R scores later on. CONCLUSIONS Our data confirm that ITB may exert beneficial effects in selected DOC patients with respect to improved cognitive functions, which, however, do not correlate to its antispastic effect. The lack of correlation between time to ITB and CRS-R outcome, but significant CRS-R improvements following pump implantation, renders spontaneous remissions unlikely and leaves room for alternative pharmacological mechanisms.
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Affiliation(s)
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | | | | | - Elena Fava
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | | | - Mario Werkmann
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno, Italy.,Research Unit for Neurorehabilitation, Bolzano, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno, Italy
| | - Judith Dobesberger
- Rehabilitation Center Großgmain, Pensionsversicherungsanstalt, Teaching Hospital of Paracelsus Medical University, Salzburg, Austria
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Yang H, Ye C, Liu X, Sun L, Wang A, Wang J, Hu N, Hu X, Gosseries O, Laureys S, Di H, Fang J. Corrigendum: Estimating the Minimal Number of Repeated Examinations for Random Responsiveness With the Coma Recovery Scale-Revised as an Example. Front Integr Neurosci 2021; 15:745196. [PMID: 34602989 PMCID: PMC8485934 DOI: 10.3389/fnint.2021.745196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fnint.2021.685627.].
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Affiliation(s)
- Hao Yang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Chengyin Ye
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xiaochen Liu
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Lingxiu Sun
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Anqi Wang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Jing Wang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Nantu Hu
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Xiaohua Hu
- Hangzhou Wujing Hospital, Hangzhou, China
| | - Olivia Gosseries
- Coma Science Group, GIGA- Consciousness and Centre du Cerveau, University and University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA- Consciousness and Centre du Cerveau, University and University Hospital of Liège, Liège, Belgium
| | - Haibo Di
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Jiqian Fang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
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Yang H, Ye C, Liu X, Sun L, Wang A, Wang J, Hu N, Hu X, Gosseries O, Laureys S, Di H, Fang J. Estimating the Minimal Number of Repeated Examinations for Random Responsiveness With the Coma Recovery Scale-Revised as an Example. Front Integr Neurosci 2021; 15:685627. [PMID: 34305542 PMCID: PMC8297543 DOI: 10.3389/fnint.2021.685627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to develop a general method to estimate the minimal number of repeated examinations needed to detect patients with random responsiveness, given a limited rate of missed diagnosis. Methods: Basic statistical theory was applied to develop the method. As an application, 100 patients with disorders of consciousness (DOC) were assessed with the Coma Recovery Scale–Revised (CRS-R). DOC patients were supposed to be examined for 13 times over 20 days, while anyone who was diagnosed as a minimally conscious state (MCS) in a round would no longer be examined in the subsequent rounds. To test the validation of this method, a series of the stochastic simulation was completed by computer software under all the conditions of possible combinations of three kinds of distributions for p, five values of p, and four sizes of the sample and repeated for 100 times. Results: A series of formula was developed to estimate the probability of a positive response to a single examination given by a patient and the minimal number of successive examinations needed based on the numbers of patients detected in the first i (i =1, 2,.) rounds of repeated examinations. As applied to the DOC patients assessed with the CRS-R, with a rate of missed diagnosis < 0.0001, the estimate of the minimal number of examinations was six in traumatic brain injury patients and five in non-traumatic brain injury patients. The outcome of the simulation showed that this method performed well under various conditions possibly occurring in practice. Interpretation: The method developed in this paper holds in theory and works well in application and stochastic simulation. It could be applied to any other kind of examinations for random responsiveness, not limited to CRS-R for detecting MCS; this should be validated in further research.
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Affiliation(s)
- Hao Yang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Chengyin Ye
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xiaochen Liu
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Lingxiu Sun
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Anqi Wang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Jing Wang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Nantu Hu
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Xiaohua Hu
- Hangzhou Wujing Hospital, Hangzhou, China
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness and Centre du Cerveau, University and University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness and Centre du Cerveau, University and University Hospital of Liège, Liège, Belgium
| | - Haibo Di
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Jiqian Fang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
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Bareham CA, Allanson J, Roberts N, Hutchinson PJA, Pickard JD, Menon DK, Chennu S. Longitudinal assessments highlight long-term behavioural recovery in disorders of consciousness. Brain Commun 2019; 1:fcz017. [PMID: 31886461 PMCID: PMC6924536 DOI: 10.1093/braincomms/fcz017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/13/2019] [Accepted: 08/25/2019] [Indexed: 11/30/2022] Open
Abstract
Accurate diagnosis and prognosis of disorders of consciousness is complicated by the variability amongst patients' trajectories. However, the majority of research and scientific knowledge in this field is based on cross-sectional studies. The translational gap in applying this knowledge to inform clinical management can only be bridged by research that systematically examines follow-up. In this study, we present findings from a novel longitudinal study of the long-term recovery trajectory of 39 patients, repeatedly assessed using the Coma Recovery Scale-Revised once every 3 months for 2 years, generating 185 assessments. Despite the expected inter-patient variability, there was a statistically significant improvement in behaviour over time. Further, improvements began approximately 22 months after injury. Individual variation in the trajectory of recovery was influenced by initial diagnosis. Patients with an initial diagnosis of unresponsive wakefulness state, who progressed to the minimally conscious state, did so at a median of 485 days following onset-later than 12-month period after which current guidelines propose permanence. Although current guidelines are based on the expectation that patients with traumatic brain injury show potential for recovery over longer periods than those with non-traumatic injury, we did not observe any differences between trajectories in these two subgroups. However, age was a significant predictor, with younger patients showing more promising recovery. Also, progressive increases in arousal contributed exponentially to improvements in behavioural awareness, especially in minimally conscious patients. These findings highlight the importance of indexing arousal when measuring awareness, and the potential for interventions to regulate arousal to aid long-term behavioural recovery in disorders of consciousness.
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Affiliation(s)
- Corinne A Bareham
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Judith Allanson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Neil Roberts
- Sawbridgeworth Medical Services, Jacobs & Gardens Neuro Centres, Sawbridgeworth CM21 0HH, UK
| | - Peter J A Hutchinson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - John D Pickard
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Srivas Chennu
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
- School of Computing, University of Kent, Chatham Maritime, ME4 4AG, UK
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Mochalova EG, Legostaeva LA, Zimin AA, Yusupova DG, Sergeev DV, Ryabinkina YV, Bodien Y, Suponeva NA, Piradov MA. [The Russian version of Coma Recovery Scale-revised - a standardized method for assessment of patients with disorders of consciousness]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:25-31. [PMID: 29798977 DOI: 10.17116/jnevro20181183225-31] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors officially present for the first time the Russian version of Coma Recovery Scale-Revised (CRS-R). Today CRS-R is the only validated scale in Russian for assessment of patients with chronic disorders of consciousness (DOC). The study showed high consistency for different researchers, high sensitivity in the evaluation of patients over time as well as high concurrent validity. This article contains the text of the scale and recommendations how to use CRS-R and interpret the data. Presented version of the CRS-R is recommended for use in DOC patients. Russian version of the CRS-R is a standardized, comprehensive and systematic approach to the examination and assessment of patients with chronic DOS. It ensures the standard approach to examination and assessment that warrants the accuracy and homogeneity of the obtained results.
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Affiliation(s)
| | | | - A A Zimin
- Research Center of Neurology, Moscow, Russia
| | | | - D V Sergeev
- Research Center of Neurology, Moscow, Russia
| | | | - Y Bodien
- Spaulding Rehabilitation Hospital Harvard Medical School, Boston, MA, USA
| | | | - M A Piradov
- Research Center of Neurology, Moscow, Russia
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Zhang Y, Wang J, Schnakers C, He M, Luo H, Cheng L, Wang F, Nie Y, Huang W, Hu X, Laureys S, Di H. Validation of the Chinese version of the Coma Recovery Scale-Revised (CRS-R). Brain Inj 2019; 33:529-533. [PMID: 30663434 DOI: 10.1080/02699052.2019.1566832] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PRIMARY OBJECTIVE This study aims to validate the Chinese version of the Coma Recovery Scale-Revised (CRS-R). METHODS One hundred sixty-nine patients were assessed with both the CRS-R and the Glasgow Coma Scale (GCS), diagnosed as being in unresponsive wakefulness syndrome (UWS, formerly known as vegetative state), minimally conscious state (MCS), or emergence from MCS (EMCS). A subgroup of 50 patients has been assessed twice by the same rater, within 24 h. Patient outcome was documented six months after assessment. RESULTS The internal consistency for the CRS-R total score was excellent (Cronbach's α = 0.84). Good test-retest reliability was obtained for CRS-R total score and subscale scores (intra-class correlation coefficient [ICC] = 0.87 and ICC = 0.66-0.84, respectively). Inter-rater reliability was high (ICC = 0.719; p < 0.01). Concurrent validity was good between CRS-R total scale and GCS total scale. Diagnostic validity was excellent compared with GCS (emerged from UWS: 24%; emerged from MCS: 28%). When considering patient outcome, diagnostic validity was good. In addition, false-positive rates have been detected for both diagnoses. CONCLUSION The Chinese version of the CRS-R is a reliable and sensitive tool and can discriminate patients in UWS, MCS, and EMCS successfully.
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Affiliation(s)
- Ying Zhang
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China.,b The Affiliated Hospital of Hangzhou Normal University , Hangzhou Normal University , Hangzhou , Zhejiang , China
| | - Jing Wang
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China
| | - Caroline Schnakers
- c Research Institute , Casa Colina Hospital and Centers for Healthcare , Pomona , CA , USA.,d Department of Psychiatry , University of California , Los Angeles , CA , USA
| | - Minhui He
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China.,b The Affiliated Hospital of Hangzhou Normal University , Hangzhou Normal University , Hangzhou , Zhejiang , China
| | - Hong Luo
- b The Affiliated Hospital of Hangzhou Normal University , Hangzhou Normal University , Hangzhou , Zhejiang , China
| | - Lijuan Cheng
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China.,e Hangzhou Normal University Qianjiang College , Hangzhou , Zhejiang , China
| | - Fuyan Wang
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China.,b The Affiliated Hospital of Hangzhou Normal University , Hangzhou Normal University , Hangzhou , Zhejiang , China
| | - Yunzhi Nie
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China.,f Ningbo NO.7 Hospital , Ningbo , Zhejiang , China
| | - Wangshan Huang
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China
| | - Xiaohua Hu
- g Department of Rehabilitation , Hangzhou Wujing Hospital , Hangzhou , China
| | - Steven Laureys
- h GIGA, GIGA-Consciousness, Coma Science Group, University & Neurology Department , Hospital of Liege , Liege , Belgium
| | - Haibo Di
- a International Vegetative State and Consciousness Science Institute, Hangzhou Normal University , Hangzhou , Zhejiang , China
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Formisano R, Aloisi M, Iosa M, Contrada M, Rizza F, Sattin D, Leonardi M, D'Ippolito M; on the behalf of the Italian National Consortium on Functioning and Disability in Disorders of Consciousness Patients. A new tool to assess responsiveness in disorders of consciousness (DoC): a preliminary study on the Brief Post-Coma Scale (BPCS). Neurol Sci 2018; 39:1651-6. [PMID: 29948469 DOI: 10.1007/s10072-018-3466-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/02/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The Brief Post-Coma Scale (BPCS) is an easy diagnostic tool for individuals with disorders of consciousness (DoC), in a reduced version from a previously Post-Coma Scale, that could distinguish patients in the minimally conscious state (MCS) from those in unresponsive wakefulness syndrome (UWS), formerly defined as vegetative state (VS). OBJECTIVE Aim of the study was to assess the diagnostic validity of the BPCS in comparison with the Coma Recovery Scale-Revised (CRS-R), in its Italian validated version, the Disability Rating Scale (DRS), the Level of Cognitive Functioning (LCF), and the Glasgow Outcome Scale (GOS). METHODS In an Italian multicenter study on 545 patients with DoC, 36 post-acute rehabilitation wards, 32 long-term care centers, and 2 family associations participated to data collection. RESULTS Statistically significant correlations were found between the BPCS and the other clinical scales: R = 0.586 (p < 0.001) with LCF, R = - 0.566 (p < 0.001) with DRS, R = 0.622 (p < 0.001) with CRS-R. The BPCS scores resulted significantly correlated with the time from acute event (R = 0.117, p = 0.006). Patients with GOS score 2 had mean BPCS of 1.84 ± 1.19, whereas those with GOS 3 had significantly higher scores 3.88 ± 1.71 (p < 0.001). Similarly, in patients with vegetative state/UWS (VS/UWS), the mean BPSC score was 1.71 ± 1.09, significantly lower (p < 0.001) than that of patients with minimally conscious state (BPCS = 3.83 ± 1.29). Finally, the agreement of the BPCS and clinical diagnosis was of 84.4%, with an odds ratio OR = 3.781 (95% CI = 3.026-4.725, p < 0.001). CONCLUSIONS The BPCS has demonstrated statistically significant correlations with the most commonly used scales in persons with DoC.
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Wu M, Bao WX, Zhang J, Hu YF, Gao J, Luo BY. Effect of acoustic stimuli in patients with disorders of consciousness: a quantitative electroencephalography study. Neural Regen Res 2018; 13:1900-1906. [PMID: 30233062 PMCID: PMC6183039 DOI: 10.4103/1673-5374.238622] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Auditory stimuli are proposed as beneficial neurorehabilitation methods in patients with disorders of consciousness. However, precise and accurate quantitative indices to estimate their potential effect remain scarce. Fourteen patients were recruited from the Neuro-Rehabilitation Unit of Hangzhou Hospital of Zhejiang Armed Police Corps of China. Altogether, there were seven cases of unresponsive wakefulness syndrome (five males and two females, aged 45.7 ± 16.8 years) and seven cases of minimally conscious state (six males and one female, aged 42.3 ± 20.8 years). Simultaneously, fourteen healthy controls (10 males and 4 females, aged 51.7 ± 9.7 years) also participated in this case-control experiment. Brain response to music, subjects’ own name, and noise was monitored by quantitative electroencephalography (QEEG) in the resting state and with acoustic stimulation. Predictive QEEG values in various brain regions were investigated. Our results show that cerebral activation was high in subjects stimulated by their own name, especially in the temporal lobe in patients with disorders of consciousness, and the frontal lobe in the control group. Further, during resting and stimulation, QEEG index (δ + θ/α + β ratio) negatively correlated with the Coma Recovery Scale-Revised score in traumatic disorders of consciousness patients. Hence, we speculate that a subject's own name might be an effective awakening therapy for patients with disorders of consciousness. Moreover, QEEG index in specific stimulation states may be used as a prognostic indicator for disorders of consciousness patients (sensitivity, 75%; specificity, 50%). This clinical study has been registered at ClinicalTrials.gov (identifier: NCT03385291).
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Affiliation(s)
- Min Wu
- Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Wang-Xiao Bao
- Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jie Zhang
- Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yang-Fan Hu
- Department of Computer Science, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jian Gao
- Department of Rehabilitation, Hangzhou Hospital of Zhejiang Armed Police Corps, Hangzhou, Zhejiang Province, China
| | - Ben-Yan Luo
- Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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Estraneo A, Moretta P, Cardinale V, De Tanti A, Gatta G, Giacino JT, Trojano L. A multicentre study of intentional behavioural responses measured using the Coma Recovery Scale-Revised in patients with minimally conscious state. Clin Rehabil 2014; 29:803-8. [PMID: 25381347 DOI: 10.1177/0269215514556002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 09/26/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate which conscious behaviour is most frequently detected using the Coma Recovery Scale-Revised in patients with minimally conscious state. DESIGN Multicentre, cross-sectional study. SETTING One intensive care unit, 8 post-acute rehabilitation centres and 2 long-term facilities. SUBJECTS Fifty-two patients with established diagnosis of minimally conscious state of different aetiology. MAIN MEASURES All patients were assessed by the Coma Recovery Scale-Revised. RESULTS In most patients (34/52) non-reflexive responses were identified by two or more subscales of the Coma Recovery Scale-Revised, whereas in 14 patients only the visual subscale could identify cortically-mediated behaviours, and in the remaining 4 patients only the motor subscale did so.The clinical signs of intentional behaviour were most often detected by the visual subscale (43/52 patients) and by the motor subscale (31/52), and least frequently by the oromotor/verbal subscale (3/52) of the Coma Recovery Scale-Revised. This clinical pattern was observed independently from time post-onset and aetiology. CONCLUSIONS Non-reflexive visual behaviour, identified by the visual subscale of Coma Recovery Scale-Revised, is the most frequently detected intentional sign consistent with the diagnosis of minimally conscious state, independently from aetiology and time post-onset.
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Affiliation(s)
- Anna Estraneo
- Lab. for the study of Disorders of Consciousness, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy
| | - Pasquale Moretta
- Lab. for the study of Disorders of Consciousness, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy
| | - Viviana Cardinale
- Lab. for the study of Disorders of Consciousness, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy
| | - Antonio De Tanti
- Department of Rehabilitation, Cardinal Ferrari Hospital Fontanellato-Parma, Italy
| | - Giordano Gatta
- Rehabilitation Medicine Unit, Ravenna Hospital, Ravenna, Italy
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Luigi Trojano
- Lab. for the study of Disorders of Consciousness, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy Neuropsychology Lab, Department of Psychology, Second University of Naples, Caserta, Italy
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13
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Verger J, Ruiz S, Tillmann B, Ben Romdhane M, De Quelen M, Castro M, Tell L, Luauté J, Perrin F. [Beneficial effect of preferred music on cognitive functions in minimally conscious state patients]. Rev Neurol (Paris) 2014; 170:693-9. [PMID: 25287735 DOI: 10.1016/j.neurol.2014.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/07/2014] [Accepted: 06/05/2014] [Indexed: 11/30/2022]
Abstract
Several studies have shown that music can boost cognitive functions in normal and brain-damaged subjects. A few studies have suggested a beneficial effect of music in patients with a disorder of consciousness but it is difficult to conclude since they did not use quantified measures and a control condition/group. The aim of the present study was to compare the effect of music to that of a continuous sound on the relational behavior of patients in a minimally conscious state (MCS). Behavioral responses of six MCS patients were evaluated using items from the Coma Recovery Scale-Revised. Weekly evaluation sessions were carried out, over four weeks, under two conditions: following the presentation of either the patient's preferred music, or following a continuous sound (control condition). Qualitative and quantitative analyses showed that twelve of the eighteen sessions (66.6%) showed a better result for the music condition than for the control condition. This new protocol suggests that preferred music has a beneficial effect on the cognitive abilities of MCS patients. The results further suggest that cerebral plasticity may be enhanced in autobiographical (emotional and familiar) contexts. These findings should now be further extended with an increased number of patients to further validate the hypothesis of the beneficial effect of music on cognitive recovery.
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Affiliation(s)
- J Verger
- Équipe cognition auditive et psychoacoustique, université Lyon 1, CNRS UMR5292, inserm U1028, centre de recherche en neurosciences de Lyon, 50 avenue Tony-Garnier, 69366 Lyon cedex 07, France; Service de médecine physique et de réadaptation, hôpital Henry Gabrielle, 20, route de Vourles, 69230 Saint Genis Laval, France
| | - S Ruiz
- Équipe cognition auditive et psychoacoustique, université Lyon 1, CNRS UMR5292, inserm U1028, centre de recherche en neurosciences de Lyon, 50 avenue Tony-Garnier, 69366 Lyon cedex 07, France; Service de médecine physique et de réadaptation, hôpital Henry Gabrielle, 20, route de Vourles, 69230 Saint Genis Laval, France
| | - B Tillmann
- Équipe cognition auditive et psychoacoustique, université Lyon 1, CNRS UMR5292, inserm U1028, centre de recherche en neurosciences de Lyon, 50 avenue Tony-Garnier, 69366 Lyon cedex 07, France
| | - M Ben Romdhane
- Service de médecine physique et de réadaptation, hôpital Henry Gabrielle, 20, route de Vourles, 69230 Saint Genis Laval, France
| | - M De Quelen
- Service de médecine physique et de réadaptation, hôpital Henry Gabrielle, 20, route de Vourles, 69230 Saint Genis Laval, France
| | - M Castro
- Équipe cognition auditive et psychoacoustique, université Lyon 1, CNRS UMR5292, inserm U1028, centre de recherche en neurosciences de Lyon, 50 avenue Tony-Garnier, 69366 Lyon cedex 07, France
| | - L Tell
- Service de médecine physique et de réadaptation, hôpital Henry Gabrielle, 20, route de Vourles, 69230 Saint Genis Laval, France
| | - J Luauté
- Service de médecine physique et de réadaptation, hôpital Henry Gabrielle, 20, route de Vourles, 69230 Saint Genis Laval, France; Équipe IMPACT, inserm U1028, université Lyon 1, CNRS UMR5292, centre de recherche en neurosciences de Lyon, 16, avenue du Doyen-Lépine, 69675 Bron cedex, France
| | - F Perrin
- Équipe cognition auditive et psychoacoustique, université Lyon 1, CNRS UMR5292, inserm U1028, centre de recherche en neurosciences de Lyon, 50 avenue Tony-Garnier, 69366 Lyon cedex 07, France.
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Nakase-Richardson R, McNamee S, Howe LL, Massengale J, Peterson M, Barnett SD, Harris O, McCarthy M, Tran J, Scott S, Cifu DX. Descriptive characteristics and rehabilitation outcomes in active duty military personnel and veterans with disorders of consciousness with combat- and noncombat-related brain injury. Arch Phys Med Rehabil 2013; 94:1861-9. [PMID: 23810353 DOI: 10.1016/j.apmr.2013.05.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/24/2013] [Accepted: 05/23/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report the injury and demographic characteristics, medical course, and rehabilitation outcome for a consecutive series of veterans and active duty military personnel with combat- and noncombat-related brain injury and disorder of consciousness (DOC) at the time of rehabilitation admission. DESIGN Retrospective study. SETTING Rehabilitation center. PARTICIPANTS From January 2004 to October 2009, persons (N=1654) were admitted to the Polytrauma Rehabilitation System of Care. This study focused on the N=122 persons admitted with a DOC. Participants with a DOC were primarily men (96%), on active duty (82%), ≥12 years of education, and a median age of 25. Brain injury etiologies included mixed blast trauma (24%), penetrating (8%), other trauma (56%), and nontrauma (13%). Median initial Glasgow Coma Scale score was 3, and rehabilitation admission Glasgow Coma Scale score was 8. Individuals were admitted for acute neurorehabilitation approximately 51 days postinjury with a median rehabilitation length of stay of 132 days. INTERVENTIONS None. MAIN OUTCOME MEASURES Recovery of consciousness and the FIM instrument. RESULTS Most participants emerged to regain consciousness during neurorehabilitation (64%). Average gains ± SD on the FIM cognitive and motor subscales were 19 ± 25 and 7 ± 8, respectively. Common medical complications included spasticity (70%), dysautonomia (34%), seizure occurrence (30%), and intracranial infection (22%). Differential outcomes were observed across etiologies, particularly for those with blast-related brain injury etiology. CONCLUSIONS Despite complex comorbidities, optimistic outcomes were observed. Individuals with severe head injury because of blast-related etiologies have different outcomes and comorbidities observed. Health-services research with a focus on prevention of comorbidities is needed to inform optimal models of care, particularly for combat injured soldiers with blast-related injuries.
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Affiliation(s)
- Risa Nakase-Richardson
- Mental Health and Behavioral Science Service, James A. Haley Veterans Hospital, Tampa, FL; Department of Psychology, University of South Florida, Tampa, FL; Center of Excellence for Maximizing Rehabilitation Outcomes, Tampa, FL.
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Whyte J, Nordenbo AM, Kalmar K, Merges B, Bagiella E, Chang H, Yablon S, Cho S, Hammond F, Khademi A, Giacino J. Medical complications during inpatient rehabilitation among patients with traumatic disorders of consciousness. Arch Phys Med Rehabil 2013; 94:1877-83. [PMID: 23735519 DOI: 10.1016/j.apmr.2012.12.027] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 11/29/2012] [Accepted: 12/18/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the incidence of medical complications in patients with recent traumatic disorders of consciousness (DOCs). DESIGN Data on adverse events in a placebo controlled trial of amantadine hydrochloride revealed no group difference, which allowed these events to be reanalyzed descriptively as medical complications experienced by the 2 groups collectively. SETTING Eleven clinical facilities in the United States, Denmark, and Germany with specialty rehabilitation programs for patients with DOCs. PARTICIPANTS Patients (N=184) with nonpenetrating traumatic brain injury enrolled from acute inpatient rehabilitation programs between 4 and 16 weeks postinjury. INTERVENTIONS Participants were randomized to receive 200 to 400mg of amantadine hydrochloride or placebo daily for 4 weeks, and followed for an additional 2 weeks. Adverse events were recorded and categorized with respect to their nature, timing, and severity. MAIN OUTCOME MEASURE Number, type, and severity of medical complications occurring during the 6-week study interval. RESULTS A total of 468 medical complications were documented among the patients (.40 events per week per patient). More than 80% of patients experienced at least 1 medical complication, and 41 of these were defined as serious adverse events. New medical complications declined over time in rehabilitation and were not dependent on time since injury. Hypertonia, agitation/aggression, urinary tract infection, and sleep disturbance were the most commonly reported problems. Hydrocephalus, pneumonia, gastrointestinal problems, and paroxysmal sympathetic hyperactivity were the most likely to be severe. CONCLUSIONS Patients with DOCs have a high rate of medical complications early after injury. Many of these complications require brain injury expertise for optimal management. Active medical management appears to contribute to the reduction in new complications. An optimal system of care for DOC patients must provide expert medical management in the early weeks after injury.
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Affiliation(s)
- John Whyte
- Moss Rehabilitation Research Institute and MossRehab, Elkins Park, PA.
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Pistoia F, Sacco S, Carolei A, Sarà M. Corticomotor facilitation in vegetative state: results of a pilot study. Arch Phys Med Rehabil 2013; 94:1599-606. [PMID: 23385107 DOI: 10.1016/j.apmr.2013.01.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 01/08/2013] [Accepted: 01/21/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate whether corticomotor facilitation induced by transcranial magnetic stimulation (TMS-CF) could evoke a simple purposeful motor behavior in patients with a diagnosis of vegetative state. DESIGN Cross-sectional survey. SETTING Post-coma and rehabilitation care unit. PARTICIPANTS Patients (N=6) with a diagnosis of vegetative state. INTERVENTIONS A cascade of consecutive motor-evoked potentials (MEPs) was elicited under 3 different conditions: in the first condition, patients were at rest (Rest); in the second, they were asked to open and close the right hand (Execution); in the third, the examiner modeled a movement of abduction of the thumb in front of the patient who was encouraged in advance to imitate the action (Observation to Imitate). MAIN OUTCOME MEASURES Changes in MEP values from the abductor pollicis brevis muscle and improvement in scores on the Coma Recovery Scale-Revised. RESULTS TMS-CF alone or combined with verbal instructions did not yield any change; only the combination with imitation caused changes in MEPs (shorter latency and increased amplitude) associated with behavioral improvement in 4 patients. CONCLUSIONS Encouraging observation to imitate may favor the transformation of some perceived actions into motor images and performances, probably depending on the activation of mirror motor neurons. In our opinion, combining visual input with TMS-CF might have reinforced the coupling between movement planning and execution, promoting the recovery of elementary motor activities in some patients. The proposed protocol may contribute to unmasking signs of preserved consciousness in patients with latent capacities for recovery.
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