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Locked-in syndrome in basilar artery thrombosis is a classic example of dissociation between preserved consciousness and complete deefferentation as total myoplegia with preserved vertical eye movement. Something similar is observed in post-comatose patients, described under the name “functional locked-in syndrome”, and is also a clinical reflection of the phenomenon of cognitive-motor dissociation (CMD). Diagnosis of this condition in a patient with chronic consciousness disorders indicates that there may be a cognitive imprint, which gives a chance for the maximum realization of the rehabilitation potential of latent consciousness as an exit to the clinical level of small consciousness or creation of a brain-interface. In any case, this patient should be given an extended rehabilitation program.Objective: to search for the optimal set of clinical and instrumental diagnostic methods, allowing the identification of CMD in patients with chronic consciousness disorder.Patients and methods. The 2016–2018 prospective single-center study enrolled patients with unresponsive wakefulness syndrome (UWS) who had received a treatment cycle at the Clinical Brain Institute (Yekaterinburg). The study included 39 patients (22 men, 17 women) aged 19 to 71 years who had sustained various cerebral injuries (traumatic, hypoxic, and acute vascular disease-associated) in different periods (from 32 to 2431 days) before being included in the study. All the patients underwent 5-fold clinical assessments according to the Coma Recovery ScaleRevised (CRS-R) and navigated transcranial magnetic stimulation (nTMS) in order to determine the time course of changes in the activity of the cortical motor centers at the time of presentation of verbal paradigms. Registration of the changes was assessed as the presence of a cognitive imprint and served as a criterion for diagnosing CMD as a positive predictor for the outcome of UWS. The outcome of the state was analyzed using the Glasgow Outcome Scale (GOS) at 180 days.Results and discussion. Positive changes (GOS >3) were noted in 10 (66%) patients with established CMD; the patients who had not diagnosed as having the cognitive potential showed a further increase in the level of cognition in 3 (12.5%) cases. Whether the identified sign could be used in the comprehensive prediction of chronic consciousness disorder was discussed.Conclusion. The use of TMS in diagnosing the phenomenon of CMD optimizes the routing of patients, for whom intensive rehabilitation can contribute to more favorable long-term outcomes.

Introduction. Evaluation of ICU patients on specialized scales, such as the modified Rankin scale (mRS) and the rehabilitation routing scale (RRS), allows you to determine the degree of dependence on outside help in connection with the development of PICS syndrome, to decide on the level of complexity of the upcoming rehabilitation, and to route the patient to the appropriate rehabilitation center or palliative care department. Aims: Analysis of the experience of application RRS in the system of routing patients in intensive care units for rehabilitation treatment. Methods. As a result of the application of the routing algorithm based on the application of both scales, 224 patients with the level of dependence of RRS 56 (mRS 5) were selected for the examination of the rehabilitation potential and the re-habilitation attempt during 2019. Results. At the end of the rehabilitation course, 60 patients showed a decrease in the level of dependence to 34 points for both mRS and RRS. In 164 patients, the rating on the Rankin scale did not change (mRS 5), while the score on the RRS score of dependence in 135 decreased to 5 points. By the time of discharge, 29 patients with CNS continued to meet the criteria of RRS 6. All of them were verticalized to the level of landing in the chair and included in the remote tele patronage. During the quarterly visits, 9 patients showed signs of realizing their positive prognosis, underwent repeated rehabilitation courses during 20202021, and reduced the level of dependence to RRS 45. In practical terms, a decrease in the grade of SRM to 5 indicated that the patient was ready to stay at home, while patients with SRM 6 remained in need of highly qualified care, requiring at least a referral to the palliative care unit. From the point of view of the mRS scale, both described patient categories corresponded to 5 points, i. e., based on the assessment of the patients condition according to mRS, it was not possible to draw conclusions about further patient management tactics. Conclusions. Thus, the experience of using the RRS scale demonstrated its effectiveness in routing patients with acute cerebral injury and showed greater sensitivity and specificity in comparison with mRS.

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Introduction. Disorders of consciousness (DOC) form one of the most underexplored sections of neurosciences. An epidemiology of DOC may be crucial to evaluate the extent of this problem. There were several attempts to collect such data in different countries allover the world, but all of them seem to be very discrete.objective. Aim of the study was to compile information about patients of Sverdlovsk Region in which acquired brain injury (ABI) resulted in DOC, find out their outcomes and evaluate the prevalence rate of these states in the population of the region.Methods.6507 patients with ABI were monitored by Regional Neurocritical Care Center in Sverdlovsk Regional Hospital №1 during 2019. 492 patients from this group then were assessed by neurorehabilitation physicians of Clinical Institute of Brain (CIB) via telemedicineconsultation; 122 of them were directed to CIB for in-patient stage of treatment, the main intention of which was an advanced diagnostic of the level of consciousness. Unresponsive wakefulness syndrome (UWS) was confirmed in 29 patients.results. After in-patient stage of treatment changes in the level of consciousness were assessed by follow-up via telemedicine consultation.to the end of January 2020, it made possible to find out that 9 of 29 UWS patients regained the level of consciousness; thus,20 patients remained unresponsive. taking into account that population of Sverdlovsk region numbers 4,3 million, prevalence rate ofnew UWS cases in region equaled 0,46/100 000.Conclusion. Application of telemedicine consultation allows to enquire DOC patients’ outcomes regardless of the patient location.Implementation of telemedicine can be useful for collecting this data and further analysis of revealed trends.