A multicentre study of intentional behavioural responses measured using the Coma Recovery Scale–Revised in patients with minimally conscious state

Abstract

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.

The repetition of behavioral assessments in diagnosis of disorders of consciousness

“…According to our data, when a clinician did not detect a response to command in a patient at the first testing (UWS/VS or MCS – ), the diagnosis was erroneous in 36% of the cases (16/62 UWS/VS and 16/28 MCS – ). Previous studies reported that patients in MCS show more often visual and motor responses than auditory responses related to consciousness (ie, response to command), whereas a more recent study highlighted a large prevalence of response to command, visual fixation, and visual pursuit among the patients in MCS . However, we here showed that the response to command seems to be more easily detected after several evaluations, which could explain that their single assessments were not able to identify so often a response to command.…”

Score on Coma Recovery Scale-Revised at admission predicts outcome at discharge in intensive rehabilitation after severe brain injury

“…The analysis was based on the total score on the CRS-R, and the relevance of each subscale was not assessed. In previous studies (32,33), recovery of responsiveness was associated with higher scores and improvement on the visual subscale. It is possible that in our sample, the prognostic role of the total CRS-R was mainly driven by the performance on the visual subset.…”

Mirror efficiency in the assessment of visual pursuit in patients in minimally conscious state

“…This scale assesses different functions through six subscales, namely auditory, visual, motor and oromotor/verbal functions, communication and arousal. Different studies have highlighted the importance of the visual subscale (7), and more particularly of one of its items, the visual pursuit (8), in identifying patients in MCS. Moreover, the visual pursuit is one of the three most frequently observed items in patients in MCS (9).…”