Updated Measurement Characteristics and Clinical Utility of the Coma Recovery Scale-Revised Among Individuals With Acquired Brain Injury

Abstract

The Coma Recovery Scale-Revised (CRS-R) is a standardized neurobehavioral assessment measure designed for use in patients with disorders of consciousness. 1 There are 6 subscales that assess behaviors mediated by language, visuoperceptual, and motor networks. The items are hierarchically arranged reflecting brainstem, subcortical, and cortically-mediated functions. 2 Serial CRS-R assessment has high sensitivity for detecting signs of consciousness. The CRS-R can further distinguish between features of minimally conscious state plus and minimally conscious state minus. The CRS-R may be used to monitor behavioral recovery, predict outcome, 3 and assess treatment effectiveness. The CRS-R is a National Institute of Neurological Diseases and Stroke Common Data Element and is recommended by the American Congress of Rehabilitation Medicine, the American Academy of Neurology, and the National Institute on Disability, Independent Living, and Rehabilitation Research for use in clinical practice. 4 CRS-R items demonstrate excellent content and construct validity, internal consistency, interrater and test-retest reliability 1 as well as high sensitivity. 5 Rasch analysis and item response theory support the use of the CRS-R for establishing diagnosis and monitoring recovery of consciousness. 2 Translations and validations are available in 15 languages, and a pediatric version is validated in healthy children. The CRS-R can be used by a range of health professionals. CRS-R administration takes 15-30 minutes. The CRS-R Administration and Scoring Manual was updated in 2020 based on international survey responses from 63 clinicians and researchers who provided feedback on the clarity of administration and scoring of each CRS-R item. The updated manual, general guidelines, frequently asked questions, suggested training module, and reference list are on the Rehabilitation Measures Database. This abbreviated summary provides a review of the psychometric properties of the Coma Recovery Scale-Revised in acquired brain injury. A full review of the Come Recovery Scale-Revised and reviews of over 500 other instruments for patients with various health conditions can be found at: www.sralab.org/Rehabilitation-Measures.

Behavioral Assessment of Patients with Disorders of Consciousness

“…but has not been validated in these languages. 35 A pediatric version, the Coma Recovery Scale for Pediatrics, was validated in healthy subjects to determine which behaviors should be assessed in children with DoC who are at different developmental milestones. 44 The Motor Behavior Tool, which was developed to complement the CRS-R, identifies subtle motor behaviors that may identify residual cognition, 45 signaling the potential for recovery in persons with DoC.…”

Prevalence of the Minimally Conscious State Among Institutionalized Patients in the Netherlands

“…In the assessment, family members and staff were actively involved by providing personally salient stimuli and sharing their own observations of behavior possibly indicative of consciousness, such as context-related emotions and vocalizing or gesturing in response to the linguistic content of a question. 28 If reported, these were evaluated for contingency in a structured manner as suggested in the CRS-R. 28,29…”

“…In the assessment, family members and staff were actively involved by providing personally salient stimuli and sharing their own observations of behavior possibly indicative of consciousness, such as contextrelated emotions and vocalizing or gesturing in response to the linguistic content of a question. 28 If reported, these were evaluated for contingency in a structured manner as suggested in the CRS-R. 28,29 We documented the presence of proxies (i.e., representatives of the patients, not necessarily family members) and their relationship to the patient, the patient's posture (i.e., sitting or lying down), and whether the patient had had at least 30 minutes of rest before the assessment. In addition, behavioral reactions were described, and it was noted by whom these reactions were observed.…”

Behavioral Assessment of Patients with Disorders of Consciousness

“…The CRS-R is also available in Dutch, Swedish, Danish, and Greek, but has not been validated in these languages. 43 A pediatric version, the Coma Recovery Scale for Pediatrics, was validated in healthy subjects to determine which behaviors should be assessed in children with DoC who are at different developmental milestones. 44 The Motor Behavior Tool, which was developed to complement the CRS-R, identifies subtle motor behaviors that may identify residual cognition, 45 signaling the potential for recovery in persons with DoC.…”