Abstract
BackgroundBehavioral assessment has been acted as the gold standard for the diagnosis of disorders of consciousness (DOC) patients. The item “Functional Object Use” in the motor function sub-scale in the Coma Recovery Scale-Revised (CRS-R) is a key item in differentiating between minimally conscious state (MCS) and emergence from MCS (EMCS). However, previous studies suggested that certain specific stimuli, especially something self-relevant can affect DOC patients’ scores of behavioral assessment scale. So, we attempted to find out if personalized objects can improve the diagnosis of EMCS in the assessment of Functional Object Use by comparing the use of patients’ favorite objects and other common objects in MCS patients.MethodsTwenty-one post-comatose patients diagnosed as MCS were prospectively included. The item “Functional Object Use” was assessed by using personalized objects (e.g., cigarette, paper) and non-personalized objects, which were presented in a random order. The rest assessments were performed following the standard protocol of the CRS-R. The differences between functional uses of the two types of objects were analyzed by the McNemar test.ResultsThe incidence of Functional Object Use was significantly higher using personalized objects than non-personalized objects in the CRS-R. Five out of the 21 MCS studied patients, who were assessed with non-personalized objects, were re-diagnosed as EMCS with personalized objects (χ2 = 5, df = 1, p < 0.05).ConclusionsPersonalized objects employed here seem to be more effective to elicit patients’ responses as compared to non-personalized objects during the assessment of Functional Object Use in DOC patients.Trial registrationClinical Trials.gov: NCT02988206; Date of registration: 2016/12/12.
Highlights
Behavioral assessment has been acted as the gold standard for the diagnosis of disorders of consciousness (DOC) patients
Behavioral assessment is the gold standard for diagnosis in patients with disorders of consciousness (DOC) [1, 2], and the Coma Recovery Scale-Revised (CRS-R) is an important tool for the assessment of DOC such as the “vegetative state” [3] and the minimally conscious state (MCS) [4]
A study with functional magnetic resonance imaging found that 7 patients with Vegetative state/unresponsive wakefulness syndrome (VS/UWS) who responded to their own names became MCS after 3 months and showed the value of using patient’s own name [10]
Summary
Behavioral assessment has been acted as the gold standard for the diagnosis of disorders of consciousness (DOC) patients. Behavioral assessment is the gold standard for diagnosis in patients with disorders of consciousness (DOC) [1, 2], and the Coma Recovery Scale-Revised (CRS-R) is an important tool for the assessment of DOC such as the “vegetative state” ( coined unresponsive wakefulness syndrome; VS/UWS) [3] and the minimally conscious state (MCS) [4]. A study with functional magnetic resonance imaging (fMRI) found that 7 patients with VS/UWS who responded to their own names became MCS after 3 months and showed the value of using patient’s own name [10] Other selfreferential stimuli such as familiar faces result in a higher number of responses [11]; a preferred music (i.e., a selfreferential, autobiographical and emotional stimulus) [12], or a familiar voice of a relative has an effect on behavioral and cognitive processes of patients with DOC [12]
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