Revisiting Criteria for Emergence From The Minimally Conscious State

Abstract

<h3>Research Objectives</h3> To determine whether consistent command following (CCF) may be a sign of emergence from the minimally conscious state (MCS). <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Specialized disorders of consciousness (DoC) program in an inpatient rehabilitation hospital. <h3>Participants</h3> Patients with severe acquired brain injury and DoC. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Time from injury to recovery of CCF and time from injury to emergence from MCS (defined as functional object use [FO] or functional communication [FC] on the Coma Recovery Scale – Revised [CRS-R]) across the first eight weeks of rehabilitation. <h3>Results</h3> Of 214 patients admitted to rehabilitation without CCF, FO, or FC (median [interquartile range, IQR] age: 53 [34, 66] years, male: 134 (62.6%), traumatic etiology: 115 (53.7%), admission CRS-R total score: 10 [7, 13]), 162 (75.7%) recovered CCF and emerged from MCS during the eight-week observation period. Of these, 116 patients (71.6%) recovered CCF either at the same time or after emerging from MCS. Both CCF and emergence from MCS occurred approximately 46 days post-injury. FO and FC were equally likely to be the first observed behavior consistent with emergence from MCS (p <.001). <h3>Conclusions</h3> Most patients admitted to rehabilitation following severe brain injury recovered CCF and emerged from MCS during the first eight weeks of rehabilitation. CCF and emergence from MCS occur at approximately the same time during the recovery course, suggesting that CCF should be included as a criterion signaling emergence from MCS. Including CCF as a criterion for emergence from MCS may improve access to clinical services for patients with DoC, as this suggests capacity for active participation in rehabilitation. <h3>Author(s) Disclosures</h3> The authors declare no relevant conflict of interest.