Journal article
Recovery in cognitive motor dissociation after severe brain injury: A cohort study.
- Jöhr J Department of Clinical Neurosciences, Neurology Service, Acute Neurorehabilitation Unit, University Hospital Lausanne, Lausanne, Switzerland.
- Halimi F Department of Clinical Neurosciences, Neurology Service, Acute Neurorehabilitation Unit, University Hospital Lausanne, Lausanne, Switzerland.
- Pasquier J Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland.
- Pincherle A Department of Clinical Neurosciences, Neurology Service, Acute Neurorehabilitation Unit, University Hospital Lausanne, Lausanne, Switzerland.
- Schiff N Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, United States of America.
- Diserens K Department of Clinical Neurosciences, Neurology Service, Acute Neurorehabilitation Unit, University Hospital Lausanne, Lausanne, Switzerland.
- 2020-02-06
Published in:
- PloS one. - 2020
Adult
Brain Injuries
Cognition Disorders
Cohort Studies
Consciousness Disorders
Female
Humans
Length of Stay
Male
Middle Aged
Patient Discharge
Prognosis
Recovery of Function
English
OBJECTIVE
To investigate the functional and cognitive outcomes during early intensive neurorehabilitation and to compare the recovery patterns of patients presenting with cognitive motor dissociation (CMD), disorders of consciousness (DOC) and non-DOC.
METHODS
We conducted a single center observational cohort study of 141 patients with severe acquired brain injury, consecutively admitted to an acute neurorehabilitation unit. We divided patients into three groups according to initial neurobehavioral diagnosis at admission using the Coma Recovery Scale-Revised (CRS-R) and the Motor Behavior Tool (MBT): potential clinical CMD, [N = 105]; DOC [N = 19]; non-DOC [N = 17]). Functional and cognitive outcomes were assessed at admission and discharge using the Glasgow Outcome Scale, the Early Rehabilitation Barthel Index, the Disability Rating Scale, the Rancho Los Amigos Levels of Cognitive Functioning, the Functional Ambulation Classification Scale and the modified Rankin Scale. Confirmed recovery of conscious awareness was based on CRS-R criteria.
RESULTS
CMD patients were significantly associated with better functional outcomes and potential for improvement than DOC. Furthermore, outcomes of CMD patients did not differ significantly from those of non-DOC. Using the CRS-R scale only; approximatively 30% of CMD patients did not recover consciousness at discharge.
INTERPRETATION
Our findings support the fact that patients presenting with CMD condition constitute a separate category, with different potential for improvement and functional outcomes than patients suffering from DOC. This reinforces the need for CMD to be urgently recognized, as it may directly affect patient care, influencing life-or-death decisions.
To investigate the functional and cognitive outcomes during early intensive neurorehabilitation and to compare the recovery patterns of patients presenting with cognitive motor dissociation (CMD), disorders of consciousness (DOC) and non-DOC.
METHODS
We conducted a single center observational cohort study of 141 patients with severe acquired brain injury, consecutively admitted to an acute neurorehabilitation unit. We divided patients into three groups according to initial neurobehavioral diagnosis at admission using the Coma Recovery Scale-Revised (CRS-R) and the Motor Behavior Tool (MBT): potential clinical CMD, [N = 105]; DOC [N = 19]; non-DOC [N = 17]). Functional and cognitive outcomes were assessed at admission and discharge using the Glasgow Outcome Scale, the Early Rehabilitation Barthel Index, the Disability Rating Scale, the Rancho Los Amigos Levels of Cognitive Functioning, the Functional Ambulation Classification Scale and the modified Rankin Scale. Confirmed recovery of conscious awareness was based on CRS-R criteria.
RESULTS
CMD patients were significantly associated with better functional outcomes and potential for improvement than DOC. Furthermore, outcomes of CMD patients did not differ significantly from those of non-DOC. Using the CRS-R scale only; approximatively 30% of CMD patients did not recover consciousness at discharge.
INTERPRETATION
Our findings support the fact that patients presenting with CMD condition constitute a separate category, with different potential for improvement and functional outcomes than patients suffering from DOC. This reinforces the need for CMD to be urgently recognized, as it may directly affect patient care, influencing life-or-death decisions.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1371/journal.pone.0228474
- PMID 32023323
- Persistent URL
- https://sonar.ch/global/documents/186220
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