Longitudinal assessments highlight long-term behavioural recovery in disorders of consciousness

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dc.citation.issue1
dc.citation.volume1
dc.contributor.authorBareham CA
dc.contributor.authorAllanson J
dc.contributor.authorRoberts N
dc.contributor.authorHutchinson PJA
dc.contributor.authorPickard JD
dc.contributor.authorMenon DK
dc.contributor.authorChennu S
dc.coverage.spatialEngland
dc.date.accessioned2023-11-12T20:49:45Z
dc.date.accessioned2023-11-20T01:38:02Z
dc.date.available2019-09-16
dc.date.available2023-11-12T20:49:45Z
dc.date.available2023-11-20T01:38:02Z
dc.date.issued2019
dc.description.abstractAccurate diagnosis and prognosis of disorders of consciousness is complicated by the variability amongst patients’ trajectories. However, the majority of research and scientific knowledge in this field is based on cross-sectional studies. The translational gap in applying this knowledge to inform clinical management can only be bridged by research that systematically examines follow-up. In this study, we present findings from a novel longitudinal study of the long-term recovery trajectory of 39 patients, repeatedly assessed using the Coma Recovery Scale-Revised once every 3 months for 2 years, generating 185 assessments. Despite the expected inter-patient variability, there was a statistically significant improvement in behaviour over time. Further, improvements began approximately 22 months after injury. Individual variation in the trajectory of recovery was influenced by initial diagnosis. Patients with an initial diagnosis of unresponsive wakefulness state, who progressed to the minimally conscious state, did so at a median of 485 days following onset—later than 12-month period after which current guidelines propose permanence. Although current guidelines are based on the expectation that patients with traumatic brain injury show potential for recovery over longer periods than those with non-traumatic injury, we did not observe any differences between trajectories in these two subgroups. However, age was a significant predictor, with younger patients showing more promising recovery. Also, progressive increases in arousal contributed exponentially to improvements in behavioural awareness, especially in minimally conscious patients. These findings highlight the importance of indexing arousal when measuring awareness, and the potential for interventions to regulate arousal to aid long-term behavioural recovery in disorders of consciousness.
dc.format.paginationfcz017-
dc.identifier.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/31886461
dc.identifier.citationBareham CA, Allanson J, Roberts N, Hutchinson PJA, Pickard JD, Menon DK, Chennu S. (2019). Longitudinal assessments highlight long-term behavioural recovery in disorders of consciousness.. Brain Commun. 1. 1. (pp. fcz017-).
dc.identifier.doi10.1093/braincomms/fcz017
dc.identifier.eissn2632-1297
dc.identifier.elements-typejournal-article
dc.identifier.issn2632-1297
dc.identifier.piifcz017
dc.identifier.urihttps://mro.massey.ac.nz/handle/10179/69150
dc.languageeng
dc.publisherOxford University Press on behalf of the Guarantors of Brain
dc.relation.isPartOfBrain Commun
dc.rights(c) 2019 The Author/s
dc.rightsCC BY 4.0
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectComa Recovery Scale-Revised
dc.subjectarousal
dc.subjectdisorders of consciousness
dc.subjectlongitudinal
dc.subjectnatural history
dc.titleLongitudinal assessments highlight long-term behavioural recovery in disorders of consciousness
dc.typeJournal article
pubs.elements-id449418
pubs.organisational-groupOther
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