Behavioral Fluctuation in Disorders of Consciousness: A Retrospective Analysis
To assess the frequency of behavioral fluctuations in patients with prolonged disorders of consciousness (DoC), characterize the stability of consciousness ratings, and characterize the stability of behavioral signs of consciousness. Prospective observational analysis. Specialized DoC program in an...
Uložené v:
| Vydané v: | Archives of physical medicine and rehabilitation Ročník 106; číslo 10; s. 1505 |
|---|---|
| Hlavní autori: | , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
| Vydavateľské údaje: |
United States
01.10.2025
|
| Predmet: | |
| ISSN: | 1532-821X, 1532-821X |
| On-line prístup: | Zistit podrobnosti o prístupe |
| Tagy: |
Pridať tag
Žiadne tagy, Buďte prvý, kto otaguje tento záznam!
|
| Abstract | To assess the frequency of behavioral fluctuations in patients with prolonged disorders of consciousness (DoC), characterize the stability of consciousness ratings, and characterize the stability of behavioral signs of consciousness.
Prospective observational analysis.
Specialized DoC program in an inpatient rehabilitation facility and a long-term acute care hospital.
Patients in a vegetative state/unresponsive wakefulness state, minimally conscious state, and emerging from a minimally conscious state followed weekly by the Coma Recovery Scale-Revised (CRS-R) between 28 and 90days postinjury (N=241).
Change in CRS-R subscale scores and consciousness ratings.
Behavioral fluctuation was observed in >80% of patients and was most common in the CRS-R motor subscale and least common in the communication subscale (83% and 54% of patients experienced ≥1 fluctuation over the 3wk study period, respectively, with a 1-point change observed most frequently). Among patients who were conscious at baseline assessment, 25% were subsequently rated as unconscious at least once. Localization to pain and object manipulation were the most stable signs of consciousness, recurring at least 3 times after the first occurrence in ≥97% of the sample. Reproducible command-following and intelligible verbalization were the least stable, recurring at least 3 times after the first occurrence in ≤27% of the sample.
Patients with prolonged DoC who undergo serial assessment demonstrate a high rate of fluctuation in behavioral signs of consciousness. These findings highlight that repeated assessments are essential in this population, both to capture the highest level of consciousness and to help distinguish spontaneous fluctuation from response to treatment in interventional studies. |
|---|---|
| AbstractList | To assess the frequency of behavioral fluctuations in patients with prolonged disorders of consciousness (DoC), characterize the stability of consciousness ratings, and characterize the stability of behavioral signs of consciousness.OBJECTIVESTo assess the frequency of behavioral fluctuations in patients with prolonged disorders of consciousness (DoC), characterize the stability of consciousness ratings, and characterize the stability of behavioral signs of consciousness.Prospective observational analysis.DESIGNProspective observational analysis.Specialized DoC Program in an inpatient rehabilitation facility and a long-term acute care hospital.SETTINGSpecialized DoC Program in an inpatient rehabilitation facility and a long-term acute care hospital.Patients in vegetative state/unresponsive wakefulness state (VS/UWS), minimally conscious state and emerged from MCS followed weekly on the Coma Recovery Scale- Revised (CRS-R) between 28 and 90 days post-injury (N=241).PARTICIPANTSPatients in vegetative state/unresponsive wakefulness state (VS/UWS), minimally conscious state and emerged from MCS followed weekly on the Coma Recovery Scale- Revised (CRS-R) between 28 and 90 days post-injury (N=241).Change in CRS-R subscale scores and consciousness ratings.MAIN OUTCOME MEASUREChange in CRS-R subscale scores and consciousness ratings.Behavioral fluctuation was observed in more than 80% of patients, and was most common on the CRS-R Motor subscale and least common on the Communication subscale (83% and 54% of patients experienced ≥1 fluctuation over the 3-week study period, respectively, with a 1-point change observed most frequently). Among patients who were conscious on baseline assessment, 25% were subsequently rated as unconscious at least once. Localization to pain and object manipulation were the most stable signs of consciousness, recurring at least 3 times after the first occurrence in ≥ 97% of the sample. Reproducible command-following and intelligible verbalization were the least stable, recurring at least 3 times after the first occurrence in ≤ 27% of the sample.RESULTSBehavioral fluctuation was observed in more than 80% of patients, and was most common on the CRS-R Motor subscale and least common on the Communication subscale (83% and 54% of patients experienced ≥1 fluctuation over the 3-week study period, respectively, with a 1-point change observed most frequently). Among patients who were conscious on baseline assessment, 25% were subsequently rated as unconscious at least once. Localization to pain and object manipulation were the most stable signs of consciousness, recurring at least 3 times after the first occurrence in ≥ 97% of the sample. Reproducible command-following and intelligible verbalization were the least stable, recurring at least 3 times after the first occurrence in ≤ 27% of the sample.Patients with prolonged DoC who undergo serial assessment demonstrate a high rate of fluctuation in behavioral signs of consciousness. These findings highlight that repeated assessments are essential in this population, both to capture the highest level of consciousness and to help distinguish spontaneous fluctuation from response to treatment in interventional studies.CONCLUSIONSPatients with prolonged DoC who undergo serial assessment demonstrate a high rate of fluctuation in behavioral signs of consciousness. These findings highlight that repeated assessments are essential in this population, both to capture the highest level of consciousness and to help distinguish spontaneous fluctuation from response to treatment in interventional studies. To assess the frequency of behavioral fluctuations in patients with prolonged disorders of consciousness (DoC), characterize the stability of consciousness ratings, and characterize the stability of behavioral signs of consciousness. Prospective observational analysis. Specialized DoC program in an inpatient rehabilitation facility and a long-term acute care hospital. Patients in a vegetative state/unresponsive wakefulness state, minimally conscious state, and emerging from a minimally conscious state followed weekly by the Coma Recovery Scale-Revised (CRS-R) between 28 and 90days postinjury (N=241). Change in CRS-R subscale scores and consciousness ratings. Behavioral fluctuation was observed in >80% of patients and was most common in the CRS-R motor subscale and least common in the communication subscale (83% and 54% of patients experienced ≥1 fluctuation over the 3wk study period, respectively, with a 1-point change observed most frequently). Among patients who were conscious at baseline assessment, 25% were subsequently rated as unconscious at least once. Localization to pain and object manipulation were the most stable signs of consciousness, recurring at least 3 times after the first occurrence in ≥97% of the sample. Reproducible command-following and intelligible verbalization were the least stable, recurring at least 3 times after the first occurrence in ≤27% of the sample. Patients with prolonged DoC who undergo serial assessment demonstrate a high rate of fluctuation in behavioral signs of consciousness. These findings highlight that repeated assessments are essential in this population, both to capture the highest level of consciousness and to help distinguish spontaneous fluctuation from response to treatment in interventional studies. |
| Author | Malone, Christopher Barra, Alice Giacino, Joseph T Tan, Can Ozan Bodien, Yelena G Martens, Geraldine |
| Author_xml | – sequence: 1 givenname: Alice surname: Barra fullname: Barra, Alice organization: IRENEA - Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, València, Spain; Coma Science Group, GIGA Consciousness - GIGA Research, University of Liège, Liège, Belgium – sequence: 2 givenname: Yelena G surname: Bodien fullname: Bodien, Yelena G organization: Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, MA – sequence: 3 givenname: Can Ozan surname: Tan fullname: Tan, Can Ozan organization: RAM Group, Electrical Engineering, Mathematics, and Computer Science, University of Twente, the Netherlands – sequence: 4 givenname: Geraldine surname: Martens fullname: Martens, Geraldine organization: Coma Science Group, GIGA Consciousness - GIGA Research, University of Liège, Liège, Belgium; Spaulding Rehabilitation Hospital, Charlestown, MA – sequence: 5 givenname: Christopher surname: Malone fullname: Malone, Christopher organization: Spaulding Rehabilitation Hospital, Charlestown, MA – sequence: 6 givenname: Joseph T surname: Giacino fullname: Giacino, Joseph T email: jgiacino@mgh.harvard.edu organization: Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA. Electronic address: jgiacino@mgh.harvard.edu |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/40139629$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNUEtLxDAYDLLiPvQPeJAcvbTm0fThba2uCouCKHgrafoFs7RJTdqF_fcWXEEYmDkMw8ws0cw6CwhdUhJTQtObXSz7zseMMBETPiE_QQsqOItyRj9n__QcLUPYEUJSwekZmieE8iJlxQK93MGX3BvnZYs37aiGUQ7GWWwsvjfB-QZ8wE7j0tmgjBuDhRBu8Rq_weBd6EENZg94bWV7CCaco1Mt2wAXR16hj83De_kUbV8fn8v1NlKJ4EOUEqGpyEEVGde50oIQLmqtOJOqUZqDrEnCVVHztKn5NEwnDU2bImFppinJ2Apd_-b23n2PEIaqM0FB20oLU8mK05wlGc0nWqGro3WsO2iq3ptO-kP19wH7AZ0FYZo |
| CitedBy_id | crossref_primary_10_1016_j_neurot_2025_e00587 |
| ContentType | Journal Article |
| Copyright | Copyright © 2025 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved. Copyright © 2025. Published by Elsevier Inc. |
| Copyright_xml | – notice: Copyright © 2025 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved. – notice: Copyright © 2025. Published by Elsevier Inc. |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1016/j.apmr.2025.03.038 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE - Academic MEDLINE |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine Physical Therapy |
| EISSN | 1532-821X |
| ExternalDocumentID | 40139629 |
| Genre | Journal Article Observational Study |
| GrantInformation_xml | – fundername: NINDS NIH HHS grantid: R21 NS109627 – fundername: NICHD NIH HHS grantid: DP2 HD101400 – fundername: NINDS NIH HHS grantid: RF1 NS115268 – fundername: NINDS NIH HHS grantid: U01 NS086090 – fundername: NINDS NIH HHS grantid: UH3 NS095554 – fundername: ACL HHS grantid: 90DPTB0027 – fundername: NCCDPHP CDC HHS grantid: U48 DP000039 |
| GroupedDBID | --- --K -~X .1- .55 .FO .GJ 07C 0R~ 1B1 1CY 1P~ 1~5 23N 3O- 4.4 41~ 457 4G. 53G 5GY 5RE 5VS 6J9 7-5 AAEDT AAEDW AALRI AAQFI AAQOH AAQQT AAQXK AAWTL AAXUO AAYWO ABDQB ABFRF ABJNI ABLJU ABMAC ABOCM ABUFD ABWVN ACBNA ACGFO ACGUR ACRPL ADBBV ADMUD ADNMO ADRMJ AEFWE AENEX AEVXI AFFNX AFJKZ AFRHN AFTJW AGNAY AGQPQ AI. AIGII AITUG AJUYK AKRWK ALMA_UNASSIGNED_HOLDINGS AMRAJ APXCP ASPBG AVWKF AZFZN BELOY BR6 C5W CAG CGR COF CS3 CUY CVF E3Z EBS ECM EFJIC EFKBS EIF EJD F5P FDB FEDTE FGOYB FIRID G-Q GBLVA HVGLF HZ~ IHE J1W J5H K-O KOM KOO L7B M41 MO0 N4W NEJ NPM NQ- O-3 O9- OH. OHT OK1 OT. P2P QTD QZG R2- ROL RPZ SEL SES SJN SKT SSZ TWZ UDS UGJ UHB UHS UPT UQV UV1 VH1 WH7 WHG X7M XH2 XOL YQJ YRY YZZ Z5R ZGI ZXP ~S- 7X8 |
| ID | FETCH-LOGICAL-c453t-605f158ec973f8cf50035bfc32acdcf3eab043c9b36db3038f4d16d94267f1072 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 1 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=001588801500002&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1532-821X |
| IngestDate | Fri Oct 03 00:41:55 EDT 2025 Tue Nov 25 01:40:41 EST 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 10 |
| Keywords | Assessment scale Traumatic brain injury Unresponsive wakefulness syndrome Minimally conscious state Disorders of consciousness Rehabilitation Vegetative state |
| Language | English |
| License | Copyright © 2025 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c453t-605f158ec973f8cf50035bfc32acdcf3eab043c9b36db3038f4d16d94267f1072 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| OpenAccessLink | https://orbi.uliege.be/handle/2268/337967 |
| PMID | 40139629 |
| PQID | 3182471818 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_3182471818 pubmed_primary_40139629 |
| PublicationCentury | 2000 |
| PublicationDate | 2025-10-01 |
| PublicationDateYYYYMMDD | 2025-10-01 |
| PublicationDate_xml | – month: 10 year: 2025 text: 2025-10-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | Archives of physical medicine and rehabilitation |
| PublicationTitleAlternate | Arch Phys Med Rehabil |
| PublicationYear | 2025 |
| SSID | ssj0006531 |
| Score | 2.4865003 |
| Snippet | To assess the frequency of behavioral fluctuations in patients with prolonged disorders of consciousness (DoC), characterize the stability of consciousness... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 1505 |
| SubjectTerms | Adult Aged Consciousness Disorders - physiopathology Consciousness Disorders - psychology Consciousness Disorders - rehabilitation Female Humans Male Middle Aged Persistent Vegetative State - physiopathology Prospective Studies Retrospective Studies |
| Title | Behavioral Fluctuation in Disorders of Consciousness: A Retrospective Analysis |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/40139629 https://www.proquest.com/docview/3182471818 |
| Volume | 106 |
| WOSCitedRecordID | wos001588801500002&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV3NS8MwFH-oE_HidH7NLyJ4LS5NmyZeRMXhZWWHCb2VJE1goO22bv79Jm3mToIglNwKIe-X95H33u8B3AkiuNQsCrg0JIhwIgJRYOmYEZWklBmayGbYRJKmLMv42D-41b6scq0TG0VdVMq9kd9b7IVOkWL2OJsHbmqUy676ERrb0CHWlXGoTrINWziNiedLtbc-xJlvmmnru8Ts0_GBhnFDckrY7y5mY2qG3f9u8hAOvJOJnlpUHMGWLnuwN_Jp9B50x146aNKSChxD-vzTr4_Mx8q1lTiRoWmJCk_QWaPKIBs-W6NZrWqnIh-QQAu9XFTrfk0kPMfJCbwPXycvb4GftRCoKCbLwEY1BsdMK54Qw5SJXYpRGkVCoQpliBZyEBHFJaGFtGaPmajAtODWwCfGhpDhKeyUVanPAXFDqeAmUQSbSFt7FynKlRjYj-OQsj7crg8vt1h2CQpRarvxfHN8fThrJZDPWtKN3MWBnIb84g9_X8K-E2xbc3cFHWNvsr6GXfW1nNaLmwYkdk3Ho2941sf4 |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Behavioral+fluctuation+in+disorders+of+consciousness%3A+a+retrospective+analysis&rft.jtitle=Archives+of+physical+medicine+and+rehabilitation&rft.au=Barra%2C+Alice&rft.au=Bodien%2C+Yelena+G&rft.au=Tan%2C+Can+Ozan&rft.au=Martens%2C+Geraldine&rft.date=2025-10-01&rft.issn=1532-821X&rft.eissn=1532-821X&rft_id=info:doi/10.1016%2Fj.apmr.2025.03.038&rft.externalDBID=NO_FULL_TEXT |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1532-821X&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1532-821X&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1532-821X&client=summon |