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Recovery in cognitive motor dissociation after severe brain injury: A cohort study.

TitleRecovery in cognitive motor dissociation after severe brain injury: A cohort study.
Publication TypeJournal Article
Year of Publication2020
AuthorsJöhr, Jane, Halimi Floriana, Pasquier Jérôme, Pincherle Alessandro, Schiff Nicholas, and Diserens Karin
JournalPLoS One
Volume15
Issue2
Paginatione0228474
Date Published2020
ISSN1932-6203
KeywordsAdult, Brain Injuries, Cognition Disorders, Cohort Studies, Consciousness Disorders, Female, Humans, Length of Stay, Male, Middle Aged, Patient Discharge, Prognosis, Recovery of Function
Abstract

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.

DOI10.1371/journal.pone.0228474
Alternate JournalPLoS ONE
PubMed ID32023323
PubMed Central IDPMC7001945

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