Emergence from minimally conscious state: Insights from evaluation of posttraumatic confusion
| Autor: | Risa Nakase-Richardson, T. G. Nick, Stuart A. Yablon, Clea C. Evans, Mark Sherer |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty Poison control Neuropsychological Tests Electroencephalography Severity of Illness Index Suicide prevention Occupational safety and health Surveys and Questionnaires Injury prevention medicine Humans Prospective Studies Confusion Psychiatry medicine.diagnostic_test Communication Persistent Vegetative State Minimally conscious state Human factors and ergonomics Recovery of Function Middle Aged medicine.disease humanities Brain Injuries Mental Recall Female Neurology (clinical) Psychology Executive dysfunction Cognitive psychology |
| Zdroj: | Neurology. 73:1120-1126 |
| ISSN: | 1526-632X 0028-3878 |
| DOI: | 10.1212/wnl.0b013e3181bacf34 |
| Popis: | Guidelines for defining the minimally conscious state (MCS) specify behaviors that characterize emergence, including "reliable and consistent" functional communication (accurate yes/no responding). Guidelines were developed by consensus because of lack of empirical data.To evaluate the utility of the operational threshold for emergence from posttraumatic MCS, by determining yes/no accuracy to questions of varied difficulty, including simple orientation questions, using all items from the Yes/No Subscale of the Mississippi Aphasia Screening Test.Prospective observational study of a cohort of responsive patients recovering from traumatic brain injury in an acute inpatient brain injury rehabilitation program.Of the 629 observations from 144 participants, name recognition was the easiest yes/no question, with nonconfused individuals responding with 100% accuracy, whereas only 75% to 78% of confused participants on initial evaluation answered this question correctly. Generalized Estimating Equations analysis revealed that confused participants were more likely to respond inaccurately to all yes/no questions. Nonconfused participants had a reduction in odds of inaccuracy ranging from 45.6% to 99.7% (p = 0.001 to 0.02) depending on the type of yes/no question.Accuracy for simple orientation yes/no questions remains challenging for responsive patients in early recovery from traumatic brain injury. Although name recognition questions are relatively easier than other types of yes/no questions, including situational orientation questions, confused patients still may answer these incorrectly. Results suggest the operational threshold for yes/no response accuracy as a diagnostic criterion for emergence from the minimally conscious state should be revisited, with particular consideration of the type of yes/no questions and the requisite accuracy threshold for responses. |
| Databáze: | OpenAIRE |
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