Standardized assessment instruments for minimally-responsive, brain-injured patients

Issue title: Evaluation and Management of Low Level Neurologic States

Guest editors: Joseph T. GiacinoGuest Editor

Article type: Research Article

Authors: O'Dell, Michael W.^{a; *} | Jasin, Philip^b | Lyons, Nancy^c | Stivers, Maria^d | Meszaros, Frank^a

Affiliations: [a] Department of Physical Medicine and Rehabilitation, University of Cincinnati College of Medicine, 5161 Medical Science Building, Mail Location 530, 231 Bethesda Avenue, Cincinnati, OH 45267-0530, USA | [b] The Brain Injury Rehabilitation Program, Department of Psychology, Drake Center, Inc., Cincinnati, OH, USA | [c] The Brain Injury Rehabilitation Program, Department of Speech Pathology, Drake Center, Inc., Cincinnati, OH, USA | [d] The Brain Injury Rehabilitation Program, Department of Therapeutic Recreation, Drake Center, Inc., Cincinnati, OH, USA | JFK Johnson Rehabilitation Institute, Cognitive Rehabilitation Program, Edison, NJ, USA

Correspondence: [*] Corresponding author. Tel.: + 1 513 5584254. Fax: + 1 513 5584458.

Abstract: Among the most significant advances in the care and rehabilitation of severely brain injured, minimally-responsive patients (MRP) has been the development of standardized assessment scales. Currently available instruments include the Coma/Near Coma Scale (CNC), Coma Recovery Scale (CRS), Sensory Stimulation Assessment Measure (SSAM), and the Western Neuro Sensory Stimulation Profile (WNSSP). Each scale is reviewed in terms of content, psychometric properties, and clinical attributes. Data is then presented comparing converted, percentile admission scores for the CRS, WNSSP, and CNC in a group of ten MRP at Rancho Levels II–IV, with a mean age of 31 years and mean time from injury of 37.5 days. Admission CNC and CRS scores tended to group in the middle range, while WNSSP scores tended to group in the lower quartile. This suggests the potential concern for ‘floor effect’ with the WNSSP. At admission, none of the three scales was able to effectively distinguish between dichotomized outcome variables: disposition (home vs. nursing home), advancement to active rehabilitation, or discharge Functional Independence Measure score (> 80 vs. < 80). The data indicate the CRS demonstrates moderately strong relationships with both the CNC and WNSSP. Full delineation of how these scales relate to one another awaits both cross-sectional and longitudinal analyses in larger samples and should include the SSAM.

Keywords: Traumatic brain injury, Vegetative state, Functional assessment, Rehabilitation, Health status, Minimally responsive

DOI: 10.3233/NRE-1996-6106

Journal: NeuroRehabilitation, vol. 6, no. 1, pp. 45-55, 1996