Course of recovery and prediction of outcome in young patients in a prolonged vegetative or minimally conscious state after severe brain injury: An exploratory study

Article type: Research Article

Authors: Eilander, Henk J. | van Heugten, Caroline M.^; | Wijnen, Viona J.M. | Croon, Marcel A. | de Kort, Paul L.M. | Bosch, D. Andries | Prevo, Arie J.H.

Affiliations: Project VLB-NAH, Tilburg, Division Research, Rehabilitation Centre Leijpark, The Netherlands | School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands | Statistics and Methodology Department, Faculty of Social Sciences, Tilburg University, Tilburg, The Netherlands | St.Elisabeth Hospital, Division of Neurology, Tilburg, The Netherlands | Department of Neurosurgery, Academic Medical Centre, Amsterdam, The Netherlands | Rehabilitation Centre de Hoogstraat, Utrecht, The Netherlands | Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands

Note: [] Corresponding author: H.J. Eilander, Bankven 17, 5052 BA Goirle, The Netherlands. Tel.: +31 625 153 255; E-mail: [email protected]

Abstract: AIMS: To explore the course of recovery of consciousness and factors predicting the outcome of severe brain injury with a prolonged period of unconsciousness in children and young adults receiving a specialized rehabilitation treatment, the Early Intensive Neurorehabilitation Programme (EINP). METHODS: A cohort of forty-four patients aged 1.6–25.5 years (M=16.0) with traumatic acquired brain injury (TBI) or non-traumatic acquired brain injury (nTBI) were examined using the Western Neuro Sensory Stimulation Profile every two weeks, from the application for EINP until discharge. The level of consciousness was assessed with the Post-Acute Level of Consciousness Scale, and the level of disability was determined by the Disability Rating Scale. Long-term level of disability of all TBI patients (N=32) was assessed between 2.0 and 4.4 years after discharge from EINP. RESULTS: Two-thirds of all patients recovered to consciousness. Three recovery patterns were identified: remaining in a vegetative state (VS), slow recovery of consciousness, and fast recovery of consciousness. In the long-term, 11 of the TBI patients were severely disabled, 13 were moderately disabled, and 4 were mildly disabled. All TBI patients who were in VS at discharge either had deceased, or recovered to a very severely disabled state. CONCLUSIONS: Three recovery patterns identified in an early stage after starting EINP made it possible to predict long-term level of disability.

Keywords: Brain injury, level of consciousness, long-term outcome, paediatric rehabilitation, minimally conscious state, vegetative state

DOI: 10.3233/PRM-130241

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 6, no. 2, pp. 73-83, 2013