New evaluation tool reliably predicts recovery from coma

A Department of Veterans Affairs and Northwestern University researcher has developed the first reliable measure of neurobehavioral functioning that will help physicians predict the likelihood of a patient recovering consciousness during coma from severe brain injury within the first year of injury–with up to 86 percent certainty.

The study, by Theresa Pape, DrPH, and colleagues, is described in a two-part series in Volume 42, Issue 1, of the Journal of Rehabilitation Research and Development (JRRD). They report on the development of and psychometric properties of the Disorders of Consciousness Scale© (DOCS) and illustrate how repeated measures of neurobehavioral functioning derived from DOCS improve medical and rehabilitation management during coma recovery.

Ninety-five veterans and civilians over age 18 unconscious after a severe brain injury were evaluated with the DOCS weekly, for up to six weeks. Investigators measured social knowledge, taste and swallowing, olfactory, proprioceptive (perception of one’s body in space) and vestibular (balance), auditory, visual, tactile, and testing-readiness.

Investigators found that DOCS is a sensitive, reliable, and valid measure of changes in neurobehavioral functioning in unconscious people. Improvements, declines, and plateaus in neurobehavioral functioning were reliably and accurately detected.

Data also suggest that tracking individual neurobehavioral recovery patterns during coma recovery is useful for medical and rehabilitation management. For example, investigators found that medical decision-making regarding short-term effects of pharmacological interventions was improved. Previously undetected secondary medical complications were detected and successfully treated. Individual rehabilitation programs were enhanced.