Semin Neurol 2022; 42(03): 249-258
DOI: 10.1055/s-0042-1756298
Review Article

Behavioral Assessment of Patients with Disorders of Consciousness

1   Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
2   Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts
,
Douglas I. Katz
3   Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
4   Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Massachusetts
,
Nicholas D. Schiff
5   Feil Family Brain and Mind Institute, Weill Cornell Medicine, New York, New York
6   Department of Neurology, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, NY, United States
,
Joseph T. Giacino
2   Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts
› Author Affiliations
Funding Epstein Foundation, James S. McDonnell Foundation, U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Neurological Disorders and Stroke, U01 NS1365885, National Institute of Neurological Disorders and Stroke, U01-NS086090, National Institute of Neurological Disorders and Stroke, 1U01NS093334-01, National Institute of Neurological Disorders and Stroke, U54N, National Institute on Disability, Independent Living, and Rehabilitation Research, 90DPCP0008- 01-00, National Institute on Disability, Independent Living, and Rehabilitation Research, 90DP0039, Tiny Blue Dot Foundation, U.S. Department of Defense, W81XWH-14-2-0176.

Abstract

Severe brain injury is associated with a period of impaired level of consciousness that can last from days to months and results in chronic impairment. Systematic assessment of level of function in patients with disorders of consciousness (DoC) is critical for diagnosis, prognostication, and evaluation of treatment efficacy. Approximately 40% of patients who are thought to be unconscious based on clinical bedside behavioral assessment demonstrate some signs of consciousness on standardized behavioral assessment. This finding, in addition to a growing body of literature demonstrating the advantages of standardized behavioral assessment of DoC, has led multiple professional societies and clinical guidelines to recommend standardized assessment over routine clinical evaluation of consciousness. Nevertheless, even standardized assessment is susceptible to biases and misdiagnosis, and examiners should consider factors, such as fluctuating arousal and aphasia, that may confound evaluation. We review approaches to behavioral assessment of consciousness, recent clinical guideline recommendations for use of specific measures to evaluate patients with DoC, and strategies for mitigating common biases that may confound the examination.



Publication History

Article published online:
13 September 2022

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