Abstract
Disorders of consciousness represent altered mental status at its most severe, comprising
a continuum between coma, the vegetative state/unresponsive wakefulness syndrome,
the minimally conscious state, and emergence from the minimally conscious state. Patients
often transition between these levels throughout their recovery, and determining a
patient's current level can be challenging, particularly in the acute care setting.
Although healthcare providers have classically relied on a bedside neurological exam
or the Glasgow Coma Scale to aid with assessment of consciousness, studies have identified
multiple limitations of doing so. Neurobehavioral assessment measures, such as the
Coma Recovery Scale-Revised, have been developed to address these shortcomings. Each
behavioral metric has strengths as well as weaknesses when applied in the acute care
setting. In this review, we appraise common assessment approaches, outline alternative
measures for fine-tuning these assessments in the acute care setting, and highlight
strategies for implementing these practices in an interdisciplinary manner.
Keywords
disorders of consciousness - coma - vegetative state - unresponsive wakefulness syndrome
- minimally conscious state - behavioral evaluation
