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
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: h.j.eilander@brain-consult.nl
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
