Improving outcomes of severe disorders of consciousness

Article type: Research Article

Authors: DeFina, Philip A. | Fellus, Jonathan | Thompson, James W.G. | Eller, Monika | Moser, Rosemarie Scolaro^; | Frisina, Pasquale G.^; | Schatz, Philip | DeLuca, John^; | Zigarelli-McNish, Maria | Prestigiacomo, Charles J.

Affiliations: International Brain Research Foundation, Inc., Edison, NJ, USA | Kessler Institute for Rehabilitation, West Orange, NJ, USA | RSM Psychology Center, LLC, Lawrenceville, NJ, USA | Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NJ, USA | Saint Joseph's University, Philadelphia, PA, USA | University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ, USA | Neurological Surgery and Radiology, Cerebrovascular Center, University of Medicine and Dentistry of New Jersey, NJ, USA

Note: [] Corresponding author: Philip A. DeFina, PhD, International Brain Research Foundation, Inc., 100 Menlo Park, Suite 412, Edison, NJ 08837, USA. Tel.: +1 732 494 7600; Fax: +1 732 494 7611; E-mail: pdefina@ibrfinc.org

Abstract: Purpose: To evaluate the efficacy of an Advanced Care Protocol (ACP) in improving rates of clinical progression and emergence in patients with Severe Disorders of Consciousness (SDOC). Methods: Forty-one patients with SDOC were assigned to groups: Vegetative State (VS) traumatic etiology (VS-TBI), VS non-traumatic etiology (VS-NTBI), Minimally Conscious State (MCS-TBI), MCS non-traumatic etiology (MCS-NTBI). Design was a within-subjects retrospective case series measuring pre-post ACP intervention data. The ACP was administered sequentially over 12 weeks, incorporating traditional therapies (occupational, physical, speech), pharmaceuticals, median nerve stimulation, and neutraceuticals. Main Outcome Measures were: Pre- and post-treatment Disability Rating Scale (DRS), Functional Independence Measure (FIM), Glasgow Coma Scale (GCS), and Coma Recovery Scale-Revised (CRS-R); clinical diagnosis (VS, MCS, emerged) using criteria from the American Academy of Neurology and Mohonk Report. Results: Patients significantly improved across all outcome measures, from baseline to discharge. Clinical improvement of 100% of MCS patients and 78–86% of VS patients was observed following ACP treatment. Significant differences between ACP vs. the published "standard of care" rates, in favor of the ACP, based on DRS scores and on clinical status at discharge. Conclusions: These strikingly positive results of a novel multimodal intervention are a valuable contribution to this frontier of investigation.

DOI: 10.3233/RNN-2010-0548

Journal: Restorative Neurology and Neuroscience, vol. 28, no. 6, pp. 769-780, 2010