Assessment of command-following in minimally conscious brain injured patients

• Published in: Archives of physical medicine and rehabilitation Vol. 80; no. 6; pp. 653 - 660
• Main Authors: Whyte, John, DiPasquale, Madeline C., Vaccaro, Monica
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.1999; Elsevier
• Subjects: Adult; Biological and medical sciences; Brain Injuries - psychology; Consciousness; Diseases of the nervous system; Female; Humans; Male; Medical sciences; Middle Aged; Persistent Vegetative State; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Severity of Illness Index; Performance evaluation; Human; Dynamic response; Nervous system diseases; Craniocerebral; Consciousness impairment; Diseases of the osteoarticular system; Quantization; Physical rehabilitation; Trauma; Cerebral disorder; Treatment; Central nervous system disease; Skull disease; Complication; Evolution; Severity score; Neurological disorder; Stimulus order
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/S0003-9993(99)90168-5

Objective: To develop a method for establishing the presence of command-following in individuals with traumatic brain injury, based on the principles of single-subject experimental design. Design: A series of single-subject experiments, individualized to the particular command-following question about a particular patient. Setting: An inpatient rehabilitation hospital with a specialized program for vegetative and minimally conscious brain injured patients. Patients: Eight individuals with serious brain injury of traumatic or nontraumatic origin, presenting in vegetative or minimally conscious states. Interventions: The frequency of performance of the behavior in question was assessed in response to commands and in relation to appropriate control conditions. Data were analyzed with χ 2 or Fisher's exact test, as well as measures derived from signal detection theory. Main Outcome Measures: The frequency of performance of a specific behavior in the presence of a command and in relevant contrasting conditions. Results: This method identified whether a specific behavior was being performed in response to command and whether the reliability of this behavior was changing over time either spontaneously or in response to treatment. Conclusions: Quantitative assessment of command-following based on principles of single-subject experimental design can determine whether patients are capable of following commands and whether this ability changes over time or in response to treatment.