Should Consistent Command-Following Be Added to the Criteria for Emergence From the Minimally Conscious State?

Objective: To determine whether consistent command-following (CCF) should be added to the diagnostic criteria for emergence from the mini-mally conscious state (eMCS).Design: Retrospective cohort study.Setting: Inpatient rehabilitation hospital.Participants: Patients (N=214) with acquired brain injury resulting in disorders of consciousness (DoC) admitted to a specialized rehabilitation program.Main Outcome Measures: Difference between time to recovery of CCF and time to recovery of functional object use (FOU) or functional commu-nication (FC), the 2 existing criteria for eMCS as measured by the Coma Recovery Scale-Revised (CRS-R).Results: Of 214 patients (median age, 53 years [interquartile range {IQR}, 34-66 years], male: 134 [62.6%], traumatic etiology: 115 [53.7%], admission CRS-R total score: 10 [IQR, 7-13]) admitted to rehabilitation without CCF, FOU, or FC, 162 (75.7%) recovered CCF and FOU or FC during the 8-week observation period. On average, recovery of CCF, FOU, and FC was observed within 1 day of one another, approximately 46 days (IQR, 38.25-58 days) post injury. One hundred and sixteen patients (71.6%) recovered FOU or FC prior to or at the same time as CCF.Conclusions: In patients recovering from DoC, CCF reemerges around the same time as FOU and FC. This finding may reflect the shared depen-dency of these behaviors on cognitive processes (eg, language comprehension, attention, motor control) that are essential for effective interper-sonal interaction and social participation. Our results support the addition of CCF to the existing diagnostic criteria for eMCS, but further validation in an independent sample should be conducted.Archives of Physical Medicine and Rehabilitation 2022;103:1870-3 (c) 2022 by the American Congress of Rehabilitation Medicine.

Automated summary

This study investigates the significance of consistent command-following (CCF) in the diagnostic criteria for emergence from the minimally conscious state (eMCS). The findings show that CCF reemerges around the same time as functional object use (FOU) or functional communication (FC) in patients recovering from disorders of consciousness (DoC). This supports the inclusion of CCF in the existing diagnostic criteria for eMCS.