Short-Term Outcomes of Early Intensive Neurorehabilitation for Long-Term Disorders of Consciousness: A Prospective Cohort Study
Driessen, D. M., Utens, C. M., Ribbers, G. M., van Erp, W. S., & Heijenbrok-Kal, M. H. (2024)
1 June 2024Abstract
Background
Advances in medical care have increased the survival of people with severe brain injuries and, with it, the number of survivors with long-term disorders of consciousness (PDOC) has increased. In the literature, early intensive neurorehabilitation (EIN) for people with PDOC is recommended to achieve the best possible outcomes.
Objectives
To evaluate the frequency and degree of consciousness recovery, mortality, complications, pain and discomfort, and medication during a nationwide EIN program in people with PDOC after acquired brain injury. We hypothesized that the level of consciousness would improve in half of the people with PDOC.
Methods
Prospective cohort study. People with PDOC aged 16 years and older who were admitted to the EIN department centralized in one rehabilitation center in the Netherlands (Libra Rehabilitation & Audiology) were included. The EIN delivers a subacute medical level of care and rehabilitation for a maximum duration of 14 weeks. The outcome measures were level of consciousness (CRS-R), mortality, number of complications, medication, and pain/discomfort (NCS-R).
Results
Of the 104 people included, 68% entered a minimal state of consciousness with command following or higher during EIN and 44% regained consciousness. Mortality during EIN was 6% and 50% of deaths followed a decision not to receive treatment or to discontinue life-prolonging treatment. Almost all participants had at least 1 medical complication, leading to readmission to the hospital for 30%. 73% showed no pain or discomfort. During EIN, cardiovascular medication and pain relievers were reduced by 15%.
Conclusions
During the EIN program, a large percentage of people with PDOC regained at least a minimal state of consciousness or even consciousness. These outcomes and the frequent medical complications in these people suggest that intensive specialized care should be offered to all people with PDOC. The results of this study may help health professionals to better inform the families of people with PDOC about the short-term prognosis of PDOC.
