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Determining the Hierarchy of Coma Recovery Scale-Revised Rating Scale Categories and Alignment with Aspen Consensus
Jennifer A Weaver1,2, Alison M Cogan3, Katherine A O'Brien4
1Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA.
Journal of Neurotrauma
|May 16, 2022
Summary
This study validated the Coma Recovery Scale-Revised (CRS-R) for disorders of consciousness (DoC). Findings support revising diagnostic criteria for Minimally Conscious State (MCS) and Emerged from Minimally Conscious State (eMCS).
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Psychometrics
Background:
- Disorders of consciousness (DoC) after severe brain injury require accurate assessment.
- The Coma Recovery Scale-Revised (CRS-R) is a key tool, but its hierarchical structure needs empirical validation against the Aspen consensus criteria.
- Understanding the neurobehavioral continuum in DoC is crucial for diagnosis and prognosis.
Purpose of the Study:
- To empirically evaluate the hierarchical structure of CRS-R categories.
- To assess the alignment of CRS-R categories with the Aspen consensus criteria for DoC.
- To provide evidence for potential revisions in diagnostic criteria for states of consciousness.
Main Methods:
- Analysis of CRS-R data from 262 patients with DoC using the partial credit Rasch Measurement Model.
- Operationalization of CRS-R rating scale categories to Aspen consensus criteria.
- Examination of the association between CRS-R Rasch person measures and Aspen-defined states of consciousness.
Main Results:
- Most CRS-R categories aligned with the expected neurobehavioral hierarchy, with "None" (Oromotor/Verbal) being easiest and "Functional Object Use" (Motor) being hardest.
- Six of 29 categories showed unexpected ordering, with some reflecting higher neurobehavioral function than expected for their diagnostic category.
- CRS-R Rasch person measures strongly correlated with Aspen-defined states of consciousness (rs = 0.86, p < 0.01).
Conclusions:
- The study provides empirical support for the CRS-R's hierarchical structure and its alignment with Aspen criteria.
- Evidence suggests revising diagnostic criteria for Minimally Conscious State (MCS) to include "Localization to Sound" (Auditory item, category 2).
- Evidence suggests revising diagnostic criteria for Emerged from Minimally Conscious State (eMCS) to include "Consistent Movement to Command" (Auditory item, category 4).
