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Updated: May 6, 2026

Assessment and Communication for People with Disorders of Consciousness
Published on: August 1, 2017
Behavioral Fluctuation in Disorders of Consciousness: A Retrospective Analysis
Alice Barra1, Yelena G Bodien2, Can Ozan Tan3
1IRENEA - Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, València, Spain; Coma Science Group, GIGA Consciousness - GIGA Research, University of Liège, Liège, Belgium.
Behavioral fluctuations are common in prolonged disorders of consciousness (DoC), affecting over 80% of patients. Repeated assessments are crucial for accurately gauging consciousness levels and distinguishing fluctuations from treatment effects.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Clinical Neurology
Background:
- Prolonged disorders of consciousness (DoC) present diagnostic challenges.
- Assessing consciousness stability is critical for patient management and research.
Purpose of the Study:
- To determine the frequency of behavioral fluctuations in DoC patients.
- To evaluate the stability of consciousness ratings and specific behavioral signs.
Main Methods:
- Prospective observational study of 241 DoC patients.
- Weekly assessments using the Coma Recovery Scale-Revised (CRS-R) over 3-6 weeks.
- Analysis of CRS-R subscale scores and overall consciousness ratings.
Main Results:
- Over 80% of patients exhibited behavioral fluctuations, most notably in motor function.
- 25% of initially conscious patients were later rated as unconscious.
- Stable consciousness signs included pain localization and object manipulation; less stable were command-following and verbalization.
Conclusions:
- Patients with DoC show significant behavioral fluctuation during serial assessments.
- Repeated evaluations are essential to accurately capture consciousness levels and differentiate fluctuations from treatment responses.
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