Differences in Coma Recovery Scale-Revised performance in an upright position versus lying position

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Clinical Assessment

Background:

• Assessing consciousness in patients with disorders of consciousness (DoC) is challenging.
• The Coma Recovery Scale-Revised (CRS-R) is a standard tool, but its performance may be influenced by external factors.
• Patient positioning is a potential factor affecting behavioral assessments of consciousness.

Purpose of the Study:

• To investigate the impact of different patient positions on CRS-R scores in individuals with DoC.
• To determine if upright positioning enhances the accuracy of consciousness assessment.

Main Methods:

• Retrospective analysis of 1,470 CRS-R assessments from 232 patients with DoC.
• Patients were assessed in four positions: lying in bed, sitting at the edge of a mat, sitting in a wheelchair, and standing.
• A conditional random coefficients multi-level model analyzed transformed CRS-R scores across positions.

Main Results:

• CRS-R scores were significantly associated with assessment position.
• Patients scored higher in upright positions (wheelchair, mat, standing) compared to lying in bed.
• Increased arousal protocols did not significantly improve CRS-R performance.

Conclusions:

• Upright patient positioning, rather than just arousal, may improve CRS-R performance in DoC.
• The CRS-R is better performed in an upright position for patients with DoC.
• Recommend assessing consciousness in DoC patients in an upright position when feasible.