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Updated: Jan 10, 2026
Assessment and Communication for People with Disorders of Consciousness
Published on: August 1, 2017
Long-term Progress of Functional Independence of Patients With Prolonged Disorders of Consciousness Who Emerge From
Ana Sierra1, Alice Barra2, María Dolores Navarro2
1Neurorehabilitation and Brain Research Group, Institute for Human-Centered Technology Research, Universitat Politècnica de València, València.
Objective:
To investigate the long-term functional independence of individuals with prolonged disorders of consciousness (DOC) who emerge from the minimally conscious state (MCS).
Design:
Retrospective cohort study. Follow-up assessments were conducted at 6 and 12 months after emergence.
Setting:
Long-term neurorehabilitation center.
Participants:
We conducted a retrospective analysis of 62 individuals with prolonged DOC who emerged from MCS and completed 6- and 12-month follow-up assessments. Individuals were predominantly men (79%), with a median age of 35 years (interquartile range [IQR]: 25.9-49.4), and most had sustained a traumatic brain injury (74%). At admission, 21% of individuals were in an unresponsive wakefulness state and 79% in MCS (44% MCS- and 56% MCS+).
Interventions:
Not applicable.
Main Outcome Measures:
Functional independence was evaluated using the Disability Rating Scale (DRS), the Barthel Index (BI), the Functional Independence Measure (FIM), and the Functional Assessment Measure (FAM). Descriptive statistics and categorical analyses were used to evaluate changes across timepoints.
Results:
At 6 months after emergence, individuals showed severe functional dependence, with most of the sample categorized as extremely or severely disabled. Median scores indicated poor independence across all scales (DRS: 16/29 [IQR=8.25-18]; BI: 10/100 [IQR=0.25-31]; FIM: 29.5/126 [IQR=20-46.75]; FIM+FAM: 52 [IQR=36.26-80]). By 12 months, slight but nonsignificant improvements were observed (DRS: 14 [IQR=8-18]; BI: 20.5 [IQR=2.25-52.5]; FIM: 32 [IQR=23-63.25]; FIM+FAM: 60 [IQR=37.25-107]), with only a minority transitioning to less severe disability categories. Most remained highly dependent in motor, cognitive, and daily living activities.
Conclusions:
Individuals with prolonged DOC generally show limited functional recovery after emerging from MCS, with only minimal group-level improvements during the first year. These findings highlight the persistence of severe disability after emergence from prolonged DOC and the importance of long-term care strategies.
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