Consciousness and Physical Function in Prolonged Disorders of Consciousness in Japan: A Cross-sectional Comparison by Rehabilitation Status

In Japan, few patients with prolonged disorders of consciousness (pDoC) receive appropriate evaluation of consciousness, and their physical status is unclear. We investigated state of consciousness and the incidence of spasticity and contracture in patients with pDoC.

We assessed state of consciousness by using the Coma Recovery Scale-Revised (CRS-R). We evaluated physical status using the Modified Ashworth Scale (MAS) and range of motion (ROM). At Hospital A, patients did not receive rehabilitation, whereas patients at Hospital B received continuous rehabilitation.

Nine (33.3%) patients out of 27 were assessed as emergence from minimally conscious state (EMCS) at Hospital A, compared with 10 (27.8%) patients out of 36 at Hospital B. The mean ankle joint MAS score was higher in patients at Hospital A than at Hospital B. The mean ROM for ankle dorsiflexion was lower in patients at Hospital A than those at Hospital B. The mean elbow joint MAS score was lower in the EMCS group relative to the minimally conscious state (MCS) group. The mean ankle joint MAS score was lower in the EMCS group relative to the unresponsive wakefulness syndrome (UWS) group. Multiple regression analyses showed that admitted facility (Hospital A or Hospital B) was associated with ankle joint MAS scores and ankle dorsiflexion ROM, but was independent of age, classification of DOC, and time from onset to evaluation.

Some patients with pDOC may show improvement in status of consciousness. This study suggests that rehabilitation can reduce ankle spasticity and contracture in patients with pDOC.