Sequence of recovery during the course of emergence from the minimally conscious state.

OBJECTIVE

To document and examine recovery profiles of persons during the course of emergence from a minimally conscious state (MCS) after traumatic brain injury (TBI).

DESIGN

Case series.

SETTING

Participants in an inpatient brain injury rehabilitation program.

PARTICIPANTS

Nine people with TBI who emerged from MCS.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURE: The Western Neuro Sensory Stimulation Profile.

RESULTS

In all cases, stereotyped (nonreflexive) movement was the first behavior to resolve, yet by itself it was never sufficient to indicate emergence from the MCS. Two of the 9 patients showed consistent object manipulation before all 3 elements of functional communication. Conversely, in 2 patients, all 3 components of functional communication emerged before object manipulation. In the remaining 5 patients, object manipulation occurred along with components of functional communication.

CONCLUSIONS

During the course of data collection, issues were raised about differentiation between the MCS and posttraumatic amnesia. The data are also discussed within the context of the work of Giacino et al and the development of their scale to measure duration of the MCS. These data support the theory that functional communication and object manipulation are the 2 key indicators of emergence from MCS.