Manual Dexterity in Patients with Disorder of Consciousness.

OBJECTIVE

To examine hand motor features in individuals diagnosed with disorder of consciousness (DoC) after severe brain injury, and to investigate the relationship between manual dexterity and levels of consciousness.

DESIGN

Cross-sectional study.

SETTING

Rehabilitation hospital.

PARTICIPANTS

Sixty patients with DoC (44 men and 16 women), with a mean age of 55.03±15.28 years and a mean postinjury duration of 10.68±7.98 months.

INTERVENTIONS: Not applicable (no interventions were administered).

MAIN OUTCOME MEASURES: Manual dexterity (Brunnstrom Recovery Stage [BRS]), spasticity (Modified Ashworth Scale), pain (Nociception Coma Scale-Revised), and consciousness (Coma Recovery Scale-Revised) were assessed. Descriptive, nonparametric, and multivariate analyses were performed.

RESULTS

Evaluation of the best-functioning hands in the 60 patients with DoC showed that 60% (n=36) had low dexterity (BRS<4), and edema was revealed in 28.3% (17/60) of these hands. Compared with patients in minimally conscious state (MCS), those in unresponsive wakefulness syndrome (UWS) had significantly lower manual dexterity (96.2% vs 32.4%) and a higher prevalence of hand edema (42.3% vs 17.6%). BRS scores were significantly higher for hands than for arms (P<.001). Manual dexterity was strongly associated with consciousness diagnosis (adjusted odds ratios=16.03, 95% confidence interval, 2.16-119.11; P=.007). No significant difference was found between right and left hands.

CONCLUSIONS

A considerable proportion of patients with DoC experience severe hand complications, which can negatively impact their clinical diagnosis and quality of life. The BRS is effective in detecting subtle hand motor responses that may reflect residual consciousness in DoC. The observed association between manual dexterity and consciousness suggests that hand motor control may engage neural circuits involved in consciousness processing.