Which behaviours are first to emerge during recovery of consciousness after severe brain injury?

Ann Phys Rehabil Med. 2020 Jul;63(4):263-269. doi: 10.1016/j.rehab.2019.10.004. Epub 2019 Nov 26.


Background: Early detection of consciousness after severe brain injury is critical for establishing an accurate prognosis and planning appropriate treatment.

Objectives: To determine which behavioural signs of consciousness emerge first and to estimate the time course to recovery of consciousness in patients with severe acquired brain injury.

Methods: Retrospective observational study using the Coma Recovery Scale-Revised and days to recovery of consciousness in 79 patients (51 males; 34 with traumatic brain injury; median [IQR] age 48 [26-61] years; median time since injury 26 [20-36] days) who transitioned from coma or unresponsive wakefulness syndrome (UWS)/vegetative state (VS) to the minimally conscious state (MCS) or emerged from MCS during inpatient rehabilitation.

Results: Visual pursuit was the most common initial sign of MCS (41% of patients; 95% CI [30-52]), followed by reproducible command-following (25% [16-35]) and automatic movements (24% [15-33]). Ten other behaviours emerged first in less than 16% of cases. Median [IQR] time to recovery of consciousness was 44 [33-59] days. Etiology did not significantly affect time to recovered consciousness.

Conclusion: Recovery of consciousness after severe brain injury is most often signalled by reemergence of visual pursuit, reproducible command-following and automatic movements. Clinicians should use assessment measures that are sensitive to these behaviours because early detection of consciousness is critical for accurate prognostication and treatment planning.

Keywords: Brain injury; Minimally conscious state; Outcome; Vegetative state.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Brain Injuries, Traumatic / complications
  • Brain Injuries, Traumatic / physiopathology*
  • Brain Injuries, Traumatic / rehabilitation
  • Coma / etiology
  • Coma / physiopathology*
  • Coma / rehabilitation
  • Consciousness / physiology*
  • Female
  • Glasgow Coma Scale
  • Humans
  • Male
  • Middle Aged
  • Neurological Rehabilitation
  • Persistent Vegetative State / diagnosis*
  • Persistent Vegetative State / etiology
  • Prognosis
  • Pursuit, Smooth
  • Recovery of Function / physiology*
  • Retrospective Studies