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388 Early Neurorehabilitation of Disorders of Consciousness after Acute Hemorrhagic Stroke

OBJECTIVES/GOALS: Accurate classification of disorders of consciousness (DoC) is key in developing rehabilitation plans following brain injury. The Coma Recovery Scale-Revised (CRS-R) is a sensitive measure of consciousness. We explore feasibility, safety and impact of CRS-R guided rehab in hemorrha...

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Autores principales: Woodward, Matthew, Arnold, Shannon, Wells, Chris L., Salasky, Vanessa, Overholt, Brandon, Morris, Nicholas, Badjatia, Neeraj, Podell, Jamie, Motta, Melissa, Braun, Robynne, Dorman, Farra, Parikh, Gunjan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10129746/
http://dx.doi.org/10.1017/cts.2023.423
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author Woodward, Matthew
Arnold, Shannon
Wells, Chris L.
Salasky, Vanessa
Overholt, Brandon
Morris, Nicholas
Badjatia, Neeraj
Podell, Jamie
Motta, Melissa
Braun, Robynne
Dorman, Farra
Parikh, Gunjan
author_facet Woodward, Matthew
Arnold, Shannon
Wells, Chris L.
Salasky, Vanessa
Overholt, Brandon
Morris, Nicholas
Badjatia, Neeraj
Podell, Jamie
Motta, Melissa
Braun, Robynne
Dorman, Farra
Parikh, Gunjan
author_sort Woodward, Matthew
collection PubMed
description OBJECTIVES/GOALS: Accurate classification of disorders of consciousness (DoC) is key in developing rehabilitation plans following brain injury. The Coma Recovery Scale-Revised (CRS-R) is a sensitive measure of consciousness. We explore feasibility, safety and impact of CRS-R guided rehab in hemorrhagic stroke patients with DoC and evaluate predictors of recovery. METHODS/STUDY POPULATION: Consecutive patients with non-traumatic hemorrhagic stroke, defined as subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH), receiving serial CRS-R assessments during their ICU stay at University of Maryland Medical Center from 2017-2021 were retrospectively identified. Outcomes of interest included the association with CRS-R and discharge disposition, therapy-based function and mobility and occurrence of safety events during CRS assessment. We also examined the association between CRS-R and physiological and anatomical injury pattern on electroencephalography (EEG) and magnetic resonance imaging (MRI), respectively. CRS-R RESULTS/ANTICIPATED RESULTS: 76 patients with≥2 CRS-R assessments were identified (22 SAH, 54 ICH, median age = 59, 50% female). Median CRS-R completed was 3 with no SAEs identified during sessions. We identified 4 patterns: persistent VS/UWS (49%), persistent MCS or better (13%), emergence from VS/UWS to MCS or better (27%) and regression from MCS or better to VS/UWS (11%). Persistent low CRS-R correlated with older age in SAH (p=0.01), female gender in ICH (p=0.04), and history of diabetes (p=0.01). 2% of patients with final CRS-R DISCUSSION/SIGNIFICANCE: Early neurorehabilitation guided by CRS-R appears to be feasible and safe acutely following hemorrhagic stroke complicated by prolonged DoC and may enhance access to inpatient rehabilitation with a lasting benefit on recovery. Further characterization of DoC patterns and their correlation to clinical markers, including EEG and MRI is needed.
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spelling pubmed-101297462023-04-26 388 Early Neurorehabilitation of Disorders of Consciousness after Acute Hemorrhagic Stroke Woodward, Matthew Arnold, Shannon Wells, Chris L. Salasky, Vanessa Overholt, Brandon Morris, Nicholas Badjatia, Neeraj Podell, Jamie Motta, Melissa Braun, Robynne Dorman, Farra Parikh, Gunjan J Clin Transl Sci Precision Medicine/Health OBJECTIVES/GOALS: Accurate classification of disorders of consciousness (DoC) is key in developing rehabilitation plans following brain injury. The Coma Recovery Scale-Revised (CRS-R) is a sensitive measure of consciousness. We explore feasibility, safety and impact of CRS-R guided rehab in hemorrhagic stroke patients with DoC and evaluate predictors of recovery. METHODS/STUDY POPULATION: Consecutive patients with non-traumatic hemorrhagic stroke, defined as subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH), receiving serial CRS-R assessments during their ICU stay at University of Maryland Medical Center from 2017-2021 were retrospectively identified. Outcomes of interest included the association with CRS-R and discharge disposition, therapy-based function and mobility and occurrence of safety events during CRS assessment. We also examined the association between CRS-R and physiological and anatomical injury pattern on electroencephalography (EEG) and magnetic resonance imaging (MRI), respectively. CRS-R RESULTS/ANTICIPATED RESULTS: 76 patients with≥2 CRS-R assessments were identified (22 SAH, 54 ICH, median age = 59, 50% female). Median CRS-R completed was 3 with no SAEs identified during sessions. We identified 4 patterns: persistent VS/UWS (49%), persistent MCS or better (13%), emergence from VS/UWS to MCS or better (27%) and regression from MCS or better to VS/UWS (11%). Persistent low CRS-R correlated with older age in SAH (p=0.01), female gender in ICH (p=0.04), and history of diabetes (p=0.01). 2% of patients with final CRS-R DISCUSSION/SIGNIFICANCE: Early neurorehabilitation guided by CRS-R appears to be feasible and safe acutely following hemorrhagic stroke complicated by prolonged DoC and may enhance access to inpatient rehabilitation with a lasting benefit on recovery. Further characterization of DoC patterns and their correlation to clinical markers, including EEG and MRI is needed. Cambridge University Press 2023-04-24 /pmc/articles/PMC10129746/ http://dx.doi.org/10.1017/cts.2023.423 Text en © The Association for Clinical and Translational Science 2023 https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
spellingShingle Precision Medicine/Health
Woodward, Matthew
Arnold, Shannon
Wells, Chris L.
Salasky, Vanessa
Overholt, Brandon
Morris, Nicholas
Badjatia, Neeraj
Podell, Jamie
Motta, Melissa
Braun, Robynne
Dorman, Farra
Parikh, Gunjan
388 Early Neurorehabilitation of Disorders of Consciousness after Acute Hemorrhagic Stroke
title 388 Early Neurorehabilitation of Disorders of Consciousness after Acute Hemorrhagic Stroke
title_full 388 Early Neurorehabilitation of Disorders of Consciousness after Acute Hemorrhagic Stroke
title_fullStr 388 Early Neurorehabilitation of Disorders of Consciousness after Acute Hemorrhagic Stroke
title_full_unstemmed 388 Early Neurorehabilitation of Disorders of Consciousness after Acute Hemorrhagic Stroke
title_short 388 Early Neurorehabilitation of Disorders of Consciousness after Acute Hemorrhagic Stroke
title_sort 388 early neurorehabilitation of disorders of consciousness after acute hemorrhagic stroke
topic Precision Medicine/Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10129746/
http://dx.doi.org/10.1017/cts.2023.423
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