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When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Functional Independence

Accurate estimation of the functional independence of patients with unresponsive wakefulness syndrome (UWS) is essential to adjust family and clinical expectations and plan long-term necessary resources. Although different studies have described the clinical course of these patients, they have metho...

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Autores principales: Olaya, José, Noé, Enrique, Navarro, María Dolores, O’Valle, Myrtha, Colomer, Carolina, Moliner, Belén, Ippoliti, Camilla, Ferri, Joan, Maza, Anny, Llorens, Roberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7765669/
https://www.ncbi.nlm.nih.gov/pubmed/33339138
http://dx.doi.org/10.3390/brainsci10120990
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author Olaya, José
Noé, Enrique
Navarro, María Dolores
O’Valle, Myrtha
Colomer, Carolina
Moliner, Belén
Ippoliti, Camilla
Ferri, Joan
Maza, Anny
Llorens, Roberto
author_facet Olaya, José
Noé, Enrique
Navarro, María Dolores
O’Valle, Myrtha
Colomer, Carolina
Moliner, Belén
Ippoliti, Camilla
Ferri, Joan
Maza, Anny
Llorens, Roberto
author_sort Olaya, José
collection PubMed
description Accurate estimation of the functional independence of patients with unresponsive wakefulness syndrome (UWS) is essential to adjust family and clinical expectations and plan long-term necessary resources. Although different studies have described the clinical course of these patients, they have methodological limitations that could restrict generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the functional independence staging of those patients who emerged from a minimally conscious state (MCS) during the first year post-emergence. Our results showed that one year after emergence, most patients were severely dependent, although some of them showed extreme or moderate severity. Clinically meaningful functional improvement was less likely to occur in cognitively-demanding activities, such as activities of daily living and executive function. Consequently, the use of specific and staging functional independence measures, with domain-specific evaluations, are recommended to detect the functional changes that might be expected in these patients. The information provided by these instruments, together with that obtained from repeated assessments of the preserved consciousness with standardized instruments, could help clinicians to adjust expectations and plan necessary resources for this population.
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spelling pubmed-77656692020-12-27 When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Functional Independence Olaya, José Noé, Enrique Navarro, María Dolores O’Valle, Myrtha Colomer, Carolina Moliner, Belén Ippoliti, Camilla Ferri, Joan Maza, Anny Llorens, Roberto Brain Sci Article Accurate estimation of the functional independence of patients with unresponsive wakefulness syndrome (UWS) is essential to adjust family and clinical expectations and plan long-term necessary resources. Although different studies have described the clinical course of these patients, they have methodological limitations that could restrict generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the functional independence staging of those patients who emerged from a minimally conscious state (MCS) during the first year post-emergence. Our results showed that one year after emergence, most patients were severely dependent, although some of them showed extreme or moderate severity. Clinically meaningful functional improvement was less likely to occur in cognitively-demanding activities, such as activities of daily living and executive function. Consequently, the use of specific and staging functional independence measures, with domain-specific evaluations, are recommended to detect the functional changes that might be expected in these patients. The information provided by these instruments, together with that obtained from repeated assessments of the preserved consciousness with standardized instruments, could help clinicians to adjust expectations and plan necessary resources for this population. MDPI 2020-12-16 /pmc/articles/PMC7765669/ /pubmed/33339138 http://dx.doi.org/10.3390/brainsci10120990 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Olaya, José
Noé, Enrique
Navarro, María Dolores
O’Valle, Myrtha
Colomer, Carolina
Moliner, Belén
Ippoliti, Camilla
Ferri, Joan
Maza, Anny
Llorens, Roberto
When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Functional Independence
title When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Functional Independence
title_full When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Functional Independence
title_fullStr When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Functional Independence
title_full_unstemmed When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Functional Independence
title_short When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Functional Independence
title_sort when, how, and to what extent are individuals with unresponsive wakefulness syndrome able to progress? functional independence
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7765669/
https://www.ncbi.nlm.nih.gov/pubmed/33339138
http://dx.doi.org/10.3390/brainsci10120990
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