PDF(Pubmed)
Abstract：
BACKGROUND: Family caregivers (FC) contribute to reducing the misdiagnosis rate in patients with disorders of consciousness (DOC). Unfortunately, the recent pandemic of COVID-19 imposed drastic restrictions that limited the access of FC to the sensory/cognitive stimulation protocols. Telemedicine approaches have been implemented to avoid discontinuity in care pathways and to ensure caregivers involvement in rehabilitation programs.
OBJECTIVE: The aim was to investigate whether the presence of FC remotely connected might help clinicians in eliciting higher cortically mediated behavioral responses in patients with DOC.
METHODS: Cross-sectional study.
METHODS: Post-acute Unit of Neurorehabilitation.
METHODS: DOC due to severe brain injury.
METHODS: Consecutive patients with DOC were assessed by means of the Coma Recovery Scale-Revised (CRS-R) by two expert examiners. Each patient underwent to five assessments in two weeks in three different conditions: 1) by the examiner only (standard); 2) with the verbal stimulation given by the FC remotely connected by PC tablet (caregiver in remote); and 3) with the verbal stimulation given by the FC physically present (caregiver in presence).
RESULTS: Thirty patients with DOC (VS/UWS=10; MCS=20; mean age: 51, range: 21-79; vascular: 16; anoxic: 6; TBI=8) and their FC were enrolled. Higher total scores of CRS-R were recorded both in \"caregiver in remote\" and in \"caregiver in presence\" than in standard condition (standard vs. remote, Z=2.942, P=0.003; standard vs. presence, Z=3.736, P<0.001). Furthermore, the administration of the CRS-R with a FC, elicited higher levels of behavioral responses in MCS patients, than CRS-R performed in standard condition. In particular, 2 patients out of 30 (6.66%) showed higher scores and better diagnosis when the CRS-R was administered with FC in remote. Similarly, 5 out of 30 patients (16.66%) showed better diagnoses when the CRS-R was administered with FC in presence. Five patients changed diagnosis between standard and presence conditions (3 MCS- were diagnosed as MCS+; 2 MCS+ were diagnosed as conscious).
CONCLUSIONS: Our findings add new evidence regarding the beneficial role of family members in the diagnosis of DOC, even mediated by telemedicine approach.
CONCLUSIONS: In future guidelines, FC should have an active and supporting role in the diagnostic and rehabilitative process of DOC.
OBJECTIVE: The aim was to investigate whether the presence of FC remotely connected might help clinicians in eliciting higher cortically mediated behavioral responses in patients with DOC.
METHODS: Cross-sectional study.
METHODS: Post-acute Unit of Neurorehabilitation.
METHODS: DOC due to severe brain injury.
METHODS: Consecutive patients with DOC were assessed by means of the Coma Recovery Scale-Revised (CRS-R) by two expert examiners. Each patient underwent to five assessments in two weeks in three different conditions: 1) by the examiner only (standard); 2) with the verbal stimulation given by the FC remotely connected by PC tablet (caregiver in remote); and 3) with the verbal stimulation given by the FC physically present (caregiver in presence).
RESULTS: Thirty patients with DOC (VS/UWS=10; MCS=20; mean age: 51, range: 21-79; vascular: 16; anoxic: 6; TBI=8) and their FC were enrolled. Higher total scores of CRS-R were recorded both in \"caregiver in remote\" and in \"caregiver in presence\" than in standard condition (standard vs. remote, Z=2.942, P=0.003; standard vs. presence, Z=3.736, P<0.001). Furthermore, the administration of the CRS-R with a FC, elicited higher levels of behavioral responses in MCS patients, than CRS-R performed in standard condition. In particular, 2 patients out of 30 (6.66%) showed higher scores and better diagnosis when the CRS-R was administered with FC in remote. Similarly, 5 out of 30 patients (16.66%) showed better diagnoses when the CRS-R was administered with FC in presence. Five patients changed diagnosis between standard and presence conditions (3 MCS- were diagnosed as MCS+; 2 MCS+ were diagnosed as conscious).
CONCLUSIONS: Our findings add new evidence regarding the beneficial role of family members in the diagnosis of DOC, even mediated by telemedicine approach.
CONCLUSIONS: In future guidelines, FC should have an active and supporting role in the diagnostic and rehabilitative process of DOC.
摘要：
背景：家庭照顾者（FC）有助于降低意识障碍（DOC）患者的误诊率。不幸的是,最近的COVID-19大流行施加了严格的限制，限制了FC获得感觉/认知刺激方案。已经实施了远程医疗方法，以避免护理途径的不连续性，并确保护理人员参与康复计划。
目的：目的是研究远程连接FC的存在是否有助于临床医生在DOC患者中引起更高的皮质介导行为反应。
方法：横断面研究。
方法：急性后神经康复单元。
方法：严重脑损伤导致的DOC。
方法：由两名专家检查者通过昏迷恢复量表修订（CRS-R）对连续DOC患者进行评估。每位患者在三个不同的条件下在两周内接受五次评估：1）仅由检查者（标准）；2）由PC平板电脑远程连接的FC（远程看护者）给予的言语刺激；3）由FC物理在场（看护者在场）给予的言语刺激。
结果：纳入30例DOC患者（VS/UWS=10；MCS=20；平均年龄：51，范围：21-79；血管：16；缺氧：6；TBI=8）及其FC。在“远程看护者”和“在场看护者”中记录的CRS-R总分均高于标准条件（标准与远程,Z=2.942，P=0.003；标准与存在,Z=3.736,P<0.001)。此外，与FC一起管理CRS-R，在MCS患者中引起更高水平的行为反应，比标准条件下执行的CRS-R。特别是,当CRS-R与FC一起远程施用时，30名患者中有2名（6.66％）显示出更高的评分和更好的诊断。同样，当CRS-R与FC一起存在时,30名患者中有5名(16.66%)显示出更好的诊断。五名患者在标准条件和存在条件之间改变了诊断（3MCS-被诊断为MCS；2MCS被诊断为清醒）。
结论：我们的发现增加了关于家庭成员在DOC诊断中的有益作用的新证据，甚至由远程医疗方法介导。
结论：在未来的指南中，FC应在DOC的诊断和康复过程中发挥积极和支持作用。
目的：目的是研究远程连接FC的存在是否有助于临床医生在DOC患者中引起更高的皮质介导行为反应。
方法：横断面研究。
方法：急性后神经康复单元。
方法：严重脑损伤导致的DOC。
方法：由两名专家检查者通过昏迷恢复量表修订（CRS-R）对连续DOC患者进行评估。每位患者在三个不同的条件下在两周内接受五次评估：1）仅由检查者（标准）；2）由PC平板电脑远程连接的FC（远程看护者）给予的言语刺激；3）由FC物理在场（看护者在场）给予的言语刺激。
结果：纳入30例DOC患者（VS/UWS=10；MCS=20；平均年龄：51，范围：21-79；血管：16；缺氧：6；TBI=8）及其FC。在“远程看护者”和“在场看护者”中记录的CRS-R总分均高于标准条件（标准与远程,Z=2.942，P=0.003；标准与存在,Z=3.736,P<0.001)。此外，与FC一起管理CRS-R，在MCS患者中引起更高水平的行为反应，比标准条件下执行的CRS-R。特别是,当CRS-R与FC一起远程施用时，30名患者中有2名（6.66％）显示出更高的评分和更好的诊断。同样，当CRS-R与FC一起存在时,30名患者中有5名(16.66%)显示出更好的诊断。五名患者在标准条件和存在条件之间改变了诊断（3MCS-被诊断为MCS；2MCS被诊断为清醒）。
结论：我们的发现增加了关于家庭成员在DOC诊断中的有益作用的新证据，甚至由远程医疗方法介导。
结论：在未来的指南中，FC应在DOC的诊断和康复过程中发挥积极和支持作用。
