{Reference Type}: Journal Article
{Title}: Family caregivers improve the diagnostic accuracy of disorders of consciousness: from remote to near-bed auditory stimulation.
{Author}: Moretta P;Femiano C;Cavallo ND;Lanzillo A;Luciano F;Ferrante C;Maiorino A;Santangelo G;Marcuccio L;
{Journal}: Eur J Phys Rehabil Med
{Volume}: 60
{Issue}: 2
{Year}: 2024 Apr 21
{Factor}: 5.313
{DOI}: 10.23736/S1973-9087.24.08179-6
{Abstract}: <B>BACKGROUND: </B>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.<BR><B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>Cross-sectional study.<BR><B>METHODS: </B>Post-acute Unit of Neurorehabilitation.<BR><B>METHODS: </B>DOC due to severe brain injury.<BR><B>METHODS: </B>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).<BR><B>RESULTS: </B>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).<BR><B>CONCLUSIONS: </B>Our findings add new evidence regarding the beneficial role of family members in the diagnosis of DOC, even mediated by telemedicine approach.<BR><B>CONCLUSIONS: </B>In future guidelines, FC should have an active and supporting role in the diagnostic and rehabilitative process of DOC.