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Volume 42, Number 1, January/February 2005
Pages 19 — 28

A measure of neurobehavioral functioning after coma. Part II: Clinical and scientific implementation

Theresa Louise-Bender Pape, DrPH, MA, CCC-SLP/L;1-4* Ricardo G. Senno, MD, MS; Ann Guernon, MS, CCC-SLP/L;3 James P. Kelly, MA, MD5

1Department of Veterans Affairs (VA), Veterans Health Administration, Research Service, Edward Hines Jr. VA Hospital, Hines, IL; 2Marianjoy Rehabilitation Hospital, Wheaton, IL; Northwestern University, Feinberg School of Medicine, 3Department of Physical Medicine and Rehabilitation and 4Institute for Health Services Research and Policy Studies, Chicago, IL; 5University of Colorado School of Medicine, Department of Neurosurgery, Denver, CO
Abstract — This longitudinal validation study is Part II of a two-part series. Part I focuses on the methods used to construct the neurobehavioral measure derived from the Disorders of Consciousness Scale (DOCS) as well as the evidence of reliability and validity. Part II illustrates, through a series of selected case reports, the clinical use of repeated DOCS measures to enhance and complement medical rehabilitation management. The use of repeated DOCS measures in scientific investigations of mechanisms of injury is also described. Participants included patients at rehabilitation hospitals who were 18 years of age and older and unconscious after severe brain injury. Medical decision making regarding short-term effects of pharmacological intervention was augmented and improved through the examination of individual neurobehavioral recovery patterns. We identified medications to treat secondary medical complications and successfully determined effective dosage, presumably improving prognosis for recovery. We facilitated and enhanced development and refinement of individualized rehabilitation programs. Two investigations of treatment effectiveness during coma recovery and examination of the relationship between behavioral changes and neural adaptation are also described. By systematically tracking and mapping individual patterns of neurobehavioral recovery, we show that medical and rehabilitation management after coma can be enhanced. In addition, we also show that by examining the relationship between the DOCS neurobehavioral measure with mechanistic indicators of neurological recovery such as functional magnetic resonance imaging, scientific investigations of treatment and rehabilitation effectiveness can be enhanced.
Key words: brain injury, coma recovery, measurement, medical management, outcomes, prognostication, translation of research into practice.

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