Evidence map›Paper›PMID 40139629›Full record

Observational studyArchives of physical medicine and rehabilitation2025

Behavioral Fluctuation in Disorders of Consciousness: A Retrospective Analysis.

Alice Barra, Yelena G Bodien, Can Ozan Tan, Geraldine Martens, Christopher Malone, Joseph T Giacino

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Archives of physical medicine and rehabilitation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Review
  3. Review
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Alice BarraIRENEA - Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, València, Spain; Coma Science Group, GIGA Consciousness - GIGA Research, University of Liège, Liège, Belgium.
Yelena G BodienSpaulding Rehabilitation Hospital, Charlestown, MA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Can Ozan TanRAM Group, Electrical Engineering, Mathematics, and Computer Science, University of Twente, the Netherlands.
Geraldine MartensComa Science Group, GIGA Consciousness - GIGA Research, University of Liège, Liège, Belgium; Spaulding Rehabilitation Hospital, Charlestown, MA.
Christopher MaloneSpaulding Rehabilitation Hospital, Charlestown, MA.
Joseph T GiacinoSpaulding Rehabilitation Hospital, Charlestown, MA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA. Electronic address: jgiacino@mgh.harvard.edu.

Funding

Transforming Research and Clinical Knowledge in Traumatic Brain InjuryU01NS086090 · NINDS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI DIAZ-ARRASTIA, RAMON, GIACINO, JOSEPH THOMAS · 2013 to 2017
$19.1M
The Late Effects of TBI (LETBI) Study: Injury Patterns and Biological Markers of Post-Traumatic NeurodegenerationRF1NS115268 · NINDS · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI Kristen Dams-O'Connor · 2019 to 2026
$10.3M
Central thalamic stimulation for traumatic brain injuryUH3NS095554 · NINDS · WEILL MEDICAL COLL OF CORNELL UNIV · PI BUTSON, CHRISTOPHER R, GIACINO, JOSEPH THOMAS · 2015 to 2021
$6.9M
A Connectome-Based Clinical Trial Platform to Promote Early Recovery of Consciousness after Traumatic ComaDP2HD101400 · NICHD · MASSACHUSETTS GENERAL HOSPITAL · PI EDLOW, BRIAN L. · 2019 to 2019
$2.5M
Brainstem Connectome Mapping to Guide Targeted Stimulant Therapy in Patients with Traumatic ComaR21NS109627 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI EDLOW, BRIAN L. · 2019 to 2020
$480k
ACL HHS 90DPTB0027NCCDPHP CDC HHS U48 DP000039NICHD NIH HHS DP2 HD101400NINDS NIH HHS R21 NS109627NINDS NIH HHS RF1 NS115268NINDS NIH HHS U01 NS086090NINDS NIH HHS UH3 NS095554
6 · The paper itself

Abstract

objectivesTo assess the frequency of behavioral fluctuations in patients with prolonged disorders of consciousness (DoC), characterize the stability of consciousness ratings, and characterize the stability of behavioral signs of consciousness.

designProspective observational analysis.

settingSpecialized DoC program in an inpatient rehabilitation facility and a long-term acute care hospital.

participantsPatients in a vegetative state/unresponsive wakefulness state, minimally conscious state, and emerging from a minimally conscious state followed weekly by the Coma Recovery Scale-Revised (CRS-R) between 28 and 90days postinjury (N=241).

main outcome measuresChange in CRS-R subscale scores and consciousness ratings.

resultsBehavioral fluctuation was observed in >80% of patients and was most common in the CRS-R motor subscale and least common in the communication subscale (83% and 54% of patients experienced ≥1 fluctuation over the 3wk study period, respectively, with a 1-point change observed most frequently). Among patients who were conscious at baseline assessment, 25% were subsequently rated as unconscious at least once. Localization to pain and object manipulation were the most stable signs of consciousness, recurring at least 3 times after the first occurrence in ≥97% of the sample. Reproducible command-following and intelligible verbalization were the least stable, recurring at least 3 times after the first occurrence in ≤27% of the sample.

conclusionsPatients with prolonged DoC who undergo serial assessment demonstrate a high rate of fluctuation in behavioral signs of consciousness. These findings highlight that repeated assessments are essential in this population, both to capture the highest level of consciousness and to help distinguish spontaneous fluctuation from response to treatment in interventional studies.

Indexed as

Consciousness DisordersPersistent Vegetative StateAdultAgedFemaleHumansMaleMiddle AgedProspective StudiesRetrospective StudiesAssessment scaleDisorders of consciousnessMinimally conscious stateRehabilitationTraumatic brain injuryUnresponsive wakefulness syndromeVegetative state

Identifiers

PMID40139629
PMCPMC12353754

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.