Optimizing Neurobehavioral Assessment for Patients with Disorders of Consciousness: Proposal of a Comprehensive Pre-Assessment Checklist for Clinicians.
Kristen Keech, Caroline Schnakers, Brooke Murtaugh, Katherine O'Brien, Beth Slomine, Marie-Michèle Briand, Rita Formisano, Aurore Thibaut, Anna Estraneo, Enrique Noé, Olivia Gosseries, Liliana da Conceição Teixeira
Author Information
Kristen Keech: The Queen's Medical Center, Honolulu, HI 96813, USA.
Caroline Schnakers: Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA. ORCID
Brooke Murtaugh: Department of Rehabilitation Programs, Madonna Rehabilitation Hospitals, Lincoln, NE 68506, USA. ORCID
Katherine O'Brien: TIRR Memorial Hermann, Houston, TX 77030, USA.
Beth Slomine: Brain Injury Clinical Research Center, Kennedy Krieger Institute, Baltimore, MD 21205, USA.
Marie-Michèle Briand: Physical Medicine and Rehabilitation Department, Hôpital du Sacré-Coeur de Montréal, Montreal, QC H4J 1C5, Canada.
Rita Formisano: IRCCS Santa Lucia Foundation, 00179 Rome, Italy. ORCID
Aurore Thibaut: Coma Science Group, GIGA-Consciousness, University of Liège, 4000 Liège, Belgium. ORCID
Anna Estraneo: IRCCS, Don Gnocchi Foundation, 50143 Florence, Italy.
Enrique Noé: IRENEA Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, 46011 Valencia, Spain. ORCID
Olivia Gosseries: Coma Science Group, GIGA-Consciousness, University of Liège, 4000 Liège, Belgium. ORCID
Liliana da Conceição Teixeira: RISE-Health, Center for Translational Health and Medical Biotechnology Research (TBIO), ESS, Polytechnic of Porto, R. Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal. ORCID
BACKGROUND: Clinicians are challenged by the ambiguity and uncertainty in assessing level of consciousness in individuals with disorder of consciousness (DoC). There are numerous challenges to valid and reliable neurobehavioral assessment and classification of DoC due to multiple environmental and patient-related biases including behavioral fluctuation and confounding or co-occurring medical conditions. Addressing these biases could impact accuracy of assessment and is an important aspect of the DoC assessment process. METHODS: A pre-assessment checklist was developed by a group of interdisciplinary DoC clinical experts and researchers based on the existing literature, current validated tools, and expert opinions. Once finalized, the checklist was electronically distributed to clinicians with a range of experience in neurobehavioral assessment with DoC. Respondents were asked to use the checklist prior to completing a neurobehavioral assessment. A survey was also provided to respondents to obtain feedback regarding checklist feasibility and utility in optimizing the behavioral assessments. RESULTS: Thirty-three clinicians completed the survey after using the checklist. Over half of the respondents were a combination of physicians, neuropsychologists, and physical therapists. All respondents served the adult DoC population and 42% percent had over ten years of clinical experience. Eighty percent reported they found the format of the checklist useful and easy to use. All respondents reported the checklist was relevant to preparing for behavioral assessment in the DoC population. Eighty-four percent reported they would recommend the use of the tool to other clinicians. CONCLUSIONS: The use of a pre-assessment checklist was found to be feasible and efficacious in increasing interdisciplinary clinician's ability to optimize the patient and environment in preparation for neurobehavioral assessment. Initial results of clinicians' perception of the utility of a pre-assessment checklist were positive. However, further validation of the tool is needed with larger sample sizes to improve representation of clinical use across disciplines and care settings.
