A new ICT system coupling electromyography and coma recovery scale-revised to support the diagnostic process in disorders of consciousness
The Coma Recovery Scale-revised (CRS-r) is the gold standard for the behavioral assessment of patients with Disorders of Consciousness (DoCs). However, the misdiagnosis rate is around 40%. For this reason, recent guidelines suggested enhancing the assessment with neurophysiological measures: among these, surface electromyography (sEMG) represents a convenient bedside solution. This work presents the use of the STRIVEfc system, a wearable device that allows CRS-r administration while recording four sEMG signals. STRIVEfc was employed in 40 sessions on 33 DoCs patients and the sEMG was analyzed to look for voluntary and consistent over threshold (OT) muscular activities. Their duration, amplitude, and number were retained and compared between patients in Unresponsive Wakefulness Syndrome (UWS) and Minimally Conscious State (MCS), revealing more numerous and significantly longer OTs in the latter group. Lastly, the EMG information was exploited to enrich the behavioral assessment by building the instrumented CRS-r score (ICRS-r). In 9/16 UWS sessions, the ICRS-r score suggested a higher-level functioning, not translated into a behavioral response, compatible with MCS diagnosis. Overall, the use of STRIVEfc allows to reveal hidden muscular patterns not detectable by the clinician, thus improving the characterization of DoCs patient's functional capabilities and supporting the diagnostic process.
Authors
- Simone Toffoli (ORCID: https://orcid.org/0000-0002-7254-1362)
- Jorge Navarro (ORCID: https://orcid.org/0000-0003-1508-6727)
- Guya Devalle (ORCID: https://orcid.org/0000-0003-4200-3771)
- Martina Cacciatore (ORCID: https://orcid.org/0000-0002-3379-6725)
- Matilde Leonardi (ORCID: https://orcid.org/0000-0003-0552-8923)
- Sara Marelli (ORCID: https://orcid.org/0000-0003-0074-5371)
- Davide Sattin (ORCID: https://orcid.org/0000-0001-7736-4337)
- Simona Ferrante (ORCID: https://orcid.org/0000-0002-7835-1965)
- Filippo Barbadoro (ORCID: https://orcid.org/0000-0002-9330-362X)
- Maurizio Lanfranchi
- Milad Malavolti (ORCID: https://orcid.org/0000-0003-4784-9602)
- Camilla Ippoliti (ORCID: https://orcid.org/0000-0003-2850-0691)
- Luigi Ferini‐Strambi (ORCID: https://orcid.org/0000-0003-2867-5424)
- Francesca Giulia Magnani (ORCID: https://orcid.org/0000-0002-6503-3052)
- Valeria Pingue (ORCID: https://orcid.org/0000-0001-9376-4699)
- Davide Rossi Sebastiano (ORCID: https://orcid.org/0000-0003-3698-8615)
- Francesca Lunardini (ORCID: https://orcid.org/0000-0003-4705-6733)
Institutions
- Vita-Salute San Raffaele University (IT)
- Istituti Clinici Scientifici Maugeri (IT)
- Don Carlo Gnocchi Foundation (IT)
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- Ospedale Valduce (IT)
- Fondazione IRCCS Istituto Neurologico Carlo Besta (IT)
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT)
- Politecnico di Milano (IT)
Publication Details
- Journal
- Scientific Reports
- Published
- 2024-11-06
- DOI
- https://doi.org/10.1038/s41598-024-73565-8
- Primary Topic
- Traumatic Brain Injury Research
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Ministero della Salute