Head Control Contributes to Prediction of Emergence From the Minimally Conscious State in Children Admitted to Inpatient Rehabilitation.
Adrian M Svingos, Heather B McLean, Beth S Slomine and 1 others
PMID 37348826WHAT IT FOUND
In children in inpatient rehabilitation after brain injury, any independent head control at admission helped identify those likely to emerge from a minimally conscious state.
Its absence did not rule out emergence, and trunk control did not predict emergence.
Key findings
01Admission state of consciousness identified nearly all children who emerged: 17 of 18 who emerged were in MCS at admission, and 15 of 16 admitted in VS/UWS did not emerge.
02Any independent head control at admission was associated with emergence: 9 of 11 children with PAMS Head Control greater than 1 emerged, but 9 children emerged without independent head control, so absent head control did not rule out emergence.
03Admission trunk control was not a useful predictor: 34 scored at the lowest trunk control level, and of the 6 who scored higher, 4 emerged, but the association was not significant.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study identified 49 patients but analysed 40 after exclusions, so the final sample was small. All data came from one hospital over 7 years, and changes in care since then may affect how admission head and trunk control scores look. The prediction rules were not tested in a separate group because the sample was small. The outcome was limited to emergence during the inpatient rehabilitation stay, not after discharge. Children under 2 years and children with conditions affecting head or trunk control were excluded, so the results do not apply to those groups. Most children scored at the lowest trunk control level, so there was little room to use that score for prediction. This was an observational study, so it cannot show that head control caused emergence.
Declared interests
The authors declared no conflicts of interest. The article is listed as supported by NIH extramural research funding.
The easy way to misread this
Do not conclude that head control causes emergence or that a child without head control cannot emerge. The study was observational, and some children emerged without independent head control at admission.