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Comment & Response
October 4, 2021

Traumatic Brain Injury Recovery Trajectories in Patients With Disorders of Consciousness—Reply

Author Affiliations
  • 1Department of Neurology, University of Colorado School of Medicine, Aurora
  • 2Research Department, Craig Hospital, Englewood, Colorado
  • 3Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
  • 4Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital and Harvard Medical School, Boston
JAMA Neurol. 2021;78(11):1412-1413. doi:10.1001/jamaneurol.2021.3430

In Reply We thank Arnts et al and Smith et al for their insightful comments on our article1 showing that almost all survivors of traumatic brain injury with a disorder of consciousness (DOC) early after injury recover consciousness by the end of inpatient rehabilitation, and a substantial proportion regain functional independence.

Our article defined DOC as failure to follow commands, assessed with the motor component of the Glasgow Coma Scale (GCS) (GCS motor score <6) or the Disability Rating Scale (Disability Rating Scale motor score >0). Arnts et al question the specificity of this approach, particularly the motor score’s ability to distinguish DOC from other impairments such as language disorders. They suggest the JFK Coma Recovery Scale–Revised (CRS-R)2 is the gold standard for DOC and a better measure of recovery of consciousness.

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