A Estraneo1,2, A Pascarella3, O Masotta3, M Bartolo4, F Pistoia5, C Perin6, S Marino7, L Lucca8, V Pingue9, E Casanova10, A M Romoli1, S Gentile11, R Formisano12, G P Salvi13, F Scarponi14, A De Tanti15, P Bongioanni16, E Rossato17, A Santangelo18, A R Diana19, M Gambarin20, D Intiso21, R Antenucci22, S Premoselli23, M Bertoni24, L Trojano12,25. 1. Department of Acquired Brain Injury, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy. 2. Neurology Unit, Santa Maria Della Pietà General Hospital, Nola, Italy. 3. Lab for DoC Study, Istituti Clinici Scientifici Maugeri IRCCS, SB S.p.A., Telese Terme (BN), Italy. 4. Neurorehabilitation Unit, HABILITA Zingonia/Ciserano, Bergamo, Italy. 5. Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, L'Aquila, Italy. 6. Unità di Neuroriabilitazione cognitiva, Istituti Clinici Zucchi, Carate Brianza, Italy. 7. Neurorehabilitation Unit, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy. 8. Neurorehabilitation Unit, Istituto S. Anna, Crotone, Italy. 9. Neurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy. 10. UO Di Medicina Riabilitativa E Neuroriabilitazione, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy. 11. Dipartimento Riabilitazione F.T. Camplani Clinica Ancelle Carità, Cremona, Italy. 12. IRCCS, Fondazione Santa Lucia, Rome, Italy. 13. U.F. Riabilitazione Neuromotoria Istituto Clinico Quarenghi, S. Pellegrino Terme, Italy. 14. Dipartimento Neurologia UGCA Ospedale S. Giovanni Battista, Foligno, Italy. 15. Neurorehabilitation Unit, Centro Cardinal Ferrari, S, Stefano, Fontanellato di Parma, Italy, Centro Cardinal Ferrari, S. Stefano Riabilitazione, Fontanellato Di Parma, Italy. 16. sABI Section, Integrated Care Dept of Medical Specialties, AO-Universitaria Pisana, Pisa, Italy. 17. Dipartimento Di Riabilitazione, IRCCS Ospedale Sacro Cuore Don Calabria - Negrar, Verona, Italy. 18. Rehabilitation Dept, Giuseppe Giglio Foundation, Unit for Severe Acquired Brain Injuries, Cefalù, Italy. 19. Dip. Neuroscienze e Riabilitazione, Azienda Ospedaliera Brotzu, Cagliari, Italy. 20. Unità di Medicina Fisica e Riabilitazione, Ospedale Riabilitativo Di Marzana, Verona, Italy. 21. Unità di Medicina Fisica e Neuroriabilitazione, IRCCS "Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy. 22. Medicina Riabilitativa Intensiva- Ospedale Castel San Giovanni, Italy. 23. UOC Di Riabilitazione Neuromotoria Specialistica, Unità Comi ASST, Vimercate, Monza, Italy. 24. Azienda Socio Sanitaria Territoriale Dei Sette Laghi- Presidio Di Riabilitazione Neuromotoria, Cuasso Al Monte, Italy. 25. Department of Psychology, University of Campania 'Luigi Vanvitelli', Caserta, Italy.
Abstract
Aims: to assess occurrence and clinical correlates of neurogenic heterotopic ossifications (NHO) in patients with prolonged disorder of consciousness (DoC).Design: multi-center cross-sectional observational study.Setting: 23 intensive neurorehabilitation units.Subjects: 287 patients with prolonged disorder of consciousness (DoC; 150 in vegetative state, VS, and 128 in minimally conscious state, MCS) of different etiology (vascular = 125, traumatic = 83, anoxic = 56, others = 14).Main Measures: clinical evidence of NHO confirmed by standard radiological and/or sonographic evaluation; Coma Recovery Scale-Revised; Disability Rating Scale (DRS); Early Rehabilitation Barthel Index; presence of ventilator support, spasticity, bone fractures and paroxysmal sympathetic hyperactivity. Results: 31 patients (11.2%) presented NHO. Univariate analyses showed that NHO was associated with VS diagnosis, traumatic etiology, high DRS category and total score, and high occurrence of limb spasticity and bone fractures. A cluster-corrected binary logistic regression model (excluding spasticity available in a subset of patients) showed that only lower DRS total score and presence of bone fractures were independently associated with NHO.Conclusions: NHO are relatively frequent in patients with DoC, and are independently associated with functional disability, bone fractures and spasticity. These findings contribute to identifying patients with DoC prone to develop NHO and requiring special interventions to improve functional recovery.
Aims: to assess occurrence and clinical correlates of neurogenic heterotopic ossifications (NHO) in patients with prolonged disorder of consciousness (DoC).Design: multi-center cross-sectional observational study.Setting: 23 intensive neurorehabilitation units.Subjects: 287 patients with prolonged disorder of consciousness (DoC; 150 in vegetative state, VS, and 128 in minimally conscious state, MCS) of different etiology (vascular = 125, traumatic = 83, anoxic = 56, others = 14).Main Measures: clinical evidence of NHO confirmed by standard radiological and/or sonographic evaluation; Coma Recovery Scale-Revised; Disability Rating Scale (DRS); Early Rehabilitation Barthel Index; presence of ventilator support, spasticity, bone fractures and paroxysmal sympathetic hyperactivity. Results: 31 patients (11.2%) presented NHO. Univariate analyses showed that NHO was associated with VS diagnosis, traumatic etiology, high DRS category and total score, and high occurrence of limb spasticity and bone fractures. A cluster-corrected binary logistic regression model (excluding spasticity available in a subset of patients) showed that only lower DRS total score and presence of bone fractures were independently associated with NHO.Conclusions: NHO are relatively frequent in patients with DoC, and are independently associated with functional disability, bone fractures and spasticity. These findings contribute to identifying patients with DoC prone to develop NHO and requiring special interventions to improve functional recovery.
Entities:
Keywords:
Heterotopic ossification; disorders of consciousness; minimally conscious state; rehabilitation; vegetative state