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Duan X, Zhang T, Chen Y, Hou X, Huang Q, Li T, Feng Y, Xiao N. Natural course and predictors of consciousness recovery in children with prolonged disorder of consciousness. Sci Rep 2024; 14:17417. [PMID: 39075188 PMCID: PMC11286944 DOI: 10.1038/s41598-024-68370-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024] Open
Abstract
Prolonged disorder of consciousness (DoC) is a rising challenge. Pediatric data on diagnosis and prognosis of prolonged DoC were too limited and heterogeneous, making it difficult to define the natural course and evaluate the prognosis. The present study explored the emergence from the Minimally Conscious State (eMCS) incidence at different months postinjury drawing the natural course, and detected the predictors of the incidence in children with prolonged DoC. A hospital-based prospective cohort study was conducted. Kaplan-Meier curves, as well as univariate and multivariate COX regression analysis, were performed. The study enrolled 383 pediatric DoC individuals, including 220 males (57.4%), with an average age of 3.9 (1.9-7.3) years. The median duration between onset and rehabilitation is 30.0 (21.0-46.0) days. At enrollment, the ratio of vegetative state/unresponsive wakefulness syndrome (VS/WUS) to MCS is 78.9%-21.1%. Traumatic brain injury and infection are the major etiologies (36.8% and 37.1%, respectively), followed by hypoxia cerebral injury (12.3%). For children with prolonged DoC, the cumulative incidence of eMCS at months 3, 6, 12, and 24 was 0.510, 0.652, 0.731, 0.784 VS 0.290, 0.418, 0.539, 0.603 in the traumatic VS non-traumatic subgroup, respectively. For children in a persistent vegetative state (PVS), the cumulative incidence of emergence at months in 3, 6, 12, 24, 36 and 48 was testified as 0.439, 0.591, 0.683, 0.724, 0.743 and 0.743 in the traumatic subgroup, and 0.204, 0.349, 0.469, 0.534, 0.589 and 0.620 in the non-traumatic subgroup. Participants who exhibit any of the following four demographical and/or clinical characteristics-namely, older than 4 years at onset, accepted rehabilitation within 28 days of onset, remained MCS at enrollment, or with etiology of traumatic brain injuries-had a significantly positive outcome of consciousness recovery (eMCS). Moreover, both prolongation of the central somatosensory conductive time (CCT) (level 2) and absence of N20 (level 3) independently predict a negative outcome. In children with prolonged DoC, we found that 12 months postinjury was critical to eMCS, and a preferred timepoint to define chronic vegetative state (VS). The characteristics including age, etiology, time before rehabilitation, consciousness state, and SEP results were useful predictors of conscious recovery.Trial registration Registered 06/11/2018, the registration number is chiCTR1800019330 (chictr.org.cn). Registered prospectively.
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Affiliation(s)
- Xiaoling Duan
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University (CHCMU), Building 8th, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Ting Zhang
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University (CHCMU), Building 8th, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Yuxia Chen
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University (CHCMU), Building 8th, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Xueqin Hou
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University (CHCMU), Building 8th, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Qiuyi Huang
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University (CHCMU), Building 8th, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Tingsong Li
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University (CHCMU), Building 8th, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Ying Feng
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University (CHCMU), Building 8th, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.
- National Clinical Research Center for Child Health and Disorders, Chongqing, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
- International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China.
| | - Nong Xiao
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University (CHCMU), Building 8th, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.
- National Clinical Research Center for Child Health and Disorders, Chongqing, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
- International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China.
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Molteni E, Canas LDS, Briand MM, Estraneo A, Font CC, Formisano R, Fufaeva E, Gosseries O, Howarth RA, Lanteri P, Licandro GI, Magee WL, Veeramuthu V, Wilson P, Yamaki T, Slomine BS. Scoping Review on the Diagnosis, Prognosis, and Treatment of Pediatric Disorders of Consciousness. Neurology 2023; 101:e581-e593. [PMID: 37308301 PMCID: PMC10424839 DOI: 10.1212/wnl.0000000000207473] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/17/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Comprehensive guidelines for the diagnosis, prognosis, and treatment of disorders of consciousness (DoC) in pediatric patients have not yet been released. We aimed to summarize available evidence for DoC with >14 days duration to support the future development of guidelines for children, adolescents and young adults aged 6 months-18 years. METHODS This scoping review was reported based on Preferred Reporting Items for Systematic reviews and Meta-Analyses-extension for Scoping Reviews guidelines. A systematic search identified records from 4 databases: PubMed, Embase, Cochrane Library, and Web of Science. Abstracts received 3 blind reviews. Corresponding full-text articles rated as "in-scope" and reporting data not published in any other retained article (i.e., no double reporting) were identified and assigned to 5 thematic evaluating teams. Full-text articles were reviewed using a double-blind standardized form. Level of evidence was graded, and summative statements were generated. RESULTS On November 9, 2022, 2,167 documents had been identified; 132 articles were retained, of which 33 (25%) were published over the past 5 years. Overall, 2,161 individuals met the inclusion criteria; female patients were 527 of 1,554 (33.9%) cases included, whose sex was identifiable. Of 132 articles, 57 (43.2%) were single case reports and only 5 (3.8%) clinical trials; the level of evidence was prevalently low (80/132; 60.6%). Most studies included neurobehavioral measures (84/127; 66.1%) and neuroimaging (81/127; 63.8%); 59 (46.5%) were mainly related to diagnosis, 56 (44.1%) to prognosis, and 44 (34.6%) to treatment. Most frequently used neurobehavioral tools included the Coma Recovery Scale-Revised, Coma/Near-Coma Scale, Level of Cognitive Functioning Assessment Scale, and Post-Acute Level of Consciousness scale. EEG, event-related potentials, structural CT, and MRI were the most frequently used instrumental techniques. In 29/53 (54.7%) cases, DoC improvement was observed, which was associated with treatment with amantadine. DISCUSSION The literature on pediatric DoCs is mainly observational, and clinical details are either inconsistently presented or absent. Conclusions drawn from many studies convey insubstantial evidence and have limited validity and low potential for translation in clinical practice. Despite these limitations, our work summarizes the extant literature and constitutes a base for future guidelines related to the diagnosis, prognosis, and treatment of pediatric DoC.
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Affiliation(s)
- Erika Molteni
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD.
| | - Liane Dos Santos Canas
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Marie-Michèle Briand
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Anna Estraneo
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Carolina Colomer Font
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Rita Formisano
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Ekaterina Fufaeva
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Olivia Gosseries
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Robyn A Howarth
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Paola Lanteri
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Gimena Inès Licandro
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Wendy L Magee
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Vigneswaran Veeramuthu
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Pamela Wilson
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Tomohiro Yamaki
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Beth S Slomine
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
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