A new ICT system coupling electromyography and coma recovery scale-revised to support the diagnostic process in disorders of consciousness
Abstract 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...
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Nature Portfolio
2024-11-01
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| Online Access: | https://doi.org/10.1038/s41598-024-73565-8 |
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| author | Francesca Giulia Magnani Simone Toffoli Martina Cacciatore Camilla Ippoliti Filippo Barbadoro Milad Malavolti Francesca Lunardini Jorge Navarro Guya Devalle Maurizio Lanfranchi Valeria Pingue Sara Marelli Luigi Ferini Strambi Matilde Leonardi Davide Sebastiano Rossi Davide Sattin Simona Ferrante |
| author_facet | Francesca Giulia Magnani Simone Toffoli Martina Cacciatore Camilla Ippoliti Filippo Barbadoro Milad Malavolti Francesca Lunardini Jorge Navarro Guya Devalle Maurizio Lanfranchi Valeria Pingue Sara Marelli Luigi Ferini Strambi Matilde Leonardi Davide Sebastiano Rossi Davide Sattin Simona Ferrante |
| author_sort | Francesca Giulia Magnani |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-f2a3be80a4914947bbf0e4b0de908c98 |
| institution | DOAJ |
| issn | 2045-2322 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-f2a3be80a4914947bbf0e4b0de908c982025-08-20T02:50:03ZengNature PortfolioScientific Reports2045-23222024-11-0114111610.1038/s41598-024-73565-8A new ICT system coupling electromyography and coma recovery scale-revised to support the diagnostic process in disorders of consciousnessFrancesca Giulia Magnani0Simone Toffoli1Martina Cacciatore2Camilla Ippoliti3Filippo Barbadoro4Milad Malavolti5Francesca Lunardini6Jorge Navarro7Guya Devalle8Maurizio Lanfranchi9Valeria Pingue10Sara Marelli11Luigi Ferini Strambi12Matilde Leonardi13Davide Sebastiano Rossi14Davide Sattin15Simona Ferrante16SC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo BestaDepartment of Electronics, Information and Bioengineering, Politecnico di MilanoSC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo BestaSC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo BestaSC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo BestaDepartment of Electronics, Information and Bioengineering, Politecnico di MilanoCenter for Clinical Neuroscience, Hospital los MadroñosIRCCS Fondazione Don Carlo GnocchiVegetative State Unit – IRCCS Don Gnocchi FoundationRehabilitation Unit – Villa Beretta, Valduce HospitalNeurorehabilitation and Spinal Unit of Pavia Institute – Istituti Scientifici Maugeri IRCCSDepartment of Clinical Neurosciences, Neurology-Sleep Disorders Centre – IRCCS San Raffaele Scientific InstituteDepartment of Clinical Neurosciences, Neurology-Sleep Disorders Centre – IRCCS San Raffaele Scientific InstituteSC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo BestaSC Neurofisiopatologia , Fondazione IRCCS Istituto Neurologico Carlo BestaIstituti Clinici Scientifici Maugeri IRCCSDepartment of Electronics, Information and Bioengineering, Politecnico di MilanoAbstract 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.https://doi.org/10.1038/s41598-024-73565-8ElectromyographyDisorders of consciousness |
| spellingShingle | Francesca Giulia Magnani Simone Toffoli Martina Cacciatore Camilla Ippoliti Filippo Barbadoro Milad Malavolti Francesca Lunardini Jorge Navarro Guya Devalle Maurizio Lanfranchi Valeria Pingue Sara Marelli Luigi Ferini Strambi Matilde Leonardi Davide Sebastiano Rossi Davide Sattin Simona Ferrante A new ICT system coupling electromyography and coma recovery scale-revised to support the diagnostic process in disorders of consciousness Scientific Reports Electromyography Disorders of consciousness |
| title | A new ICT system coupling electromyography and coma recovery scale-revised to support the diagnostic process in disorders of consciousness |
| title_full | A new ICT system coupling electromyography and coma recovery scale-revised to support the diagnostic process in disorders of consciousness |
| title_fullStr | A new ICT system coupling electromyography and coma recovery scale-revised to support the diagnostic process in disorders of consciousness |
| title_full_unstemmed | A new ICT system coupling electromyography and coma recovery scale-revised to support the diagnostic process in disorders of consciousness |
| title_short | A new ICT system coupling electromyography and coma recovery scale-revised to support the diagnostic process in disorders of consciousness |
| title_sort | new ict system coupling electromyography and coma recovery scale revised to support the diagnostic process in disorders of consciousness |
| topic | Electromyography Disorders of consciousness |
| url | https://doi.org/10.1038/s41598-024-73565-8 |
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