Post-Acute Level Of Consciousness scale revised (PALOC-sr): adaptation of a scale for classifying the level of consciousness in patients with a prolonged disorder of consciousness†

Henk J. Eilander; Willemijn S. van Erp; Daniëlle M F. Driessen; Berno U H. Overbeek; Jan C M. Lavrijsen

doi:10.1071/IB23011

RESEARCH ARTICLE (Open Access)

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Post-Acute Level Of Consciousness scale revised (PALOC-sr): adaptation of a scale for classifying the level of consciousness in patients with a prolonged disorder of consciousness^†

Henk J. Eilander

^A ^* , Willemijn S. van Erp ^A ^B ^C , Daniëlle M F. Driessen ^A ^C , Berno U H. Overbeek ^A ^D ^E and Jan C M. Lavrijsen ^A

+ Author Affiliations

- Author Affiliations

^A Department of Elderly Care Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

^B Accolade Zorg, Bosch en Duin, The Netherlands

^C Libra Revalidatie & Audiologie, locatie Leijpark, Tilburg, The Netherlands

^D Azora, Terborg, The Netherlands

^E Kalorama, Veste Brakkestein, Nijmegen, The Netherlands

^* Correspondence to: h.j.eilander@brain-consult.nl

Brain Impairment 24(2) 341-346 https://doi.org/10.1017/BrImp.2022.7

Submitted: 9 September 2021 Accepted: 15 March 2022 Published: 26 April 2022

© The Author(s), 2022. Published by Cambridge University Press on behalf of Australasian Society for the Study of Brain Impairment. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective:

To present an updated version of the ‘Post-acute Level Of Consciousness scale’ (PALOC-s), in accordance with the latest scientific insights.

Methods:

Within the context of a research project, 20 years ago, the PALOC-s was developed for the purpose of following the development of the level of consciousness of young unconscious patients participating in a rehabilitation program. Meanwhile, the understanding of the behavior related to different levels of consciousness has developed and terminology has changed, resulting in the need to revise the PALOC-s. With the preservation of the original description of the eight hierarchical levels of PALOC-s, adaptations are made in the terminology and grouping of these levels.

Results and conclusion:

This manuscript presents the revised version of PALOC-sr, which is suitable for use in clinical practice. The validation of this scale is recommended for its optimal use in future (international) research projects.

Keywords: Severe brain injury, prolonged disorders of consciousness, observation scale, recovery evaluation.

References

Andrews K. (1996) International working party on the management of the vegetative state. Brain Injury 10(11), 797-806 10.1080/026990596123918.
| Google Scholar |

Ansell B. J., Keenan J. E. (1989) The Western Neuro Sensory Stimulation Profile: A tool for assessing slow-to-recover head-injured patients. Archives of Physical Medicine and Rehabilitation 70(2), 104-108 http://www.ncbi.nlm.nih.gov/pubmed/2916926.
| Google Scholar |

Bruno M. A., Vanhaudenhuyse A., Thibaut A., Moonen G., Laureys S. (2011) From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: Recent advances in our understanding of disorders of consciousness. Journal of Neurology 258(7), 1373-1384.
| Crossref | Google Scholar |

Eilander H. J., van de Wiel M., Wijers M., van Heugten C. M., Buljevac D., Lavrijsen J. C., Prevo A. J. (2009) The reliability and validity of the PALOC-s: A post-acute level of consciousness scale for assessment of young patients with prolonged disturbed consciousness after brain injury. Neuropsychological Rehabilitation 19(1), 1-27.
| Crossref | Google Scholar |

Eilander H. J., van Heugten C. M., Wijnen V. J., Croon M. A., de Kort P. L., Bosch D. A., Prevo A. J. (2013) Course of recovery and prediction of outcome in young patients in a prolonged vegetative or minimally conscious state after severe brain injury: An exploratory study. Journal of Pediatric Rehabilitation Medicine 6(2), 73-83.
| Crossref | Google Scholar |

Eilander H. J., Wijnen V. J. M., Scheirs J. G. M., de Kort P. L. M., Prevo A. J. H. (2005) Children and young adults in a prolonged unconscious state due to severe brain injury: Outcome after an early intensive neurorehabilitation programme. Brain Injury 19(6), 425-436.
| Crossref | Google Scholar |

Estraneo A., De Bellis F., Masotta O., Loreto V., Fiorenza S., Lo Sapio M., Trojano L. (2019) Demographical and clinical indices for long-term evolution of patients in vegetative or in minimally conscious state. Brain Injury 33(13-14), 1633-1639.
| Crossref | Google Scholar |

Formisano R., Giustini M., Aloisi M., Contrada M., Schnakers C., Zasler N., Estraneo A. (2019) An International survey on diagnostic and prognostic protocols in patients with disorder of consciousness. Brain Injury 33(8), 974-984.
| Crossref | Google Scholar |

Giacino J. T., Ashwal S., Childs N., Cranford R., Jennett B., Katz D. I., Zasler N. D. (2002) The minimally conscious state. Definition and diagnostic criteria. Neurology 58, 349-353.
| Google Scholar |

Giacino J. T., Fins J. J., Laureys S., Schiff N. D. (2014) Disorders of consciousness after acquired brain injury: The state of the science [Review]. Nature Reviews: Neurology 10(2), 99-114.
| Crossref | Google Scholar |

Giacino J. T., Kalmar K., Whyte J. (2004) The JFK Coma Recovery Scale-Revised: Measurement characteristics and diagnostic utility. Archives of Physical Medicine and Rehabilitation 85(12), 2020-2029.
| Crossref | Google Scholar |

Giacino J. T., Katz D. I., Schiff N. D., Whyte J., Ashman E. J., Ashwal S., Armstrong M. J. (2018) Practice guideline update recommendations summary: Disorders of consciousness: Report of the Guideline Development, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Neurology 91(10), 450-460.
| Crossref | Google Scholar |

Giacino J. T., Kezmarsky M. A., DeLuca J., Cicerone K. D. (1991) Monitoring rate of recovery to predict outcome in minimally responsive patients. Archives of Physical Medicine and Rehabilitation 72(11), 897-901.
| Crossref | Google Scholar |

Giacino J. T., Zasler N. D., Katz D. I., Kelly J. P., Rosenberg J. H., Filley C. M. (1997) Development of practice guidelines for assessment and management of the vegetative and minimally conscious states. Journal of Head Trauma Rehabilitation 12(4), 79-89.
| Crossref | Google Scholar |

Jox R. J., Kuehlmeyer K., Klein A. M., Herzog J., Schaupp M., Nowak D. A., Bender A. (2015) Diagnosis and decision making for patients with disorders of consciousness: A survey among family members. Archives of Physical Medicine and Rehabilitation 96(2), 323-330.
| Crossref | Google Scholar |

Laureys S., Celesia G. G., Cohadon F., Lavrijsen J., Leon-Carrion J., Sannita W. G., Dolce G. (2010) Unresponsive wakefulness syndrome: A new name for the vegetative state or apallic syndrome. BMC Medicine 8, 1-4.
| Crossref | Google Scholar |

Lindsley D. B. (1988). Activation, arousal, alertness, and attention. In States of brain and mind. Readings from the encyclopedia of neuroscience. Boston, MA: Birkhäuser. doi: 10.1007/978-1-4899-6771-8_1

Nettleton S., Kitzinger J., Kitzinger C. (2014) A diagnostic illusory? The case of distinguishing between "vegetative and "minimally conscious" states. Social Science and Medicine 116, 134-141.
| Crossref | Google Scholar |

Royal College of Physicians (2020). Prolonged disorders of consciousness following sudden onset brain injury. National clinical guidelines. London: Royal College of Physicians.

Schnakers C., Hirsch M., Noe E., Llorens R., Lejeune N., Veeramuthu V., Estraneo A. (2020) Covert cognition in disorders of consciousness: A meta-analysis. Brain Sciences 10(12), 930.
| Crossref | Google Scholar |

Seel R. T., Sherer M., Whyte J., Katz D. I., Giacino J. T., Rosenbaum A. M., Zasler N. (2010) Assessment scales for disorders of consciousness: Evidence-based recommendations for clinical practice and research [Research Support, Non-U.S. Gov’tReview]. Archives of Physical Medicine and Rehabilitation 91(12), 1795-1813.
| Crossref | Google Scholar |

Thibaut A., Bodien Y. G., Laureys S., Giacino J. T. (2020) Minimally conscious state "plus": Diagnostic criteria and relation to functional recovery. Journal of Neurology 267(5), 1245-1254.
| Crossref | Google Scholar |

Wade D. (2017) Back to the bedside? Making clinical decisions in patients with prolonged unconsciousness. Journal of Medical Ethics 43(7), 457-458.
| Crossref | Google Scholar |