Multidisciplinary assessment measure for individuals with disorders of consciousness

Abstract

Objective: This study introduces the Comprehensive Assessment Measure for the Minimally Responsive Individual (CAMMRI) and reports on its development, inter-rater reliability, construct validity and clinical value.

Methods: A multidisciplinary team of therapists developed this measure, which comprises 12 sub-tests that examine three main areas: Response to the Environment, Motor Control and Communication and Swallowing. The sub-tests are scored using a 7-point scale; sub-tests can also be administered individually. The measure was administered during a pilot project and then 1 year later to 12 adult clients with severe acquired brain injury at a long-term rehabilitation programme. The age range of the participants was 18–65 years; individuals were 1.5–10 years post-injury.

Results: Comparison measures included the Western Neuro Sensory Stimulation Profile (WNSSP), the Coma Recovery Scale-Revised (CRS-R) and the Chedoke McMaster Impairment Inventory (CMII). Inter-rater reliability of each sub-test ranged from 0.87–1.0, with an average of 0.90 in the first year of the assessments.

Conclusion: Validity data supported the use of the CAMMRI for minimally conscious adults with ABI to measure behavioural changes and plan treatment for this population. Future research should focus on using this measure with other neurological populations.

• Minimally conscious
• multidisciplinary
• outcome measure
• rehabilitation
• brain injury

Acknowledgements

The authors extend sincere thanks to the Alberta Government Ministry of Seniors and Community Supports and the Dave Irwin Foundation for Brain Injury Research for their funding support for this project. The University of Calgary initially supported this study with initial guidance from Dr. Marlene Reimer (in memoriam) and current advisory assistance by Dr Don Saklofske. The authors also extend thanks to: Eriko Fukuda, for assisting with the statistical analysis and data processing; Mai Tran, who assisted with the literature search for the project; Jacqueline Smith, for the revision of the article; and to Physiotherapists Brenda Lee-Kemp and Sari Martin and Occupational Therapist Arlene Jachak, who assisted with early drafts of the Motor Control sub-test and the Response to the Environment sub-tests. Finally, we thank all the community therapists that reviewed early drafts of the scale, ARBI staff, volunteers, clients and families, who made this project possible.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

The Alberta Government Ministry of Seniors and Community Supports and the Dave Irwin Foundation for Brain Injury Research provided funding support for this project.