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​CRS-Rは世界で最も認められている意識障害の評価です

【概要】

  • CRS-Rは2004年にJoseph T. Giacino教授らが開発した、新しい意識障害の評価です。

  • 聴覚、視覚、運動、口腔運動・言語、コミュニケーション、覚醒の6項目で構成されます。

  • CRS-Rの総得点は0点から23点であり、得点が高いほど意識は良好と解釈します。

  • 6種類の下位項目の組み合わせによって、意識障害をUWS(無反応覚醒症候群)、MCS-(最小意識状態マイナス)、MCS+(最小意識状態プラス)、EMCS(最小意識状態から脱した状態)の4つのカテゴリーに分類可能です。

  • CRS-Rは意識障害に関する研究領域ではゴールドスタンダードの評価と認識されています。

意識障害の種類

[参考文献]​

  1. Giacino JT, Kezmarsky MA, DeLuca J, Cicerone KD. Monitoring rate of recovery to predict outcome in minimally responsive patients. Arch Phys Med Rehabil. 1991 Oct;72(11):897-901. doi: 10.1016/0003-9993(91)90008-7. PMID: 1929808.

  2. Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, Kelly JP, Rosenberg JH, Whyte J, Zafonte RD, Zasler ND. The minimally conscious state: definition and diagnostic criteria. Neurology. 2002 Feb 12;58(3):349-53. doi: 10.1212/wnl.58.3.349. PMID: 11839831.

  3. Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004 Dec;85(12):2020-9. doi: 10.1016/j.apmr.2004.02.033. PMID: 15605342.

  4. American Congress of Rehabilitation Medicine, Brain Injury-Interdisciplinary Special Interest Group, Disorders of Consciousness Task Force; Seel RT, Sherer M, Whyte J, Katz DI, Giacino JT, Rosenbaum AM, Hammond FM, Kalmar K, Pape TL, Zafonte R, Biester RC, Kaelin D, Kean J, Zasler N. Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Arch Phys Med Rehabil. 2010 Dec;91(12):1795-813. doi: 10.1016/j.apmr.2010.07.218. PMID: 21112421.

  5. Giacino JT, Katz DI, Schiff ND, Whyte J, Ashman EJ, Ashwal S, Barbano R, Hammond FM, Laureys S, Ling GSF, Nakase-Richardson R, Seel RT, Yablon S, Getchius TSD, Gronseth GS, Armstrong MJ. Practice guideline update recommendations summary: Disorders of consciousness: Report of the Guideline Development, Dissemination, 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. 2018 Sep 4;91(10):450-460. doi: 10.1212/WNL.0000000000005926. Epub 2018 Aug 8. Erratum in: Neurology. 2019 Jul 16;93(3):135. PMID: 30089618; PMCID: PMC6139814.

  6. Laureys S, Celesia GG, Cohadon F, Lavrijsen J, León-Carrión J, Sannita WG, Sazbon L, Schmutzhard E, von Wild KR, Zeman A, Dolce G; European Task Force on Disorders of Consciousness. Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med. 2010 Nov 1;8:68. doi: 10.1186/1741-7015-8-68. PMID: 21040571; PMCID: PMC2987895.

  7. Kondziella D, Bender A, Diserens K, van Erp W, Estraneo A, Formisano R, Laureys S, Naccache L, Ozturk S, Rohaut B, Sitt JD, Stender J, Tiainen M, Rossetti AO, Gosseries O, Chatelle C; EAN Panel on Coma, Disorders of Consciousness. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol. 2020 May;27(5):741-756. doi: 10.1111/ene.14151. Epub 2020 Feb 23. PMID: 32090418.

  8. Bodien YG, Vora I, Barra A, Chiang K, Chatelle C, Goostrey K, Martens G, Malone C, Mello J, Parlman K, Ranford J, Sterling A, Waters AB, Hirschberg R, Katz DI, Mazwi N, Ni P, Velmahos G, Waak K, Edlow BL, Giacino JT. Feasibility and Validity of the Coma Recovery Scale-Revised for Accelerated Standardized Testing: A Practical Assessment Tool for Detecting Consciousness in the Intensive Care Unit. Ann Neurol. 2023 Nov;94(5):919-924. doi: 10.1002/ana.26740. Epub 2023 Aug 9. PMID: 37488068; PMCID: PMC10701693.

  9. Kitano T, Giacino JT, Bodien Y, Waters A, Hioki D, Shinya J, Nakayama T, Ohgi S. Reliability and validation of the Japanese version of the coma recovery scale-revised (CRS-R). Brain Inj. 2024 Mar 20;38(4):249-259. doi: 10.1080/02699052.2024.2309549. Epub 2024 Feb 8. PMID: 38329043.

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