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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あり、意識障害の評価におけるゴールドスタンダードと認識されています。

  • CRS-Rは聴覚、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。総得点は0点から23点で表され、得点が高いほど意識は良好と解釈されます。

  • 6種類の下位項目の組み合わせによって、意識障害の重症度を以下の4段階に分類できます。

  1. 無反応覚醒症候群:Unresponsive Wakefulness Syndrome (UWS) 

  2. 最小意識状態マイナス:Minimally Conscious State Minus (MCS-)

  3. 最小意識状態プラス:Minimally Conscious State  Plus (MCS+)

  4.  最小意識状態からの脱却:Emergence from Minimally Conscious State (EMCS)

意識障害の種類
意識障害の重症度分類.png

[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. 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.

  6. 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.

  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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CRS-R研究会事務局

​​場所:浜松医療センターリハビリテーション科 

   CRS-R研究会 事務局

住所:〒432-8580 静岡県浜松市中央区富塚町328

メールアドレス:coma.recovery.scale@gmail.com

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