RESUMEN
OBJECTIVE: To elucidate the characteristics of recovery progression during long-term rehabilitation after moderate-to-severe traumatic brain injury. METHODS: Longitudinal changes in consciousness, swallowing disorders, activities of daily living, and psychological and behavioural status were studied in 7 patients with moderateto-severe traumatic brain injury, using scores of the National Agency for Automotive Safety & Victim's Aid (NASVA score), Glasgow Coma Scale (GCS), Dysphagia Severity Scale (DSS), Eating Status Scale (ESS), Functional Independence Measure (FIM), Cognitive-related Behavioural Assessment (CBA), and Neuropsychiatric Inventory (NPI). Scores were collected every month until discharge (median 359 days after injury), or until the study end date for those patients who remained hospitalized (432 days). RESULTS: Patients were qualitatively classified into those who improved well in the early phase, in terms of consciousness, swallowing, and activities of daily living, and those with less or delayed improvement. Psychological and behavioural difficulties appeared to remain less improved than the other functions for longer periods in many patients. Statistical comparisons that included all 7 patients revealed a significant improvement in NASVA score, GCS, DSS, and ESS, but not in FIM, CBA, and NPI at discharge/at the last measurement compared with scores at admission. CONCLUSION: Swallowing function is more responsive to long-term rehabilitation in patients with moderate-to-severe traumatic brain injury, while neuropsychiatric and behavioural difficulties tend to persist for longer periods.
RESUMEN
OBJECTIVE: To investigate whether automatic facial expression analysis can quantify differences in the intensity of facial responses depending on the affective stimuli in a patient with minimally conscious state (MCS). METHODS: We filmed the facial responses of a patient with MCS during the delivery of three 1-minute auditory stimuli: audio clips of comedy movies, a nurse hilariously talking, and recitation of a novel (comedy, nurse, and recitation conditions, respectively). These measures were repeated at least 13 times for each condition on different days for approximately 10 months. The intensity of being "happy" was estimated from the smiling face using a software called FaceReader. The intensity among 5 conditions including those at 2 resting conditions (pre- and poststimuli) was compared using the Kruskal-Wallis test and the Dunn-Bonferroni test for multiple comparisons. RESULTS: Significantly higher values were found in the intensity of being "happy" in the comedy and nurse conditions versus other conditions, with no significant differences between the recitation and pre- or poststimulus conditions. These findings indicate that the automated facial expression analysis can quantify differences in context-dependent facial responses in the patient recruited in this study. CONCLUSIONS: This case study demonstrates the feasibility of using automated facial expression analysis to quantitatively evaluate the differences in facial expressions and their corresponding emotions in a single patient with MCS.
