An analysis of assessment instruments for the minimally responsive patient (MRP): clinical observations

The purpose for presenting these cases is to report on clinical observations that may have relevance for improvement in individuals responding minimally to their environment as a result of a severe traumatic brain injury. Specifically, the authors observe that there is a sub-group of minimally responsive patients who, when given sensory stimulation, show an increase in responding that is being under-reported with current assessment instruments. Further, subtle changes in responding can occur over a wide temporal gradient and under-reporting of said changes may result in the premature cessation of a beneficial therapeutic intervention. Advantages and disadvantages of the instruments that have been developed to specifically assess responses to sensory stimulation are discussed. The authors' observations suggest that clinical findings do not correlate with assessment scores. These provisory observations indicate that there is a need to develop methodologically sound tools that will accurately monitor individuals throughout the rehabilitative process.