Sleep to Predict Recovery In Unconscious Patients With Acute Brain Injury

P-value for separating move vs non-move instructions on power spectral density data using a support vector machine learning algorithm.

Recovery of consciousness will be determined using the Coma Recovery Scale-Revised Scale (CRS-R) indexing consciousness as either minimally conscious state-plus (MCS-plus: the presence of signs of conscious awareness that include responses to commands or intelligible verbal output) or emergence from a minimally conscious state (EMCS: the return of the ability to use common objects in a functional manner or correctly respond to basic yes-or-no questions about situational orientation). Both would qualify as recovery of consciousness. The CRS-R full score ranges from 0 to 23, with higher scores representing higher levels of consciousness.

This outcome will be assessed using the Glasgow Outcome Scale-Extended (GOS-E) Scale, which is an 8-level standardized clinical scale used to measure functional recovery and independence after a brain injury. Higher GOS-E scores indicate a better recovery, higher functional independence, and a greater return to normal daily activities. GOS-E score of ≥4 by 12-month post injury will serve as the primary measure to define independence indicating that the participant can be left alone at home for at least 8 hours in a day.

This outcome will be assessed using the Modified Rankin Scale (mRS). The full score ranges from 0 to 6, measuring the degree of disability or dependence in daily activities. Higher scores mean greater disability and dependence, whereas lower scores mean better recovery and independence. Recovery from disability will be set at a score of 3 or below by 12 months post injury, indicating no more than moderate disability, where a person requires some help with daily activities but is still able to walk without assistance.

Number of participants who have a Coma Recovery Scale-Revised (CRS-R) score of 8 or above.

Number of participants who have a Coma Recovery Scale-Revised (CRS-R) score of 10.

Presence of subtle clinical signs of consciousness

Coma Recovery Scale-Revised For Accelerated Standardized Testing (CRSR-FAST) score does not use a numerical scoring range like the full-length test; instead, it results in a binary rating of "conscious" or "not conscious." If at least one of the five core behaviors are present, the participant is considered conscious.

Average CRS-R scores following equal interval transformation using the partial credit Rash model.

The CAM-ICU (Confusion Assessment Method for the Intensive Care Unit) is a bedside tool used to screen for delirium in critically ill or mechanically ventilated patients. Instead of a numeric point scale, it yields a positive or negative result for delirium based on four specific clinical features.

Number of participants who have a Glasgow Outcome Scale-Extended score of ≥4

utility weighted transformation of modified Rankin Scale score

Quality of Life in Neurological Disorders (Neuro-QOL) to quantify quality of life as a patient-reported outcome measure. Neuro-QOL uses a standardized T-score metric where the mean of a reference population is set at 50 and the standard deviation is 10. Scores above or below 50 represent better or worse health-related quality of life than the reference group, depending on the specific symptom or functional domain.

Disability will be evaluated using the Disability Rating Scale (DRS), which ranges from 0 to 29, where higher scores indicate a greater level of impairment.

Evaluating recovery after traumatic brain injury (TBI) using a sliding dichotomy with the IMPACT Score tailors the definition of a "favorable" functional outcome to each participant's unique baseline prognosis. Instead of applying a single fixed cutoff (e.g., GOS-E ≥ 4 for everyone), this method sets a customized recovery threshold for each participant based on their predicted baseline risk profile. A participant recovering better than their individual baseline prediction is classified as a "favorable" outcome

Evaluating recovery after intracerebral hemorrhage (ICH) using a sliding dichotomy with the FUNC Score tailors the definition of a "favorable" functional outcome to each participant's unique baseline prognosis. Instead of applying a single fixed cutoff, this method sets a customized recovery threshold for each participant based on their predicted baseline risk profile. A participant recovering better than their individual baseline prediction is classified as a "favorable" outcome.

Participants will be assessed if they were able to return to work as measured by the GOS-E with a score of 6 or above, indicating they are able to return to work even with special arrangements.