719 - Coma Recovery Scale–Revised is Better to Be Performed in an Upright Position Rather Than a Lying Position in Patients with Disorders of Consciousness

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

NP

Neha Prathivadi, BS

Medical Student
TTUHSC School of Medicine
Lubbock, Texas, United States

Corresponding Author(s)

BZ

Bei Zhang, MD, MSc

Associate Professor
Division of Physical Medicine and Rehabilitation, Department of Neurology, Texas Tech University Health Sciences Center
Lubbock, Texas, United States

Co-Author(s)

KO

Katherine O'Brien, PhD

Clinical Neuropsychologist
Brain Injury & Stroke Program / TIRR Memorial Hermann
Houston, Texas, United States
SS

Stephanie Stroever, PhD

Assistant Professor | Dept. of Medical Education, Director of Research | Emergency Medicine Division
Division of Biostatistics, Clinical Research Institute, TTUHSC
Lubbock, Texas, United States
AD

Andrew DaCosta, PsyD

Neuropsychologist
LPG Memory Care, Lee Health
Fort Myers, Florida, United States
AF

Aya Bou Fakhreddine, MSc

Epidemiologist
Division of Biostatistics, Clinical Research Institute, TTUHSC
Lubbock, Texas, United States

Submitter(s)

NP

Neha Prathivadi, BS

TTUHSC School of Medicine
Lubbock, Texas, United States

Objectives: It is unclear whether the assessment position of patients with Disorders of Consciousness (DoC) affects the result of Coma Recovery Scale–Revised (CRS–R), besides their arousal levels. The CRS-R is the gold standard for patients in the most severe comatose or unresponsive states, and assessment scores can support diagnoses in DoC. This study investigated the impact of positioning on CRS-R total score to observe a quantitative change in scores and overall arousal levels.

Design: This retrospective study analyzed 1470 CRS-Rs performed on 232 patients in four positions: lying in bed, sitting at the edge of a mat, sitting in a wheelchair, and standing, in an acute inpatient rehabilitation setting. A conditional random coefficients multi-level model was used to examine the changes of CRS–R based on position.

Results: The cohort contained 65.1% male, age 37.4±16.2, and included primarily traumatic brain injury (47.0%). Each patient underwent an average of 10.3±6.8 CRS–Rs, with a mean score of 7.4±4.1. The average arousal protocol used was 3.0±2.1 per session. The CRS–R total score was found to be significantly associated with assessment position. Using the Bed as reference, patients assessed in the Mat, Wheelchair, and Standing had 1.3-, 1.1-, and 1.5-point increases in the CRS–R total score, respectively (P= 0.002, 0.008, and 0.050; upright vs. lying, P = 0.003). The number of arousal protocol administrations was not associated with assessment position. With every additional administration of the arousal protocol, the CRS–R total score decreased by 0.8-point (P < 0.001), suggesting lower arousal levels at baseline.

Conclusions: CRS–R is better performed in an upright position than a lying position in patients with DoC. This is significant because one-point changes in the scores might lead to changes in diagnostic categories. This finding may be related to generally improved physical and cognitive functionality in an upright position, rather than to arousal only.