{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T01:08:00Z","timestamp":1774314480605,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T00:00:00Z","timestamp":1736899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: Clinicians are challenged by the ambiguity and uncertainty in assessing level of consciousness in individuals with disorder of consciousness (DoC). There are numerous challenges to valid and reliable neurobehavioral assessment and classification of DoC due to multiple environmental and patient-related biases including behavioral fluctuation and confounding or co-occurring medical conditions. Addressing these biases could impact accuracy of assessment and is an important aspect of the DoC assessment process. Methods: A pre-assessment checklist was developed by a group of interdisciplinary DoC clinical experts and researchers based on the existing literature, current validated tools, and expert opinions. Once finalized, the checklist was electronically distributed to clinicians with a range of experience in neurobehavioral assessment with DoC. Respondents were asked to use the checklist prior to completing a neurobehavioral assessment. A survey was also provided to respondents to obtain feedback regarding checklist feasibility and utility in optimizing the behavioral assessments. Results: Thirty-three clinicians completed the survey after using the checklist. Over half of the respondents were a combination of physicians, neuropsychologists, and physical therapists. All respondents served the adult DoC population and 42% percent had over ten years of clinical experience. Eighty percent reported they found the format of the checklist useful and easy to use. All respondents reported the checklist was relevant to preparing for behavioral assessment in the DoC population. Eighty-four percent reported they would recommend the use of the tool to other clinicians. Conclusions: The use of a pre-assessment checklist was found to be feasible and efficacious in increasing interdisciplinary clinician\u2019s ability to optimize the patient and environment in preparation for neurobehavioral assessment. Initial results of clinicians\u2019 perception of the utility of a pre-assessment checklist were positive. However, further validation of the tool is needed with larger sample sizes to improve representation of clinical use across disciplines and care settings.<\/jats:p>","DOI":"10.3390\/brainsci15010071","type":"journal-article","created":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T05:59:42Z","timestamp":1736920782000},"page":"71","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Optimizing Neurobehavioral Assessment for Patients with Disorders of Consciousness: Proposal of a Comprehensive Pre-Assessment Checklist for Clinicians"],"prefix":"10.3390","volume":"15","author":[{"given":"Kristen","family":"Keech","sequence":"first","affiliation":[{"name":"The Queen\u2019s Medical Center, Honolulu, HI 96813, USA"},{"name":"Doctor of Occupational Therapy Program, Hawaii Pacific University, Honolulu, HI 96813, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1143-0658","authenticated-orcid":false,"given":"Caroline","family":"Schnakers","sequence":"additional","affiliation":[{"name":"Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9434-7539","authenticated-orcid":false,"given":"Brooke","family":"Murtaugh","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Programs, Madonna Rehabilitation Hospitals, Lincoln, NE 68506, USA"}]},{"given":"Katherine","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"TIRR Memorial Hermann, Houston, TX 77030, USA"},{"name":"Department of Physical Medicine & Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA"}]},{"given":"Beth","family":"Slomine","sequence":"additional","affiliation":[{"name":"Brain Injury Clinical Research Center, Kennedy Krieger Institute, Baltimore, MD 21205, USA"},{"name":"Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA"}]},{"given":"Marie-Mich\u00e8le","family":"Briand","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation Department, H\u00f4pital du Sacr\u00e9-Coeur de Montr\u00e9al, Montreal, QC H4J 1C5, Canada"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2516-0540","authenticated-orcid":false,"given":"Rita","family":"Formisano","sequence":"additional","affiliation":[{"name":"IRCCS Santa Lucia Foundation, 00179 Rome, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5991-1747","authenticated-orcid":false,"given":"Aurore","family":"Thibaut","sequence":"additional","affiliation":[{"name":"Coma Science Group, GIGA-Consciousness, University of Li\u00e8ge, 4000 Li\u00e8ge, Belgium"},{"name":"Centre du Cerveau, University Hospital of Li\u00e8ge, 4000 Li\u00e8ge, Belgium"}]},{"given":"Anna","family":"Estraneo","sequence":"additional","affiliation":[{"name":"IRCCS, Don Gnocchi Foundation, 50143 Florence, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2547-8727","authenticated-orcid":false,"given":"Enrique","family":"No\u00e9","sequence":"additional","affiliation":[{"name":"IRENEA Instituto de Rehabilitaci\u00f3n Neurol\u00f3gica, Fundaci\u00f3n Hospitales Vithas, 46011 Valencia, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9011-7496","authenticated-orcid":false,"given":"Olivia","family":"Gosseries","sequence":"additional","affiliation":[{"name":"Coma Science Group, GIGA-Consciousness, University of Li\u00e8ge, 4000 Li\u00e8ge, Belgium"},{"name":"Centre du Cerveau, University Hospital of Li\u00e8ge, 4000 Li\u00e8ge, Belgium"}]},{"given":"Liliana","family":"da Concei\u00e7\u00e3o Teixeira","sequence":"additional","affiliation":[{"name":"RISE-Health, Center for Translational Health and Medical Biotechnology Research (TBIO), ESS, Polytechnic of Porto, R. Dr. Ant\u00f3nio Bernardino de Almeida, 400, 4200-072 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,15]]},"reference":[{"key":"ref_1","first-page":"293","article-title":"The vegetative and minimally conscious states: Consensus-based criteria for establishing diagnosis and prognosis","volume":"19","author":"Giacino","year":"2005","journal-title":"NeuroRehabilitation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1212\/WNL.58.3.349","article-title":"The minimally conscious state: Definition and diagnostic criteria","volume":"58","author":"Giacino","year":"2002","journal-title":"Neurology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1136\/jnnp.73.4.355","article-title":"The vegetative state","volume":"73","author":"Jennett","year":"2002","journal-title":"J. Neurol. Neurosurg. 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