The Unsteady Return of Command-Following: Recovery and Instability of Bedside Motor Command-Following After Acute Brain Injury

The study examined how patients with acute brain injury recover the ability to follow verbal commands, which is an important sign of consciousness recovery. The research included 13,900 brain-injured patients, of whom 5,498 (39.6%) could not follow commands at baseline. Within 24 hours, command-following appeared in 43.5% of patients and in 65% by 14 days. Recovery timing varied by injury type, ranging from 36.9% in anoxic injury to 77.2% in ischemic stroke. Among patients who recovered, first recovery was transient in 22.2%, and 62.4% repeatedly crossed the threshold of command-following ability. Sedation strongly influenced test results. The findings were confirmed in another database with similar numbers. Single bedside observations are an unreliable indicator of the actual state of consciousness.