Treatment of Disorders of Consciousness in the Veterans Health Administration Polytrauma Centers

Abstract

This article describes the evolution of the emerging consciousness programs and the approach to care for veterans and active duty service members with disorders of consciousness (DOC) at the 4 polytrauma rehabilitation centers of the Veterans Health Administration. Compared to traditional rehabilitation patients, DOC patients have unique recovery patterns and rehabilitative needs, and they require an intensive medical and nursing support structure. This requires closely integrated rehabilitation and acute medical care to ensure the highest level of outcomes. Unfortunately, little information exists in the literature to establish best practices for the rehabilitation of this population. It is the authors' intentions to bridge the literature gap in regard to programmatic structure, treatment approaches for those with DOC, and support of their caregivers. This article includes descriptions of medical care protocols, review of stimulation approaches (environmental and pharmacologic) caregiver support, and monitoring of recovery patterns.

Disorders of consciousness after acquired brain injury: the state of the science

“…Episodic behaviours are inherent to the definition of MCS, highlighting the need for coverage metrics better suited to such conditions. 73 A more integrated and comprehensive approach to care, linking academic medical centres, hospitals, acute in patient rehabilitation and chronic care settings (as currently existing in some European countries, such as Belgium), has been proposed by the Mohonk Group, 182 and implemented in part by the US Veterans Administration, 185 but care remains fragmented for most patients once they leave rehabilitation. Truncated in patient rehabilitation stays are particularly problematic because this might be the only course of rehabilitation that a patient obtains before placement in less-intensive settings.…”

Functional MRI and Outcome in Traumatic Coma

“…Some civilians and veterans remain in a vegetative state (VS) [6] or a minimally conscious state (MCS) [7] for months to years after emergence from coma [8, 9]. Yet, recent evidence from the United States Department of Veterans Affairs “Emerging Consciousness” Program and the Traumatic Brain Injury Model Systems suggests that a majority of patients with traumatic coma ultimately recover consciousness [9–11]. In addition, recovery of functional independence is possible in both civilian [10, 12, 13] and military [4] patients after traumatic coma.…”

Assessment and Intervention with Patients with Severe Disorders of Consciousness

“…In practice, the objective of these programs is to help the patients acquire an active role characterized by selfdetermination and positive behavioral engagement. Promoting such a role affords an opportunity to grow rather than a simple increase in stimulation input (Lancioni et al 2014c;McNamee et al 2012;Müller-Patz et al 2013).…”