Assessment and Treatment of People With a Disorder of Consciousness

This paper describes a number of studies looking at the assessment and treatment of people with disorders of consciousness (DOCs). These include patients in a coma, patients in a vegetative state (VS), and patients in a minimally conscious state (MCS). It is important to distinguish between these latter 2 states, as referral decisions may well be different for the 2 groups. A new version of a measure to assess patients with DOCs is described. The effects of posture on awareness are then considered. Provided that medical conditions do not contraindicate this, assessments should be carried out when the patient is in an upright position, as the majority of patients with DOCs show more behaviors when assessed on a tilt table or a standing frame. The third study looks at the effect of modafinil, an agent that maintains wakefulness and promotes attention and concentration, on levels of consciousness. Those with a traumatic brain injury (TBI) would appear to respond more to this than those whose DOC is caused by hypoxia. The fourth study compares the delayed recovery of 2 groups of patients, those with a TBI and those with hypoxic brain damage. Not surprisingly, those who showed delayed recovery of consciousness were far more likely to have sustained a TBI than hypoxic brain damage. The paper concludes with a case study of a man who had a DOC for 19 months before regaining consciousness and proceeding to regain skills so that he is now leading a reasonably normal life.