Criteria to Care for Patients with Disorders of Consciousness

Head shot of Dr. John Whyte

Rehabilitation after brain injury has traditionally required the active participation of the patient to learn new skills and ways of coping with their disability. As a result, for many years, patients with a disorder of consciousness (DOC – i.e., unconscious or minimally conscious) after brain injury, were typically excluded from acute inpatient rehabilitation and treated, instead, in subacute nursing facilities or in family homes with medical support. Recent research has shown that patients who are unconscious when they enter acute rehabilitation often show great improvement in function and participation before discharge. Moreover, their complex medical and physical problems are best managed by experienced brain injury rehabilitation professionals in specialized programs.

Clinicians and researchers within the Traumatic Brain Injury Model System (TBIMS), in collaboration with colleagues with similar interests from the American Congress of Rehabilitation Medicine (ACRM), seek to expand access to rehabilitation for DOC patients. However, since access has been restricted for many years, even facilities with substantial TBI rehabilitation expertise are not necessarily skilled in caring for patients with DOC. Thus, if rehabilitation access for this population is to expand, it is important to ensure that the necessary staff, resources, and skills are available to treat them.

Experts in DOC rehabilitation from the TBIMS and the ACRM have collaborated to develop consensus-based recommendations for the minimal competencies needed by programs serving this population. The 21 recommendations focus on skills and processes needed for diagnosis and outcome prediction, treatment, transitioning of care, and ethical issues. Recommendations are supported by research when available, and are accompanied by an “audit checklist” for program evaluation.

The recommendations are available in an article in the journal Archives of Physical Medicine and Rehabilitation with former MRRI Director John Whyte, MD, PhD, as a lead author.

This article was adapted from an article originally published in The MossRehab Traumatic Brain Injury Model System’s Spring 2020 Edition of Brain E-News.

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