Neurorehabilitation in Disorders of Consciousness

Joseph T. Giacino, PhD; Douglas I. Katz, MD; John Whyte, MD, PhD

Disclosures

Semin Neurol. 2013;33(2):142-156. 

In This Article

Abstract and Introduction

Abstract

Survivors of severe acquired brain injury often experience prolonged disturbance in consciousness following emergence from coma. Most individuals pass through the vegetative or minimally conscious states en route to eventual recovery of consciousness, although either condition may be permanent. Rehabilitation clinicians charged with the care of these patients face numerous challenges as there are many open questions concerning diagnostic and prognostic accuracy, the natural history of recovery, and the most effective approaches to prevent medical complications and facilitate functional recovery. The last 5 years have been witness to a marked increase in well-designed empirical investigations concerning the rehabilitation of patients with disorders of consciousness. In this article, the authors review recent evidence concerning key factors that influence the course of recovery, present a model of care designed to mitigate medical complications, describe a systematic approach to assessment, and review the effectiveness of treatment interventions utilized in the rehabilitation setting.

Introduction

Many survivors of severe acquired brain injury experience prolonged disturbance in consciousness following emergence from coma. Advances in rehabilitation science over the last 5 years have significantly expanded our understanding of the natural history of recovery from disorders of consciousness and helped to elucidate intrinsic and extrinsic factors that influence outcome. Despite these advancements, access to rehabilitation for persons with disorders of consciousness continues to be impeded by the restrictive treatment authorization policies maintained by payers and the overly pessimistic views of prognosis held by many clinicians. In this article, we review recent evidence concerning long-term outcome in this population, the impact of medical complications on recovery, and the effectiveness of treatment interventions utilized in the rehabilitation setting.

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