Assessment and treatment of people with a disorder of consciousness: An account of some recent studies.

Abstract

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.

Effect of robotic tilt table verticalization on recovery in patients with disorders of consciousness: a randomized controlled trial

“…The efficiency of the RTT treatment with regard to net therapy time is in line with previous research [ 22 ], and scientifically demonstrates its feasibility in the treatment of DoC patients. Likewise, the traditional therapeutic experience is that head-up-tilt seems to be associated with recovery of consciousness [ 4 ]. However, as there was no control group without any mobilization, it is hard to say if the observed rate of recovery is related to the intervention or if it should be interpreted as a sign of natural recovery.…”

“…Therefore, the clinical need for evidence-based therapies to improve DoC outcome is substantial. Bringing DoC patients into an upright, verticalized body position has long been a method advocated by experienced therapists to further recovery of consciousness [ 4 ]. This treatment strategy is mainly based on experience rather than on scientific evidence, though.…”

“…Fig 4. Change scores in spasticity as measured with the Modified Ashworth Scale (MAS) between baseline (T0) and end of treatment (T4).…”