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Disorders of Consciousness

Condition: Disorders of consciousness include coma (cannot be aroused, eye remain closed), vegetative state (can appear to be awake, but unable to purposefully interact), minimally conscious state (minimal but definite awareness), locked-in syndrome (not a disorder of consciousness, but because paralysis of limbs and facial muscles is unable to speak and/or appears to be unable to react) and post-traumatic confusional state (confusion and amnesia).

Background:  Most patients who survive injury to the brain regain consciousness but may develop a disorder of consciousness. Patients with locked-in syndrome appear unable to react or speak, but the cause of this is paralysis of the limbs and facial muscles.  Locked-in syndrome is often misdiagnosed as a disorder of consciousness.

Causes: Trauma, reduced blood supply or oxygen to the brain, and poisoning are leading causes for disorders of consciousness.

Disease Phases: Patients may be in a coma for up to four weeks and emerge into a vegetative state or minimally conscious state. The duration of vegetative state is variable, lasting more than one month and, in some reports, up to one year.  Patients emerging from a minimally conscious state show signs of being able to interact and communicate.

Physical Exam: Healthcare providers perform neurological examinations at the bedside to assess if the patient’s responses to commands are reflexive or voluntary.

Diagnostic Process: There are no laboratory or imaging tests available to diagnose disorders of consciousness. Several diagnostic scales or profiles can assess the level of a patient’s brain injury and prognosis, and help healthcare providers develop a treatment plan. These assessments evaluate a patient’s attention, communication, response to stimulation, vision and ability to follow commands.

Rehabilitation Management: Other than general health care that may include skin care, range of motion exercises, and bowel and bladder management, there are no standard treatment guidelines for disorders of consciousness.

Outcomes:  Trauma-related disorders have better outcomes among patients with disorders of consciousness.   Patients in minimally conscious states receiving rehabilitation during the first six months may improve. Patients recovering at later states usually have poorer outcomes.

Family Education: Family education regarding a patient’s prognosis and long-term planning are essential parts of disorders of consciousness care.

For Patients and Families:

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