There are many levels of brain injury, and those who suffer the most severe traumatic brain injuries are often found in a state where it is difficult to maintain wakefulness and experience impaired awareness. This lack of consciousness is called disorders of consciousness (DoC), and often occurs in people who experience diffuse axonal brain injuries, anoxic brain injuries and injuries to the brainstem. At Madonna, our DoC program is comprised of a specialized interdisciplinary team of doctors, nurses and therapists who work together to care for even the most severe DoC cases.
Disorders of consciousness actually consists of three states:
- Coma—signs of awareness or arousal are absent. Patients demonstrate impaired spontaneous breathing and brainstem function,
- Vegetative State—patients demonstrate spontaneous eye opening and may also demonstrate spontaneous breathing or other generalized responses to their environment, but are not considered conscious. This can also be termed as “Unresponsive Wakefulness.”
- Minimally Conscious State (MCS)— patients begin to demonstrate purposeful but inconsistent responses to behaviors. They show signs of the ability to demonstrate visual eye tracking, intermittent vocalization and intermittent response to verbal commands.
The road to recovery for brain injury survivors can be long, particularly if they are in a coma, vegetative state, minimally conscious state or any variation of the three. However, recent research has demonstrated functional progress after prolonged DoC can still be obtainable 5-10 years after injury, with the most significant recovery occurring within the first few years.
“The DoC Guidelines number one recommendation emphasizes the importance of access to specialized interdisciplinary rehabilitation to facilitate recovery and promote optimal long term outcomes,” said Brooke Murtaugh, OTD, OTR/L, certified brain injury specialist and Madonna Brain Injury Program manager.
Involvement in therapy early on in the DoC recovery process is critical. Specialized rehabilitation treatments including coma sensory stimulation, early swallowing trials to support oral intake and mobilization protocols—standing frame, body weight support or robotic mobilization. The goal of therapeutic interventions is to increase arousal and awareness.
Another significant portion of rehabilitation from DoC is family involvement. A DoC diagnosis can be confusing and stressful, but Madonna’s specialized care team is always available to guide families through the process, and stand ready to answer questions and provide extensive training for important transitions throughout the course of recovery. While the length of stay in any specialized rehabilitation facility is different for every survivor, each patient and their family will be supported by their care team throughout the recovery process.*
Guidelines for DoC recommend specialized brain injury rehabilitation for severe brain injury. Madonna’s specialized DoC rehabilitation goals focus on:
- Accurate assessment and diagnosis of level of consciousness
- Accurate assessment of progression of conscious behaviors
- Maximize medical and physical management to obtain medical stability and decrease risks of medical and physical complications.
- Provide education to families on diagnosis and prognosis of severe brain injury.
- Develop plan for transition and support to home or next level of care.
- Provide specialized rehabilitation treatments to support arousal and emerging consciousness.
If you have additional questions about Madonna’s DoC program or would like more information, contact Madonna's admissions department at 402.413.4000.
*Family involvement and a secure payor are vital elements of the program.