Topic of the Month - September 2006

Much progress has been made in distinguishing between the various disorders of consciousness and in (re)defining terminology.The term minimally conscious is defined as "a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated."' Based on the few studies concerning the population, recovery potential following MCS varies from quite favorable outcomes to severe disablement. Interestingly, duration of MCS following TBI does not seem to preclude rather significant levels of functional recovery. This poses a significant dilemma in determining prognosis and best setting for such persons to receive rehabilitation services.

Kindly consider the following questions...

1. What methods do you use in your facility to measure disorders of consciousness and recovery from coma?

2. Where is the most appropriate treatment setting for individuals in a MCS to receive rehabilitation services once medical stability is obtained? What factors should be considered in determining most appropriate level of care?

3. What role do rehabilitation admission criteria and reimbursement issues play in your area when considering rehabilitative care for this subset of the TBI population?

4. In your experience, which pharmacological agents are being used successfully to enhance level of arousal and attention in the early stages of recovery following TBI and in those whom you've treated in a MCS?

A couple of articles to peruse...

Lammi MH, Smith VH, Tate RL, Taylor CM. The minimally conscious state and recovery potential: A follow-up study 2 to 5 years after traumatic brain injury. Arch Phys Med Rehabil. 2005;86,746-754.
Giacino J, Whyte J. The vegetative and minimally conscious states: current knowledge and remaining questions. Journal of Head Trauma Rehabilitation. 2005; 20(1),30-50.

Respectfully submitted,

Gretchen R. Lane, PT, NCS
Nominating Committee BI SIG