Improving outcomes of severe disorders of consciousness

To evaluate the efficacy of an Advanced Care Protocol (ACP) in improving rates of clinical progression and emergence in patients with Severe Disorders of Consciousness (SDOC).

Forty-one patients with SDOC were assigned to groups: Vegetative State (VS) traumatic etiology (VS-TBI), VS non-traumatic etiology (VS-NTBI), Minimally Conscious State (MCS-TBI), MCS non-traumatic etiology (MCS-NTBI). Design was a within-subjects retrospective case series measuring pre-post ACP intervention data. The ACP was administered sequentially over 12 weeks, incorporating traditional therapies (occupational, physical, speech), pharmaceuticals, median nerve stimulation, and neutraceuticals. Main Outcome Measures were: Pre- and post-treatment Disability Rating Scale (DRS), Functional Independence Measure (FIM), Glasgow Coma Scale (GCS), and Coma Recovery Scale-Revised (CRS-R); clinical diagnosis (VS, MCS, emerged) using criteria from the American Academy of Neurology and Mohonk Report.

Patients significantly improved across all outcome measures, from baseline to discharge. Clinical improvement of 100% of MCS patients and 78-86% of VS patients was observed following ACP treatment. Significant differences between ACP vs. the published "standard of care" rates, in favor of the ACP, based on DRS scores and on clinical status at discharge.

These strikingly positive results of a novel multimodal intervention are a valuable contribution to this frontier of investigation.