The assessment of language and the emergence from disorders of consciousness

In order to demonstrate emergence from a disorder of consciousness (DoC) an individual is currently required to demonstrate functional object use of two objects, or functional communication defined as accurately answering six yes/no questions on two consecutive occasions (Giacino et al., 2002). In practice, experienced speech and language therapists (SLTs) working with this group often focus on facilitating object use or employ other language tasks, since achieving a 100% accurate yes/no response can be difficult for patients following an extensive brain injury due to language and/or cognitive impairments. There is an increasing awareness of this issue in the literature and in practice and there is discussion about reviewing the current definition of emergence. This paper outlines the traditional definition of emergence and recent updates, discusses some of the problems and implications associated with current assessment, highlights the importance of getting it right, explores potential other ways to determine emergence, and suggests further areas for research.