Advances in Disorders of Consciousness Research and Translation Over the Last Two Decades

Significant progress has been achieved in understanding recovery from severe brain injury and resulting disorders of consciousness (DoC) since the inaugural issue of the Journal of Head Trauma Rehabilitation in 1986. Research across all biomedical sciences has sharpened diagnostic distinctions and increased prognostic accuracy and has led to the development of improved assessment strategies, pharmacologic and nonpharmacologic treatments. This article highlights achievements in these domains since the last update was provided 20 years ago. Unparalleled translation into clinical practice has been achieved in DoC compared to many areas in rehabilitation. International collaboration among scientists, clinicians, and professional organizations has resulted in critical partnerships that have helped to move evidence into practice. Specifically, evidence-based guidelines and position statements, funded and/or endorsed by interdisciplinary organizations, have helped to guide the field toward implementation. Further, public initiatives such as the Curing Coma Campaign initiated by the Neurocritical Care Society and the Model Systems Knowledge Translation Center funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) have created international engagement using traditional and online media with expansive reach. The cumulative evidence and clinical guidance endorsed by multiple professional organizations have informed the development of quality-of-care standards for DoC rehabilitation that will be published in the CARF Medical Rehabilitation Standards Manual, which goes into effect July 1, 2026. Quality of care initiatives to improve implementation of DoC evidence-based care are creatively pursued by researchers via traditional funding agencies such as NIDILRR, the Department of Defense, and professional organizations and are highlighted as exemplars. Lastly, milestones for the next 20 years highlighting acceleration in research, discovery, and innovation in DoC are described.