Disorders of consciousness
The changing landscape of treatment
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Prolonged disorders of consciousness (DOC)—the vegetative and minimally conscious states (VS/MCS)—are uncommon but devastating outcomes after severe brain injury. Until recently, the medical community has viewed them with great pessimism with respect to both prognosis and effective treatments. Within the rehabilitation community, optimizing medical stability and physical health to facilitate natural recovery is viewed as important, but attempts to accelerate recovery have generally involved off-label treatments, in the absence of proven interventions. In the United States, the climate of pessimism has been self-perpetuating; health insurers often restrict access to rehabilitation for patients with DOC, who are then transferred directly from acute care centers to long-term care facilities or family homes, largely disconnected from the academic research enterprise.
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- © 2014 American Academy of Neurology
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