Abstract
Persons who have disorders of consciousness (DoC) require care from multidisciplinary
teams with specialized training and expertise in management of the complex needs of
this clinical population. The recent promulgation of practice guidelines for patients
with prolonged DoC by the American Academy of Neurology, American Congress of Rehabilitation
Medicine (ACRM), and National Institute on Disability, Independent Living, and Rehabilitation
Research (NIDILRR) represents a major advance in the development of care standards
in this area of brain injury rehabilitation. Implementation of these practice guidelines
requires explication of the minimum competencies of clinical programs providing services
to persons who have DoC. The Brain Injury Interdisciplinary Special Interest Group
of the ACRM, in collaboration with the Disorders of Consciousness Special Interest
Group of the NIDILRR-Traumatic Brain Injury Model Systems convened a multidisciplinary
panel of experts to address this need through the present position statement. Content
area-specific workgroups reviewed relevant peer-reviewed literature and drafted recommendations
which were then evaluated by the expert panel using a modified Delphi voting process.
The process yielded 21 recommendations on the structure and process of essential services
required for effective DoC-focused rehabilitation, organized into 4 categories: diagnostic
and prognostic assessment (4 recommendations), treatment (11 recommendations), transitioning
care/long-term care needs (5 recommendations), and management of ethical issues (1
recommendation). With few exceptions, these recommendations focus on infrastructure
requirements and operating procedures for the provision of DoC-focused neurorehabilitation
services across subacute and postacute settings.
Keywords
List of abbreviations:
AAN (American Academy of Neurology), CT (computed tomography), DoC (disorders of consciousness), DNR (do not resuscitate), IRF (inpatient rehabilitation facility), MCS (minimally conscious state), MRI (magnetic resonance imaging), NIDILRR (National Institute on Disability, Independent Living and Rehabilitation Research), PAC (postacute care), QI (quality improvement), SNF (skilled nursing facility), VS (vegetative state), UWS (unresponsive wakefulness syndrome)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 20, 2020
Footnotes
This position statement was developed under the American Congress of Rehabilitation Medicine Evidence and Practice Committee (ACRM EPC), which is supported by unrestricted grants from CARF International and Paradigm. Neither CARF International nor Paradigm were involved in any phase of the development of this statement.
The recommendations and supporting text included in this article were developed through a collaboration between the ACRM and grantees of the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this publication do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government. Neither ACRM nor NIDILRR provided any funding to support this work.
Portions of this article were presented at the annual meetings of the ACRM (2014) and the International Brain Injury Association (2016, 2017).
Stuart Yablon serves on the Scientific Advisory Board of Flowonix Inc. Ross D. Zafonte serves on the Scientific Advisory Boards of Myomo, Oxeia Biopharma, Biodirection, and ElMINDA. The other authors have nothing to disclose.
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© 2020 by the American Congress of Rehabilitation Medicine
