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Disorders of Consciousness (DoC)

Disorders of Consciousness (DoC)

Texas NeuroRehab Center (TNC) Disorders of Consciousness (DoC) Program

Texas NeuroRehab Center has provided neuro-rehabilitation for over 37 years. The Disorders of Consciousness (DoC) Program at Texas NeuroRehab Center is a specialized program designed to improve function and quality of life for patients who are minimally conscious.

What are Disorders of Consciousness (DoC) and what causes them?

Disorders of consciousness (DoC), or impaired consciousness, are the result of severe brain injury. Affected are arousal and wakefulness, self-awareness, responsiveness to stimulation, and reactions to the environment.

The Main Disorders of Consciousness (DoC) are:

  • Coma: a person exhibits no signs of wakefulness or awareness.
  • Vegetative state: a person shows wake/sleep cycles but no signs of awareness of their environment or surroundings. The person may open their eyes and move spontaneously. There is no command following.
  • Minimally conscious state: a person exhibits clear but minimal, and often inconsistent, signs of awareness which can include attempts to communicate and ability to follow some commands.

What is the criteria for the Disorders of Consciousness (DoC) Program?

  • Minimally conscious or vegetative state (Rancho ≥ 2 or GCS ≥ 8)

Ventilator criteria

  • High flow O2—Under 20L
  • FiO2-under ≤ 40%
  • PEEP 6 or less
  • No pressure control (PC) or unconventional ventilation

GTT/Sedation criteria

  • Off sedation ≥ 24 hrs. (propofol, versed gtts d/c) and Precedex gtt off 24 hrs
  • Off all vasopressors: Norepi, Epi, Vasopressin

What are the benefits of the Disorders of Consciousness (DoC) Program?

  • Daily physician-directed program with “hands on” evaluation and care
  • 24-hour nursing and respiratory care
  • Individualized Treatment Plan by all therapy disciplines following assessment of consciousness
  • Modification of the environment to regulate stimuli
  • Maintenance of skin integrity, prevention of contractures, and management of tone and spasticity
  • Facilitation of mobility via seating and positioning systems
  • Prevention of medical complications and hospital readmission
  • Interdisciplinary team meetings to assess and discuss progress and emergence from a minimally conscious state
  • Family education and training to address interacting with and caring for a loved one whose consciousness is disordered
  • Opportunity to transfer to on-campus inpatient rehabilitation and post-acute brain injury programming

What are the goals of the DoC Program?

The DoC Program focuses on maintaining medical stability and improving the patient’s awareness of self and environment with consistent, replicable responses. As the patient emerges from a minimally conscious state, the focus of treatment shifts to include self-care, mobility, swallowing/eating, and communication. At that time, the patient may then be able to participate in our Inpatient Rehabilitation Program, followed by a stay in the Post-Acute Brain Injury Program. All of these programs are offered on the TNC campus for a seamless transition of care for patients and their families.

TNC Disorders of Consciousness (DoC) Interdisciplinary Team includes:

  • On-site Neurologists, Pulmonologist, Physiatrist, Psychiatrist and Neuropsychologist
  • Therapists: Physical, Occupational, Speech and Respiratory Therapies
  • Rehabilitation nurses and direct care staff
  • Case Management, social workers, counselor and chaplain

The importance of family and caregiver involvement in the program:

Family support, participation and involvement are key to the recovery of patients in the DoC Program. TNC will encourage this from admission to discharge. TNC’s Team will provide family education, training and discharge preparation as well.

We also offer:

  • Family support groups and counseling
  • Overnight stays upon administrative approval, one family member per patient
  • On-site parking (free of charge) and cafeteria for families
  • In-home evaluations prior to discharge

What sets the TNC DoC Program apart?

  • Seven dedicated physicians on-site daily including two neurologists, two pulmonologists, internal medicine, PM & R, psychiatrist/addictionologist and a neuropsychologist
  • All patients are followed by two MDs
  • Patients can receive up to three hours of neuro therapy a day as tolerated/appropriate
  • On-site dialysis and radiology
  • Can accept bariatric patients up to 1000 lbs.
  • Private rooms
  • Substance abuse counseling available
  • Aquatic, Vision and Vestibular therapies
  • Disease Specific Care Certification in Brain Injury Rehabilitation from The Joint Commission

To make a referral please visit texasneurorehab.com or call 1-800-252-5151