Disorders of Consciousness: Interprofessional Assessment

Best Practices for Serial Neurobehavioral Assessment in Disorders of Consciousness (DoC)

• Serial neurobehavioral assessment by the interprofessional team is the best-practice, evidence-based guideline for evaluation of people with disorders of consciousness (DoC)
• Importance of arousal facilitation and addressing common confounders as a precursor to assessment
• Environmental and manual techniques necessary to implement prior to attempting to facilitate arousal
• At least 3 techniques used to facilitate arousal prior to beginning neurobehavioral examination
• Optimal facilitation of arousal prior to assessment involves specific environmental and manual techniques

Environmental and Manual Techniques

• Implementation of environmental conditions and manual techniques before and during assessment
• Importance of addressing common confounders to ensure accurate assessment

Evidence-based Assessment Tools in Disorders of Consciousness (DoC)

• Guiding principles of multiple evaluations over time, different modes of assessment, and multiple examiners
• Importance of evaluating under optimal conditions and minimizing confounders
• Evaluation performed at varying times of day to capture accurate responses
• Observing baseline behaviors for one minute prior to beginning assessment of arousal
• Visual pursuit as a marker of consciousness

Standardized Neurobehavioral Assessments

• JFK-Coma Recovery Scale - Revised
  • Evidence: supports the use of this assessment tool
  • Pros: effective in assessing consciousness
  • Cons: may not capture all aspects of consciousness
• SECONDS
  • Evidence: supports the use of this assessment tool
  • Pros: effective in assessing consciousness
  • Cons: may not capture all aspects of consciousness
• DOCS-25
  • Evidence: supports the use of this assessment tool
  • Pros: effective in assessing consciousness
  • Cons: may not capture all aspects of consciousness

Limitations of Neurobehavioral Assessments

• Downsides of all neurobehavioral assessments on capturing "Covert Consciousness" (i.e., consciousness with severe disconnect to motor functions such as in locked-in syndrome)