Disorders of Consciousness Program

Shepherd Center's Disorders of Consciousness (DOC) Program is a short-term, four-to-six-week program, with about one and a half hours of therapy daily for patients who are semi-comatose or minimally conscious (Rancho I-III). It takes into account a slow response to therapeutic intervention.

Reducing medical acuity, preventing medical complications and continually measuring arousal and attention to the environment are key components of this program. The program also addresses neuropharmacological management, nutritional management, maximizing mobility, and family education and training.

Download a PDF of our Disorders of Consciousness Program Fact Sheet.

Our Approach to Disorders of Consciousness Treatment

The interdisciplinary team works closely to facilitate the patient's recovery by offering an individualized plan of care that balances medication management, therapies, environmental stimulation and rest. At Shepherd Center, we believe in educating each family to help you care for your loved one in the event that he/she is not ready for active rehabilitation. Treatment team members include physiatrists and other medical consultants, nurses, case managers, physical therapists, occupational therapists, speech-language pathologists, neuropsychologists, family counselors, recreational therapists, activities-based therapists, dietitians, respiratory therapists, chaplains and behavioral specialists.

Patient Treatment

Patients who are in a reduced or minimally conscious state following a traumatic brain injury are often not ready to begin an active rehabilitation program. However, Shepherd Center believes it is critical to optimize recovery until the patient emerges and to educate and train the family and/or caregivers about expectations and care.

For these patients, Shepherd Center's specialized Disorders of Consciousness (DOC) Program  provides pre-rehabilitation and education services. Patients get about one and a half hours of daily therapy, which takes into account a patient’s slow response to therapeutic intervention and the need for rest and structure.

In addition to the program's focus on preventing medical complications and continually measuring arousal and attention to the environment, other key components are:

  • Pharmacological management
  • Nutrition
  • Positioning and seating
  • Cognition and communication
  • Maximizing mobility
  • Family/caregiver support and education

Shepherd Center’s specially trained staff uses the Coma Recovery Scale-Revised to assess the patient’s rate of emergence and response to his or her environment. The interdisciplinary team works closely to facilitate the patient’s recovery by offering an individualized plan of care that balances medication management, therapies, environmental stimulation and rest.

Family-Centered Care/Treatment

It is important during your loved one’s treatment in the DOC Program that you get the necessary information about your loved one’s expected recovery. We are also committed to making sure you feel involved in the care and encourage you to ask questions and let us know your goals and expectations. The program will provide many opportunities for education and training to help you feel comfortable in caring for your loved one at home. Training may include, but is not limited to:

  • Medication management
  • Tube feeding – nutritional management
  • Bowel and bladder care
  • Respiratory care
  • Diabetic care
  • Safety management and care
  • Community education and reintegration
  • Transfer and retraining
  • Skin care
  • Coma Recovery Scale training

Family/Caregiver Activities

  • Medical conferences with your physician and case manager
  • Neuropsychology education/counseling for understanding your loved one’s recovery
  • Goal-setting with your treatment team
  • Scheduled hands-on training with nurses and therapists
  • Support groups
  • Peer visitors
  • Community outings

Discharge Support

During the inpatient stay, the patient will be assigned a Transition Support Coordinator (TSC) from the Transition Support Program. The TSC will support the family for 60 days post-discharge as they transition to home. The TSC will be in contact regularly to address any questions the family has as they provide care in the home and to assist in monitoring their loved one’s cognitive recovery.

Resources

For additional educational and training information, visit MyShepherdConnection.org.

Also, you may want to visit these websites: