When your patient or loved on has sustained a severe brain injury that results in a disorder of consciousness (DoC), including coma, vegetative state (VS), and minimally conscious state (MCS), a specialized program like Nexus’ Phoenix Project may be the right next step.
Know the Facts
- The annual US incidence of VS is approximately 4,200 persons
- The cost of lifetime care for persons with prolonged DoC can exceed $1,000,000
- Patients with DoC are usually transferred from the acute care setting to long-term care facilities where they are often lost to follow-up
Combining neuroscientific treatment plans and early-intervention rehabilitation, the program at Nexus Specialty Hospital follows evidence-based guidelines set by the American Academy of Neurology. These recommendations concerning the care of adult patients helps our clinical team make decisions on diagnosis and treatment.
How the Guidelines Started & When they Changed
The first diagnostic and prognostic guidelines for VS were published by the American Academy of Neurology in 1995 and the first consensus-based diagnostic criteria for MCS was published by the Aspen Neurobehavioral Workgroup in 2002. Since then, extensive research on DoC was completed and new evidence became available, leading to a practice guideline update.
In late 2018, the American Academy of Neurology published new recommendations clinical teams should consider when assessing and caring for adults with a DoC. In totality, the goal of the review and published update was meant to answer clinical queries, summarized in four overarching questions:
- What procedures accurately diagnose prolonged DoC?
- What is the natural history of prolonged DoC?
- What factors or procedures help to predict outcome in prolonged DoC?
- What treatments are effective for prolonged DoC?
Through extensive research, new recommendations were made and published in the “Practice guideline recommendations: Disorders of consciousness” developed by the American Academy of Neurology. You can read the summary here.
What the Recommendations Mean
The published guideline update offers recommendations for a variety of program features that Nexus Health Systems’ Phoenix Project already offers, including:
- Medically stable DoC patients should be referred to settings staffed by multidisciplinary rehabilitation teams with specialized training.
- Clinicians should use standardized neurobehavioral assessment measures that have been shown to be valid and reliable.
- Clinicians caring for patients should perform standardized behavioral evaluations to identify trends in the trajectory of recovery.
- Clinicians must identify patient and family preferences early and throughout the provision of care to help guide the decision-making process for persons with prolonged DoC.
- Clinicians should be vigilant to the medical complications that commonly occur.
- Clinicians should assess individuals for evidence of pain or suffering and should treat when there is reasonable cause.
- Clinicians caring for patients with traumatic VS or MCS should be prescribed [medication] to hasten functional recovery and reduce the degree of disability.
- Clinicians should provide evidence-based information regarding the projected benefits and risks of a particular treatment, and the level of uncertainty associated with the proposed intervention.
Our DoC program, the Phoenix Project combines a variety of specialties, including neurology, PM&R, physical, occupational, and speech therapy. Founder and Chief Medical Officer Dr. John W. Cassidy formalized the program in early 2018, and since then, the team has seen significant improvement in the wakefulness and awareness of 75% of patients admitted to the program.
Patients of all ages are admitted to Nexus Children’s Hospital and Nexus Specialty Hospital as part of the Phoenix Project. Individuals in our program admit with a DoC due to an acquired brain injury from a trauma, cerebrovascular event, or anoxic event. Overall, the program aims to improve cognitive, functional, and behavioral capabilities to a level where the patient who was in a coma, vegetative state, or minimally conscious state can re-enter society and families can safely take him or her home.
For more information on Nexus Health Systems’ Emerging Consciousness Program or to admit a patient or loved one, please contact our admissions team at 855.729.0855.