Treatment of disorders of consciousness in the Veterans Health Administration polytrauma centers.

This article describes the evolution of the emerging consciousness programs and the approach to care for veterans and active duty service members with disorders of consciousness (DOC) at the 4 polytrauma rehabilitation centers of the Veterans Health Administration. Compared to traditional rehabilitation patients, DOC patients have unique recovery patterns and rehabilitative needs, and they require an intensive medical and nursing support structure. This requires closely integrated rehabilitation and acute medical care to ensure the highest level of outcomes. Unfortunately, little information exists in the literature to establish best practices for the rehabilitation of this population. It is the authors' intentions to bridge the literature gap in regard to programmatic structure, treatment approaches for those with DOC, and support of their caregivers. This article includes descriptions of medical care protocols, review of stimulation approaches (environmental and pharmacologic) caregiver support, and monitoring of recovery patterns.