Continued disorders of consciousness

A person presenting with intermittent, reduced or absent consciousness lasting four weeks or more after brain injury, is diagnosed as being in a prolonged or continued disorder of consciousness (CDOC). Therapeutic work with this group centres on detecting awareness, establishing consistent care routines to manage disability and providing education and support to family and friends. SLTs have a crucial role in the team assessing for awareness. Both communication and swallowing offer key indications of level of responsiveness. They are also often both central in discussions with families on treatment decisions. Assessing and analysing behaviours to determine whether an individual is emerging from CDOC is highly complex. A recent survey found that 46% of experienced clinicians reported a lack of confidence in the tasks currently recommended to detect functional communication in emerging patients. This chapter provides clear guidance and practice recommendations for SLTs assessing communication and swallowing in CDOC patients. The case studies introduce the use of taste stimuli to assess for evidence of awareness and communication, providing guidance on when this is appropriate and differentiating between reflexive and purposeful behaviours during oral intake. Clinicians are also provided with a reference tool to assist with classification of communication and swallowing behaviours in relation to levels of responsiveness, and also an additional behavioural observation sheet and an oral desensitisation routine online for clinical use.