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Treatment of Disorders of Consciousness in the Veterans Health Administration Polytrauma Centers

McNamee, Shane MD; Howe, Laura PhD; Nakase-Richardson, Risa PhD; Peterson, Michelle DPT, NCS

The Journal of Head Trauma Rehabilitation: July/August 2012 - Volume 27 - Issue 4 - p 244–252
doi: 10.1097/HTR.0b013e31825e12c8
Original Articles

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.

Physical Medicine and Rehabilitation Service, Hunter Holmes McGuire VA Hospital, Richmond, Virginia, and Department of PM&R, Virginia Commonwealth University (Dr McNamee); Psychological Services, VA Palo Alto Health Care System, Palo Alto, California (Dr Howe); Mental Health and Behavioral Science Service, Physical Medicine and Rehabilitation Service, James A. Haley Veterans Hospital, and Center of Excellence for Maximizing Rehabilitation Outcomes, Tampa, Florida (Dr Nakase-Richardson); and Physical Medicine and Rehabilitation Service, Minneapolis VA Health Care System, Minneapolis, Virginia (Dr Peterson).

Corresponding Author: Shane McNamee, MD, Department of Veterans Affairs, Hunter Holmes McGuire Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249 (

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.