Exploring the Outcomes of Rehabilitative Care for Veterans and Service Members Treated For A Disorder Of Consciousness In The VHA Emerging Conciousness Program

Over the past several years, there has been an influx in patients being treated for polytraumatic injuries within the Veterans Health Administration (VHA), largely due to the wars in Afghanistan and Iraq, but also due to advances in life sustaining medical interventions. The polytrauma population includes veterans who have sustained a severe traumatic or non-traumatic brain injury, and a significant loss in cognitive and physical functioning, referred to as a disorder of consciousness. The purpose of the current study was to explore factors related to successful emergence from a disorder of consciousness, using a sample of veterans who were treated at one of the five VA polytrauma rehabilitation center (PRC) sites in an Emerging Consciousness (EC) Program. Participants (N = 70) included both combat and non-combat active duty military personnel and veterans who sustained either a severe traumatic brain injury or anoxic brain injury, and were considered to have a disorder of consciousness at the time of their admission to the EC program. Patient information was retrospectively collected from electronic medical records, and included demographic data, medical information, and scores on the Functional Independence Measure (FIM), Rappaport Coma Near Coma (CNC) Scale, and the JFK Coma Recovery Scale- Revised (CRS-R). In addition, Receiver Operator Characteristic Models (ROC) were utilized to explore “cut scores” for predicting emergence using the CNC and CRS-R. Results showed that age is a significant factor in changes in FIM scores over time, but it did not predict time to emerge or emergence itself. In addition, for the CNC, scores at intake tended to be a better predictor of emergence, while week three scores on the CRS-R were more accurate in determining whether someone would emerge or not. Exploratory analyses also showed a difference in discharge location after treatment based on a patient’s age. Finally, significant variance in initial scores on the CNC was seen for Caucasians, when compared to other ethnic groups. Limitations are explored, along with implications and recommendations for future research and clinical practice