Disorders of Consciousness Program

Consciousness means being awake and knowing what is happening around you. A disorder of consciousness (DoC) is a diagnosis given when someone has trouble staying awake and knowing what is going on around them. A disorder of consciousness commonly occurs after a severe brain injury, including traumatic and nontraumatic.

There are several levels of consciousness your child's care team may discuss with you:

Coma — The person is not awake and does not respond to sounds, touch or other stimulation. Eyes remain closed and there are no purposeful movements. A coma typically occurs in the earliest phase after a serious brain injury.

Unresponsive Wakefulness Syndrome — The person may open their eyes and have sleep-wake cycles, but they do not show signs of awareness of themselves or their surroundings. Movements that occur are reflexive rather than purposeful.

Minimally Conscious State — The person shows clear but inconsistent signs of awareness. They may follow simple commands, visually track objects, or respond to familiar voices intermittently. However, these responses may not happen every time.

Understanding which level your child is at helps the care team make treatment decisions and communicate with your family about what to expect.

Your child will be cared for by an interdisciplinary team that includes:

• Physical medicine and rehabilitation (PM&R) physician and pediatric hospitalist co-lead your child's care plan, evaluate your child daily or more and coordinate with other specialists as needed.
• Physical therapist focuses on movement, positioning and physical function.
• Occupational therapist addresses daily living activities, sensory processing and upper-body function.
• Speech-language pathologist evaluates communication, oral-motor function and swallowing and cognitive-linguistic skills.
• Nursing team (Magnet Accreditation) provides 24/7 bedside care, monitoring and family education.
• Additional support based on your child’s needs can include respiratory therapists, interpreter services, social workers, case managers, child life specialists, chaplains, dietitians and school program staff.

Before being accepted into the program, a complete examination and evaluation will be performed by the physical medicine and rehabilitation physician to develop an individualized care plan. For current Arkansas Children's patients, this typically happens through a consultation from the rehabilitation services team. For patients transferring from outside facilities, this may occur through a physician-to-physician handoff or telehealth evaluation.

Admission Criteria

• Your child must meet diagnostic criteria for a DoC.
• Your child must be on a medical-surgical floor and out of the pediatric intensive care unit (PICU).
• Your child must be medically able to tolerate therapy, even if they are not yet able to actively participate.
• Your child must have ongoing medical needs that justify an inpatient stay.

Transition Criteria

Patients are continuously monitored to determine ongoing needs and appropriateness of participation in the program. There may be times when a patient requires a transfer to a different level of care.

Transition criteria include, but are not limited to:

• Your child has met diagnostic criteria for emergence from a DoC and is ready for more active rehabilitation.
• Your child is ready to transfer to a post-acute rehabilitation program or another DoC program.
• Your child is medically ready for discharge.
• Your child is becoming medically unable to tolerate therapy and must transfer to a higher level of care, such as the PICU.

Discharge Criteria

• Your child is medically ready for discharge.
• Your child's caregivers have completed all necessary education and training, and a safe plan for discharge has been established.
• Your child no longer requires interdisciplinary services to achieve goals, or can achieve those goals in a less acute setting.
• Your child displays behaviors prevent them from progressing in a continued acute care program, or the patient and family are no longer willing to be active participants.
• The patient or family exercises their legal rights and refuses continued services.

Patients and families are at the center of everything we do at Arkansas Children's. We believe that families and caregivers are the primary source of strength and support for the children, adolescents and young adults served by the hospital.

Our mission within the DoC program is to partner with your family in shared decision-making, provide education and support that empower you to effectively care for and advocate for your child, help you navigate changes in your child's clinical status and balance uncertainty with hope.

We will:

• Include your family in all planning and care decisions.
• Share information about your child's care and update you in routine team meetings.
• Support you emotionally throughout what is often a difficult and uncertain journey.

Your child's room will typically be on 4D (neuroscience) or 5D/5E (acute care rehabilitation) at ACH. Our team will work closely with you and your child to plan a smooth transition back home and into the community.