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Polytrauma/TBI System of Care

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Emerging Consciousness

The Emerging Consciousness (EC) Program, which is embedded into each of the five VA Polytrauma Rehabilitation Centers, specializes in the assessment, treatment and care of individuals who have sustained the most severe traumatic brain injuries also called disorders of consciousness.  The EC Program became an integral part of the VA Polytrauma Rehabilitation Center and Polytrauma/TBI System of Care in 2007.

The EC Program admission and treatment goals include a comprehensive 90- day inpatient rehabilitation stay to provide diagnostic and prognostic information using validated assessment tools and serial assessments, to optimize physical health through management of common complications and promotion of health maintenance, to enhance recovery and level of functioning using adaptive technologies and empirically established pharmacologic treatments, to facilitate optimal transition to next level of care, to provide caregiver education, training,  and support, and address common ethical issues facing families and patients with severe brain injury. Specific goals are unique to a patient’s progress and may include the following:

  • Progressively improve arousal (awakening) level
  • Increase responsiveness and interaction within the environment
  • Work toward establishing a means of effective communication beginning with a yes and no response
  • Educate and support caregivers

The specialized EC Program care is provided by an interdisciplinary team consisting of members from the following disciplines: Physiatry, Occupational Therapy, Physical Therapy, Neuropsychology/Psychology, Family Therapy, Psychiatry, Recreational Therapy, Speech and Language Pathology, Vision Therapy, Rehabilitation Nursing, Social Work, Dietary Services, Pharmacology, and Assistive Technology.  In addition, the EC Program offers intensive family support services, education and social work/nursing case management.  Specialized consultation services commonly required by severe TBI patients and general medical care are available as well.

Criteria for admission into the EC Program include the following:  the individual is functioning in a coma, vegetative or minimally conscious state; the individual is within two years of the injury (those individuals outside of the two year timeframe will still be offered appropriate services but do not qualify for the comprehensive inpatient EC Program); the individual must be medically stable.

When the individual emerges from impaired consciousness (acquires the ability to consistently communicate and/or functionally use objects), the length of stay may be extended to maximize functional return needed to return to home or the next appropriate level of care.  The EC Program is completed if the individual does not demonstrate signs of progression toward emergence by the end of the 90-day inpatient stay and a coordinated discharge to the most appropriate supportive setting will then be arranged.