ABSTRACT

Human consciousness is a complex and relatively poorly understood process of the brain. The majority of clinical attention has been given to the disorders of consciousness that occur most commonly with severe brain trauma leading to severe arousal/vigilance issues. This chapter provides a discussion of assessment and intervention for disorders of consciousness. Assessment of severe arousal disorders includes behavioral assessment that is guided by structured instruments, such as neurobehavioral rating scales and individualized quantitative behavioral assessment (IQBA). Treatment strategies may vary based on the level of acuity of injury, duration of symptoms of arousal disorders, and availability of institutional resources. Brain trauma, infections, metabolic disturbances, and/or exposure to anesthesia or certain types of medications often results in persistent impairments in ability to focus, sustain attention, and consciously access information about oneself and the environment. These disorders are characterized by intact arousal periods punctuated by confusion secondary to impairments in the ability to attend, process, and encode information.