chapter  13
Clinical management of the minimally conscious state
ByYelena G. Bodien, Sabrina R. Taylor, Joseph T. Giacino
Pages 12

Traumatic brain injury (TBI) is an acute event that triggers a chain of long-term consequences for affected patients and family members. Disorders of consciousness (DOCs) include coma, the vegetative state (VS), the minimally conscious state (MCS), and the posttraumatic confusional state (PTCS). This chapter focuses on the diagnostic, prognostic, and clinical management issues surrounding the care of patients in MCS. It provides a brief overview of clinical features of MCS, focusing on the differences that distinguish this condition from other DOCs. The chapter focuses on the clinical management of patients with MCS. Diagnostic assessment of patients with impaired consciousness significantly impacts prognosis, treatment, resource allocation, and end-of-life decisions. Standardized behavioral assessment is recommended for monitoring recovery in patients with DOC30, 38 as there is increasing evidence that this approach minimizes diagnostic error. The Sensory Stimulation Assessment Measure (SSAM) assesses responsiveness over time to an array of sensory stimuli in severely brain-injured patients who do not consistently follow commands or communicate.