Prolonged Disorders of Consciousness (PDOC)

What is a Prolonged Disorder of Consciousness, (PDOC)?

Prolonged disorders of consciousness is a term covering patients remaining in a coma, vegetative state (VS), and minimally conscious state (MCS) after a brain injury. It is essential for the patient to receive specialist support through this process to give each patient every chance of optimising their recovery. Common causes of brain injury resulting in prolonged disorders of consciousness include:

  • Head injury
  • Stroke
  • Reduced oxygen to the brain (Anoxia)
  • Infection
  • Poisoning (drug/alchohol)
Following severe brain injury, many patients progress through the different levels of consciousness when emerging from a coma:
  • Coma (Absent wakefulness and absent awareness)
  • Unresponsive Wakefulness Syndrome or Vegetative State (Wakefulness with absent awareness)
  • Minimally Conscious State (Wakefulness with minimal/inconsistent awareness)
Our Team Approach
 
Our skilled team ensures a consistent co-ordinated approach to support recovery and includes:
  • Rehabilitation Consultant
  • Dietitian
  • Neuropsychologists
  • Specialist Nurse
  • Occupational Therapists
  • Physiotherapists
  • Speech and Language Therapist
  • Music Therapist
  • Complementary Therapists
Our specialist team who have experience in carrying out sensory assessments and devising sensory stimulation programmes to provide continual review of patient's levels of responsiveness.
 
The Royal College of Physicians launched new guidelines in December 2013 on the diagnosis and management of people with prolonged disorders of consciousness (PDOC). They help healthcare staff, families, carers, friends and others understand the clinical, ethical and legal issues surrounding the care of these patients. 
 
Download the guidelines at:
 
https://www.rcplondon.ac.uk/resources/prolonged-disorders-consciousness-national-clinical-guidelines
 
The new guidelines have an expanded remit, updated terminology, full recognition of the Mental Capacity Act 2005 and have been produced according to the international AGREE criteria. 
 
Healthcare staff, families, carers and representatives of patients with a prolonged disorder of consciousness can find the clinical and ethical situations challenging. The guidelines explain clearly who is responsible for making decisions about the care of patients with these disorders, including end-of life care, explaining the processes involved. 
 
The guidelines also emphasise the need to provide the patient’s family with information, education and support, as well as listening to families and friends. The guidelines specifically highlight the key role of families in the ‘best interests’ decision-making process. Family members provide important insights into the character, beliefs and likely wishes of the patient. Families and friends who spend time with the patient are also important because they can help assess any changes in behaviour or responsiveness.  
 
An excellent forum where families can share their experiences can be found at:
 
https://www.healthtalk.org/peoples-experiences/nerve-brain