1000 Section - Intensive Rehabilitation Program for Disorders of Consciousness: Evaluation of Care Processes and Clinical Outcomes

Objectives : Early intensive rehabilitation improves consciousness in patients with disorders of consciousness (DoC), but detailed information on specific interventions and their timing remains limited. This study aimed to describe outcomes and timing of care processes in an intensive rehabilitation program for DoC.

Design: Retrospective observational study of adults with brain injury in a vegetative state/unresponsive wakefulness syndrome (VS/UWS) or minimally conscious state (MCS), admitted to a 100-day rehabilitation program at a center in Argentina between 2019 and 2025. Data were obtained from medical records and institutional databases. Clinical and demographic variables were assessed, including level of consciousness (CRS-R), positioning and complication prevention, pharmacological and non-pharmacological stimulation, caregiver education, and prescription of assistive products for mobility and hygiene.

Results: Seventy-one patients were included (62% male), 38% with traumatic brain injury (TBI). Median age was 51 years, time since injury 63 days, and initial CRS-R 5; 60% were in VS/UWS. Twenty-four patients (34%) emerged from MCS. Kaplan–Meier analysis showed earlier emergence in TBI (mean 9.4 weeks) than non-TBI patients (12.8 weeks) (p < 0.001). Among 30 non-emergent patients at 14 weeks, four emerged after discharge. Median times were: 1 day to wheelchair positioning, 2.5 days to in-bed positioning, and 7 days to tilt-table standing. Resting upper-limb splints were provided in 65% of cases. Daily stimulation involved at least three disciplines, and pharmacological stimulation most frequently included amantadine. Educational materials were delivered at 1.5 days, psychological interviews at 5 days, and family training at 19 days. Home assessments occurred at 63 days. Wheelchairs and shower chairs were prescribed earlier in non-emergent than emergent patients (75 vs. 110 days; p = 0.01–0.02).   

Conclusion: The study outlined the implementation and timing of care processes in a local intensive rehabilitation program for patients with DoC. Future studies should compare these practices with international standards to improve effectiveness.