- better to have coma because there is no way but

SEMINAR up; the rewards are very powerful in the patient’s

Traumatic Brain Injury life.

Sir Amado Torres, M. Ed., MNZSTA

University of the Philippines (1990)
ABI Rehabilitation Ltd Behavioral Criteria for Differential Diagnosis
New Zealand (Auckland & Wellington) Behavior MCS VS Coma
Eye opening Spontaneous Spontaneous None
Spontaneous Automatic/obje Reflexive/pattern None
- The role of the SLT in the rehabilitation of a client movement ct ed
with a severe TBI from a minimally conscious state manipulation
to emergence from PTA within an intensive Response to Localization Posturing/withdr Posturing or
pain awal none
rehabilitation setting to the community. Visual Object Startle/pursuit None
response recognition/pur (rare)
*MDT = multidisciplinary team suit
Affective Contingent Random None
*MCS = Minimal conscious state response vocalizations
Commands Inconsistent None None
Coma Verbalization Unreliable None None
Communicati Unreliable None None
- Is a state of sustained pathologic unconsciousness on
in which the eyes remain closed and the patient
cannot be aroused (MSTF, 1994).
Best Practice Guidelines
- Usually caused by trauma  from vehicular
- best practice for people in MCS is individualized,
accidents, assaults, falls due to age/substance
holistic and patient-centered care.
abuse/attempted suicide, self-inflicted accidents.
- Best practice care requires a high standard of
- Neuroanatomy: heart beat (/), respiration (/), etc. =
coordinates physical, medical, allied health, and
the only thing functioning is the brain stem.
psycho-social support, delivered with compassion
o Brain is being separated from the brain stem;
and respect by a specialist team of health
space from foramen magnum
professionals working in partnership with the
*explanation for trauma: an egg yolk inside the
family.
container is being shook  the container is okay but
egg yolk is already destroyed.
Roles of MDT in Rehab of MCS
1. Specialist Medical Care
Vegetative State (VS)
2. Nursing care
- A condition in which there is complete absence of
3. Physiotherapy
behavioral evidence for awareness of self and
4. Occupational therapy
environment, with preserved capacity for
5. Clinical psychologists and social workders
spontaneous or stimulus-induced arousal (Aspen
6. Dietician
Workgroup, 2001).
- People who get usually confined: poor in executive
- There’s awareness, but unlike the coma, kahit ano
function (“pusakal” lol)
gawin mo, wala
- A range of non-medical approaches such as music
- Individuals have complete/partial preservation of
therapy, massage, recreation therapy, spiritual
brainstem and hypothalamic autonomic functions,
therapy, etc.
but show no evidence of sustained, reproducible,
- In NZ and US: SLTs work close with dieticians.
purposeful or voluntary behavioural response to
- Dieticians rely on the SLTs for the amount of food
auditory. Visual, tactile or noxious stimuli, or
they present.
evidence of language comprehension or
o In a hospital setting, patients cannot feed without
expression. (Laureys, S. et. al., 2000)
the presence of SLTs
o hypothalamus very significant in memory and
emotion
SLT’s Role
1. Swallowing
Minimal Conscious State (MCS)
2. Communication
- the MCS is a condition of severely altered
3. Cognition
consciousness in which minimal but definite
4. Education of family along with MDT
behavioural evidence of self or environmental
- TRAMS: tracheostomy team
awareness is demonstrated (Giacino J.T. et. al,
- When a patient has tracheotomy: the vocal folds
2002).
will not be exposed to respiration, amplification,
phonation, and eventually articulation.
MCS vs. Coma
1st school of thought
Clinical Assessment of the Minimally Conscious
- better to have MCS since you can engage more
Client
stimulation; can’t work with anything in a coma.
- Behavioural Assessment Methods remain to be the
2nd school of thought
gold standard of diagnosis & prognosis of the
clients in MCS
- Standardized Consciousness Rating Scales
o Glasgow Coma Scale – GCS (1974)
o Full Outline of UnResponsiveness – FOUR (2005)
o Coma Recovery Scale – CRS-R
o Rappaport Coma/Near Coma Scale – C-NC (1987)
o Sensory Modality Assessment and Rehabilitation
Technique – SMART (2004)
o Wessex Head Injury Matrix – WHIM (2000)
o Disorders of Consciousness Scale – DOCS (2005)

“It is not the amount of time, but the intensity of your

communication with your patient.”