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Oxford University Hospitals NHS Foundation Trust

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Patients with prolonged disorders of consciousness

The recently published 2014 national clinical guideline on management people with prolonged disorders of consciousness makes several recommendations of relevance to OCE, including recommendations that:

  • level one specialist neurological rehabilitation services should take responsibility for patients with prolonged disorders of consciousness from about four weeks after the original insult
  • all patients remaining unconscious should be transferred to a level one centre for further assessment and management four weeks after onset
  • the specialist service has lead clinical responsibility for all patients remaining unconscious until they achieve awareness, recognising that such patients do not necessarily have to remain within the inpatient service
  • all patients who enter the Permanent Vegetative State should have a formal assessment and then discussion of their best interests undertaken under the aegis of the specialist neurological rehabilitation service

The Oxford Centre for Enablement has the expertise to offer this service within this region. Several members of staff are specifically trained in the SMART assessment technique (Sensory Modality Assessment and Rehabilitation Technique).

Recognising that it is not necessarily appropriate for a patient to remain in a specialist centre if they are unable to benefit from ongoing therapy, we have organised a planned admission pathway lasting between four and eight weeks whereby the patient is fully assessed, meetings are held with the family and others, and advice is given. The expectation is that most patients remaining either in the vegetative state or in a minimally conscious state will then transfer to an appropriate nursing home.

They should then be followed up by the service with regular reassessment either in the nursing home or with a further planned readmission.