LAUSR

Brain injured patients who have suffered a coma require important medical supervision with a coordinated program of rehabilitation. These patients are most likely to benefit from Post Critical Care Rehabilitation Units. An important challenge is to recognize signs of awareness and establish a diagnosis of the disorder of consciousness: unresponsive wakefulness syndrome (UWS) versus minimally conscious state (MCS). The evaluation requires clinical observations by trained caregivers, the use of specific scales such as the Coma Recovery Scale Revised (CRS-R). This clinical assessment should be completed by a neurophysiological assessment and functional imagery in order to search for brain markers of awareness. Detecting awareness requires that patients are comfortable and because of the fluctuation of awareness and wakefulness, a sufficient time of observation is essential with repeated evaluations. A favorable atmosphere to promote the emergence of awareness comprises personalized stimulations such as sensory regulation programs. Music, non-invasive brain stimulations and several drugs can also boost awareness detection. The implication of family and close people should be integrated to maximize the chance to observe emotional responses. A program combining these practices is proposed in our post critical care rehabilitation unit to patients awakening from coma or for a specific assessment before the admission in dedicated units for patients in UWS/MCS. Given the large panel of tools available and the heterogeneity of practices, guidelines should be developed with a minimal standardized expertise proposed for all patients with disorder of consciousness.