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Consciousness Test Will Alter Rehabilitation

A widely publicized study recently published in The Lancet, where three patients in a “vegetative state” showed signs of consciousness on EEG testing, will have important ramifications on brain injury rehabilitation. There are two long held beliefs by both the medical community and the insurance community that are no longer valid. One is that persons in a vegetative state are not “conscious” as we understand it. This study, as well as others, is showing that assumption to be false. Secondly, the long held belief that the brain of a person in a chronic vegetative state cannot be rehabilitated is also untrue.

This development will greatly impact the already troubled field of brain injury rehabilitation. Twenty five years ago there were thousands more brain injury rehabilitation centers in the United States than there are now. The reason for the reduction has primarily been that brain injury rehabilitation is slow and expensive. Most medical coverage now in the United States severely limits the amount of brain injury rehabilitation a person can be covered for if they have suffered a severe brain injury. Most patients in a coma or in a vegetative state are simply dumped into nursing homes if they do not show improvement within the first six-months of injury.

A recent study in 2011, has shown that long term therapy for patients in a persistent vegetative state or minimally conscious state through sensory stimulation can result in long term improvements. This upsets the apple cart in an expensive way for the insurance companies. This means that common and inexpensive EEG machines can be used to measure the level of consciousness of these patients. That means, for the first time, there will be a way to objectively measure the level of improvement in a coma patient who is undergoing rehabilitation. Until these new findings came out, most patients were assessed using behavioral observations, which, of course, are mostly absent in coma patients. The recent study on rehabilitation shows us that, not only is there a way to measure the improvement in a vegetative patient undergoing therapy, but there is actually sensory stimulation therapy that can help those in a persistent vegetative state. Persistent vegetative state describes a patient who has been in a state of awake unawareness for over a year. Currently, approximately 25,000 people in the United States are in a chronic vegetative state.

While certainly larger studies need to be done on some of these issues, the revolutionary idea here is that people who appear to be in a vegetative state may, in fact, be far more conscious than we realized. We now have the tools to help them and allow for movement and communications to return in some patients. The battle over who will pay for these breakthroughs has just begun.