Presented by: Dana Pavlotzky, M.A. CCC-SLP
Contributions by: Deborah Presutti-Petrone, M.S.
Kathleen Soreth-Harman, M.A.
Vanessa Edwards, M.S.
Debra Eisen, M.A.
ASHA Convention Orlando
November 21, 2014
CCC-SLP
CCC-SLP
CCC-SLP
CCC-SLP
Financial : Dana Pavlotzky is a full-time
employee of MossRehab, Einstein Healthcare
Network.
Nonfinancial: No relevant nonfinancial
relationship.
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Acute inpatient/outpatient rehabilitation
Responsiveness Program
Assessment and treatment of minimally
responsive patients with acquired brain injury
Multidisciplinary team
Research team
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Changes in healthcare
◦ Improved survival rates after TBI
◦ Insurance coverage for rehabilitation
◦ Continuum of care
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Nontraditional role of SLP
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40% misdiagnosis rate
Littlewood, 1996)
(Andrews, Murphy, Munday, &
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Participants will be able to describe the
various states of consciousness
Participants will be able to describe the role
of a multi-disciplinary team with patients
with disorders of consciousness
Participants will explain the role of the
speech-language pathologist in clinical
assessment and treatment of patients with
disorders of consciousness
Coma
Vegetative
state
Minimally
conscious state
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No arousal/eye opening
Absent sleep/wake cycle
Reflex and postural responses only
(Giacino et al., 2002)
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No behavioral evidence of awareness of self
or environment
Sleep/wake cycle
Posture or withdraw to noxious stimuli
Occasional non-purposeful movement
Exhibit visual and auditory startle responses
Brief orienting to sound
Brief visual fixation
Reflexive crying or smiling
(Giacino et al., 2002)
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Evince some awareness of self and their
environment in an unambiguous, albeit
inconsistent manner through at least one of the
following behaviors:
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Follow simple commands
Gestural or verbal yes/no communication system
Intelligible verbalization
Purposeful behavior
Visual fixation/pursuit
Localizes to noxious stimuli
(Whyte, Hart, Laborde, & Rosenthal, 2004)
(Giacino et al., 2002)
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Consistent and accurate responses
◦ Functional yes/no communication system
◦ Functional object use for at least 2 different objects
(Giacino et al., 2002)
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Physician
Physical Therapist
Occupational Therapist
Speech-Language Pathologist
Neuropsychologist
Recreational Therapist
Nurse
Research Assistant
Patient & Family
JFK Coma Recovery Scale-Revised (CRS-R)
Systematic Observation
Develop clinical questions protocols
(Giacino, Kalmar, & Whyte, 2004)
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Arousal
Movement
Vision
Communication
Response to environment
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Developed to answer clinical questions
◦ Can the patient see?
◦ Are they able to follow commands?
◦ Do they have a reliable yes/no communication
system?
◦ Do they respond to pharmacologic treatments?
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Completed daily in each discipline’s therapy
session(s)
◦ (Whyte et al., 2004)
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Auditory Comprehension
◦ Object identification/recognition
◦ Command following
◦ Yes/no responses
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Attention/interaction with environment
◦ Cause/effect apps
◦ Single switch activation
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Swallowing
PMV trials
Andrews, K., Murphy, L., Munday, R., & Littlewood, C. (1996). Misdiagnosis of the
vegetative state: retrospective study in a rehabilitation unit. British Medical
Journal, 313, 13-16.
Giacino, J.T., Ashwal, S., Childs, N., Cranford, R., Jennett, B., Katz, D.I., . . . Zasler,
N.D. (2002). The minimally conscious state: definition and diagnostic criteria.
Neurology, 58, 349-353.
Giacino, J.T., Kalmar, K., Whyte, J. (2004). The JFK coma recovery scale—revised:
measurement characteristics and diagnostic utility. Archives of Physical Medicine
and Rehabilitation, 85, 2020-2029.
Giacino, J.T., Schnakers, C., Rodriquez-Moreno, D., Kalmar, K., Schiff, N., Hirsch, J.
(2009). Behavioral assessment in patients with disorders of consciousness: gold
standard of fool’s gold. Progress in Brain Research, 177, 33-48.
Whyte, J., Hart, T., Laborde, A., & Rosenthal, M. (2004). Rehabilitation Issues in
Traumatic Brain Injury. In J.A. Delisa et al. (Eds.), Rehabilitation Medicine:
Principles and Practices 4th Edition (pp. 1677-1713). Philadelphia, PA: Lippincott
Williams & Wilkins.
Bernat, J.L. (2006). Chronic disorders of consciousness. Lancet, 367, 1181-1192.
Whyte, J., & DiPasquale, M. (1995). Assessment of vision and visual attention in
minimally responsive brain injured patients. Archives of Physical Medicine and
Rehabilitation, 76, 804-810
Whyte, J, DiPasquale, M.C., & Vaccaro, M. (1999). Assessment of commandfollowing in minimally conscious brain injured patients. Archives of Physical
Medicine and Rehabilitation, 80, 653-660.
Whyte, J., Katz, D., Long, D., DiPasquale, M.C., Polansky, M., Kalmar, K., . . .Eifer, B.
(2005). Predictors of outcome in prolonged posttraumatic disorders of
consciousness and assessment of medication effects: a multicenter study.
Archives of Physical Medicine and Rehabilitation, 86, 453-462.
Whyte, J., Nakase-Richardson, R., Hammond, F.M., McNamee, S., Giacino, J., Kalmar,
K., . . . Horn, L. (2013). Functional outcomes in traumatic disorders of
consciousness: 5-year outcomes from the national institute on disability and
rehabilitation research traumatic brain injury model systems. Archives of Physical
Medicine and Rehabilitation, 94, 1855-1860.