False Hope or a Moral Imperative? Treating Patients with Disorders of Consciousness in Acute Care

Presenter

Elizabeth Wengraf

MSOT, OTR/L, CSRS

Learner Outcomes

By the end of this session, participants will be able to:

1. Identify at least three behavioral signs indicative of emerging consciousness in patients with disorders of consciousness (DoC) using standardized evaluation tools appropriate for acute care settings.
2. Describe two evidence-based OT interventions that can be implemented with patients with DoC in the acute care environment.
3. Analyze ethical and clinical considerations for initiating early rehabilitation with patients with DoC, supported by current research.
4. Summarize practical strategies for multidisciplinary collaboration in developing a consistent approach to care for patients with DoC, based on insights shared from the speaker’s experience.

Abstract

Patients with disorders of consciousness (DoC) in acute care are often perceived as having limited rehabilitation potential, resulting in inconsistent therapy involvement or delayed intervention. However, emerging research supports early, structured evaluation and treatment to improve diagnostic accuracy and long-term outcomes. This session challenges the misconception that therapy services offer “false hope” and reframes occupational therapy’s (OT) role as both evidence-based and ethically essential. Participants will explore current literature on DoC recovery trajectories, validated assessment tools, and treatment approaches appropriate for acute care settings. Drawing from the speaker’s experience establishing a multidisciplinary DoC team, attendees will gain practical insights into building collaborative models of care and the impact of coordinated therapy on outcomes. Through interactive case discussions and clinical reasoning exercises, participants will develop skills to identify subtle signs of consciousness, support neural recovery, and advocate for timely intervention. This session promotes a culture shift toward proactive, research-informed, and team-based rehabilitation for patients with DoC while positioning OT at the forefront of interdisciplinary practice and ensuring these patients are recognized and meaningfully included in care planning from the earliest stages of hospitalization.

Biography
Elizabeth (Danielle) Wengraf, OTR/L, CSRS, is an occupational therapist with 7+ years of neurorehabilitation experience from ICU to return to work. She helped develop and now leads a specialized interdisciplinary disorders of consciousness program, which has provided treatment to over 60 patients since its inception in 2023.

References to support evidence-based practice

1. Giacino, J. T., Katz, D. I., Schiff, N. D., Whyte, J., Ashman, E. J., Ashwal, S., ... & Armstrong, M. J. (2018). Practice guideline update recommendations summary: disorders of consciousness: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Neurology, 91(10), 450-460.
2. Keech, K., & Asiello, J. (2024). Conscious care: a proposed model to improve interprofessional care of patients with disorders of consciousness in the acute hospital setting. Brain Injury, 38(13), 1125-1132. Kondziella, D., Bender, A., Diserens, K., van Erp, W., Estraneo, A., Formisano, R., ... & EAN Panel on Coma, Disorders of Consciousness. (2020). European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. European journal of neurology, 27(5), 741-756.
3. Kowalski, R. G., Hammond, F. M., Weintraub, A. H., Nakase-Richardson, R., Zafonte, R. D., Whyte, J., & Giacino, J. T. (2021). Recovery of consciousness and functional outcome in moderate and severe traumatic brain injury. JAMA neurology, 78(5), 548-557.
4. Murtaugh, B., & Shapiro Rosenbaum, A. (2023). Clinical application of recommendations for neurobehavioral assessment in disorders of consciousness: an interdisciplinary approach. Frontiers in Human Neuroscience, 17, 1129466.
5. Norwood, M. F., Lakhani, A., Watling, D. P., Marsh, C. H., & Zeeman, H. (2023). Efficacy of multimodal sensory therapy in adult acquired brain injury: a systematic review. Neuropsychology review, 33(4), 693-713.
6. Robinson, H., & Crasta, J. E. (2022). Effectiveness of Sensory Stimulation to Increase Arousal for Patients With Disorders of Consciousness: A Systematic Review. The American Journal of Occupational Therapy, 76(Supplement_1), 7610510228p1-7610510228p1.
7. Wang, P., Cao, W., Zhou, H., Zhang, H. X., Zhang, L., Liu, L., ... & Kong, L. (2022). Efficacy of median nerve electrical stimulation on the recovery of patients with consciousness disorders: a systematic review and meta-analysis. Journal of International Medical Research, 50(12), 03000605221134467.
8. Wheeler, S., & Acord-Vira, A. (2023). Occupational therapy practice guidelines for adults with traumatic brain injury. The American Journal of Occupational Therapy, 77(4), 7704397010.
9. Zhang, B., O'Brien, K., Woo, J., Chi, B., Reeh, C., Li, S., & Kothari, S. (2023). Specialized intensive inpatient rehabilitation is crucial and time-sensitive for functional recovery from disorders of consciousness. Frontiers in Neurology, 14, 1126532.