Disorders of Consciousness Program at Spaulding Network

The DoC program is one of only a few centers with the capacity to provide brain injury rehab across multiple levels of care.

The Spaulding Rehabilitation Network Disorders of Consciousness (DoC) Program is an active clinical partnership between Spaulding Hospital Cambridge (SHC), and Spaulding Boston (SRH), offering a continuum of comprehensive medical and rehabilitation care for patients with DoC who require admission to either a Long-Term Acute Care Hospital (LTAC) or an Inpatient Rehabilitation Facility (IRF). This TBI continuum of care is one of only a few centers in the US with the capacity to provide integrated multidisciplinary brain injury rehabilitation services across multiple levels of care.

With dedicated beds at both Spaulding Boston and Spaulding Cambridge, the DoC Program provides rehabilitative care specifically designed for individuals who have experienced severe acquired brain injury and have not yet regained the ability to follow instructions consistently, communicate reliably or perform basic self-care activities. The SRN DoC Program matches rehabilitation care to the individual’s current level of function and immediate care needs.

Persons over the age of 18 who have sustained severe brain injury of high medical complexity (including those who require ventilator support) and have not yet fully regained consciousness are eligible for admission to the DoC Program at SHC. The DoC Program at Spaulding Boston serves persons with acquired brain injury who no longer require a ventilator, have regained signs of consciousness (i.e., emerged from coma and the vegetative state) and are over the age of 16.

The DoC Program in Cambridge, like the Boston Program, is led by Spaulding Director of Rehabilitation Neuropsychology and Researcher Joseph T. Giacino, PhD. The multidisciplinary rehabilitation team at SHC is led by Sandra Suduikis, M.D., an experienced physiatrist with specialized training in TBI assessment and rehabilitation. Dr. Suduikis closely collaborates in patient care and treatment planning with specialists from Internal Medicine, Pulmonary Medicine and Neurology, as well as team members from nursing, physical, occupational, speech and respiratory therapies, nutrition, case management and social work. Family education and support, as well as assistance with longer term discharge planning, are a critical component of the program.

Assessment, rehabilitation planning and service delivery are carried out in the same manner as in the Boston program, with a systematic approach in which standardized assessment and treatment protocols are performed within a pre-defined timeframe. Progress is monitored weekly using a standardized battery of physical, cognitive, linguistic, motor and functional outcome measures designed specifically for persons with DOC. Clinical benchmarks derived from published research are used to guide decision-making regarding changes in treatment and discharge to the next level of care.

Since opening in March 2011, 46 patients have been admitted to the DoC Program in Cambridge, with the following disposition outcomes:

- 22 admitted to Spaulding Boston DoC program for continuation of intensive inpatient rehabilitation
- 6 discharged to SNF/Long Term Care facilities for ongoing management of medical and clinical needs
- 12 patients were discharged back to the acute setting, and most were re-admitted back to SHC
- 1 patient expired, 1 discharged to Hospice

The SRN DoC Program is a member of the Consciousness Consortium (CC), which is comprised of inpatient brain injury rehabilitation programs based in the U.S. and Europe with clinical and research programs dedicated to individuals with acquired disorders of consciousness. CC members have been integrally involved in the development and testing of novel assessment and treatment procedures, establishing guidelines for clinical management and developing educational materials relative to persons with DoC.

For more information on the DoC Program, please visit the DoC program page here. For specific questions, please contact Dr. Joseph Giacino at jgiacino@partners.org.

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