For professionals

Abstract

Background
The vegetative state, also known as unresponsive waking syndrome, is one of the worst possible consequences of acquired brain injury and confronts rehabilitation specialists with several challenges. Achieving a (minimal) consciousness is classically considered unlikely after 3-6 months after non-traumatic or 12 months after traumatic etiologies. A growing body of evidence suggests that these timeframes are too limited, but the evidence regarding the likelihood of recovery is still limited.

Objective
To identify the moment of consciousness recovery in documented cases of late emergence from a vegetative state.

Methods
Four cases of apparent late recovery of consciousness, identified within a prospective cohort study, were studied in depth by analyzing medical, paramedic, and nursing data and interviewing the patients' families about their account of the recovery process.

Results
All patients were found to have shown signs of consciousness well within the expected time frame (5 weeks-2 months after ictus). However, this behavior went unnoticed or was misinterpreted, leading to a diagnostic delay of several months to more than 5 years. The lack of appropriate diagnostics, the use of incorrect terminology, sedative medication but also patient-related factors such as hydrocephalus, language barriers and performance fluctuations would have contributed to the delay.

Conclusions
Delayed recognition of signs of consciousness in patients in a vegetative state can lead not only to suboptimal clinical care, but also to biased prognostic figures. Distinguishing late recovery from the delayed discovery of consciousness is therefore vital for both clinical practice and science.

Keywords
Disorders of Consciousness (MeSH), Persistent Vegetative State (MeSH), Neurological Rehabilitation (MeSH)