Emerging consciousness

What is a State of Emerging Consciousness?

After an acquired brain injury (ABI), some people remain in a prolonged state of diminished consciousness. It is not as deep a level of unconsciousness as a coma, because the person can show some signs that they are aware of the world around them. These signs may be very limited, such as being able to move a finger when asked to.

Some terms that may be used to describe these conditions may be minimally responsive, minimally conscious, or vegetative state. At ABI Rehabilitation, we say that these clients are in a state of emerging consciousness, because this term reflects our positive viewpoint that all clients may eventually recover some awareness and function.

Many of our clients in states of emerging consciousness have complex medical needs. They may need tubes to help them to breathe or eat, and are likely to not have control over their bladder and bowels. They are likely to have weakness in some or all of their limbs, tightness in their muscles and joints, or may have involuntary muscle contractions. ABI Rehabilitation has specialised teams for managing these issues.

What will rehabilitation be like?

ABI Rehabilitation has a specific programme developed for treating people in states of emerging consciousness.  It is based on the latest research and international recommendations. Services for your family member will focus on:

• Health and wellbeing: preventing complications; managing pain, incontinence, and seizures; providing appropriate medications.
• Breathing, feeding and swallowing: respiratory care; assuring adequate nutrition; assessing swallowing ability.
• Environmental management: providing necessary equipment, a low-stimulation environment, fatigue management, a sensory stimulation programme, and massage including traditional Māori techniques.
• Language and thinking: providing devices to assist communication, and providing exercises that stimulate thought processes.
• Mobility: ensuring proper positioning in bed and wheelchair; maintaining joint flexibility and managing muscle tone.

What does the future hold for my family member?

It is difficult to answer this question because every person’s condition is unique and relatively little research exists on states of emerging consciousness.

Some clients do make seemingly miraculous recoveries. Others will require intensive nursing care for the rest of their lives.

In our experience, over half of clients regain awareness, communication skills, and function during rehabilitation sufficient to enable discharge home with support from their family and other community services. 

Improvement during the early stages (within the first three months) is an encouraging sign. The majority of progress is likely to occur in the first year. After this point, signs of improvement can still be observed for years to come.

We aim to provide a quality of service that can support a meaningful life. Please talk to our Medical Director and rehabilitation team for information about your family member’s current and future condition.

What can I do to help my family member?

First, it is important to understand that it is normal and common to experience feelings of sadness, anger, anxiety, frustration, and helplessness during this time.

You can support your family member by making sure to take care of yourself and your other family members.

Another thing you can do is to educate yourself about your family member’s condition and treatments. You are invited to attend ABI Rehabilitation’s Brain Interest Group and the Family Support Group. They are full of useful information and are a way for people in similar situations to share their experiences and find support.

Your family member is likely to benefit a great deal from your frequent presence and interaction. At ABI Rehabilitation we strongly value the support and input of family. You will be asked to take part in rehabilitation-focused activities when it is suitable and as much as possible.

Where can I find more information?

The Australian National Health and Medical Research Council published a comprehensive booklet in 2008 entitled, ‘Post-Coma Unresponsiveness and Minimally Responsive State: A guide for families and carers of people with profound brain damage.

Please click here to download a copy of the booklet.