On With Life's Rehabilitation Program for Persons in a Coma/Minimally Responsive State

On With Life first began accepting individuals in a coma/minimally responsive state into its rehabilitation program in 1994.  The rationale for the provision of intensive rehabilitation to persons in a coma/minimally responsive state is to provide: 

1) aggressive effort to maintain the person’s physical condition is required in order to promote medical stability, avoid contractures and skin breakdown and to increase the ease of providing care; and

2) Stimulation to the brain and the central nervous system promotes development and prevents further deterioration, which may be irreversible.

On With Life at Ankeny is a Rehabilitation Accreditation Commission (CARF) accredited “Comprehensive Integrated Inpatient Rehabilitation Program – Brain Injury”.

On With Life at Ankeny provides intensive Occupational, Physical and Speech Therapy services to persons served in a coma/minimally responsive state.  Additional group and individual sessions may be added at the discretion of the treatment team.  Sensory stimulation groups are conducted by various combinations of clinicians, including Speech Therapists, Music Therapists, Occupational Therapists, and Therapeutic Recreation Specialists.  Multi-modal stimulation is provided through auditory, visual, olfactory, taste, touch, vestibular, and oral motor stimuli.  Supplemental stimulation is also carried out by members of the rehabilitation nursing staff and Certified Nursing Assistants, and is also provided by members of the individual’s family and support system.

Throughout the person’s stay at On With Life, a national assessment instrument, the Rappaport Coma/Near Coma Scale is administered. The value of consistent administration of this instrument is the ability to compare an individual’s response to stimuli over a period of time.  This assessment instrument is administered by clinicians and performed in a highly standardized fashion with the results being shared with all members of the rehabilitation team, the person served and their family.  An individual will be considered to be out of a coma when the Rappaport Scale demonstrates consistency on three consecutive trials.

There are three separate issues addressed in the treatment and discharge planning of persons in a coma/minimally responsive state: physiological issues, communication/sensory response and mobility, and family issues/discharge planning.

These issues are addressed at the monthly rehabilitation treatment team conferences, emphasizing the assessment scores, progress in therapy, newly identified strengths and barriers, family issues or preferences, funding source reviews, estimated length of stay, and discharge planning.

Family and friends are encouraged to visit their loved ones frequently and to be involved in the therapy process as appropriate.

A person will transition into the regular intensive rehabilitation program once the person has been deemed out of the coma state. At that point, the person will be reevaluated and new goals will be established with the person served, his/her family or representative and the rehabilitation team.

Medical services include a Medical Director specializing in Internal Medicine, a Rehabilitation Medical Director, a Consulting Physiatrist, a full time staff Psychologist, and a Consulting Psychiatrist.