Disorders of consciousness after acquired brain injury: the state of the science

Disorders of consciousness (DOC) arise from direct perturbations of neural systems that regulate arousal and awareness, and indirectly from disruptions in the connections between these systemsDistinct clinical syndromes have been identified, but behavioural features often fluctuate and cross diagnostic borders within individual patients, probably reflecting aberrant dynamic changes in corticothalamic neuronal activityNovel applications of functional neuroimaging and electrophysiological techniques have been employed to detect covert signs of conscious awareness, improve outcome prediction, and establish brain–computer interfaces to augment communication abilityRecent empirical evidence suggests that treatment interventions aimed at neuromodulation can accelerate recovery and enhance outcome during both the acute and chronic phasesA paradigm shift should change the pervasive nihilism that continues to complicate patient management, family adjustment, medicolegal issues and healthcare policy in relation to DOC