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Disorders of Consciousness Program

TIRR Disorders of Consciousness Program

The TIRR Memorial Hermann Disorders of Consciousness (DOC) Program focuses on patients in a vegetative or minimally conscious state. Although these patients are often not ready to begin a traditional rehabilitation program, they can significantly benefit from a program that specializes in treating disorders of consciousness. The DOC Program applies state-of-the-art advances to assess and treat these patients to help maximize their potential recoveries and outcomes.

Studies have shown that 35 to 40 percent of patients with disorders of consciousness (DOC) are misdiagnosed and undertreated. Frequently thought of as vegetative, many are either conscious or minimally conscious.1

What are disorders of consciousness?

A disorder of consciousness (DOC) is a condition of altered consciousness in which a patient has severely impaired levels of awareness and wakefulness. Examples include patients who are in coma, a vegetative state or a minimally conscious state.

What causes disorders of consciousness?

A DOC is often seen following a severe traumatic brain injury, an anoxic brain injury or stroke.

Who does the DOC Program treat?

The DOC Program treats patients who are still unconscious or have just recovered consciousness. This includes patients who are not yet communicating or following commands, and patients who have just begun to communicate or follow commands but do so inconsistently.

What are the objectives and benefits of the DOC Program?

The TIRR Memorial Hermann team works with patients and their families to:

  • Assess the patient’s current level of consciousness
  • Evaluate treatable medical or neurological barriers to the recovery of consciousness
  • Improve the patient’s level of alertness through medications and other therapeutic interventions
  • Identify ways to establish consistent communication
  • Initiate an intensive mobility program, beginning with sitting in a wheelchair and progressing to standing
  • Address spasticity and contractures to maximize potential for functional recovery
  • Utilize recent technological advances, as needed to enhance outcomes
  • Prevent secondary complications and reduce the risk of recurrent hospitalizations
  • Offer specialized education, training and support for families and caregivers
  • Provide opportunities to participate in the latest research on assessing and treating disorders of consciousness

Meet the Team

The DOC Program is supported by an interdisciplinary team of clinicians who specialize in treating this patient population, including:

  • Neuropsychologist
  • Music therapists
  • Therapeutic recreation specialists
  • Case managers
  • Social workers
  • Respiratory therapists
  • Behavioral Neurology & Neuropsychiatry specialists

Patient Stories

John Keller thumb
John Keller's Miracle in Progress

When 33-year-old John Keller was first admitted to TIRR Memorial Hermann on March 26, 2008, he was in a vegetative state. Two hospitalizations and less than a year later, on January 29, 2009, he left the rehabilitation hospital walking and talking.

Read the Story »

TIRR Memorial Hermann Journal

Kothari DOC
Advancing Best Practices in the Treatment of Patients with Disorders of Consciousness

Studies have shown that 35 percent to 40 percent of patients diagnosed as being in a vegetative state are in fact conscious when evaluated by formal clinical examinations. More recent evidence suggests that there may be an additional 15 percent whose consciousness cannot be detected even by the best clinical examination.

Read More »


Disorders of Consciousness Program
New Knowledge Improves Care for Patients with Disorders of Consciousness

Increased awareness of the heterogeneity of patients with disorders of consciousness, new knowledge of the condition, and improved methods of assessment and treatment have led to the formalization of the DOC program at TIRR Memorial Hermann.

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In The News

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Kothari: It’s Time to Talk About Life, Death and Brain Trauma

The Houston Chronicle series "Alive Inside" by reporter Mike Hixenbaugh highlights the challenges faced by patients who are minimally conscious: misdiagnosis, inaccurate prognoses and a lack of access to appropriate care.

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Alive Inside: How a Houston Hospital Restores Patients with Severe Brain Injuries

Across the country, thousands of people with severe brain injuries are wrongly labeled as unconscious each year. Among them, a small number make it to a Houston rehab hospital, where those with even the worst injuries get a shot at recovery.

Read More »

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1Advancing Best Practices in the Treatment of Patients with Disorders of Consciousness