# data[].attributes.body
Reduced secretion management, reduced swallow frequency, reduced laryngeal level secretion. Tracheostomy management - complex. Anticipation of care needs. Stimulation and environmental management. Communication partner training (stimulation management). Person centred care.

# data[].attributes.headline
Professionals may sometimes forget to introduce themselves and the purpose of their sessions, maintain their dignity and actively engage them when interacting with them rather than treating them as passive participants. 

# data[].attributes.subject
Professionals may sometimes forget to introduce themselves and the purpose of their sessions, maintain their dignity and actively engage them when interacting with them rather than treating them as passive participants. 

# data[].attributes.body
Language, I think patients in PDOC situations should be spoken in their language can provide reassurance to family members and those individuals, they feel valued and included.

# data[].attributes.headline
dignity, control over their life, their environment - this right has been delegated to their carers in their current situation..

# data[].attributes.subject
dignity, control over their life, their environment - this right has been delegated to their carers in their current situation..

# data[].attributes.headline
Gynaecological/menstrual management in some patients in addition to bladder and bowel management

# data[].attributes.subject
Gynaecological/menstrual management in some patients in addition to bladder and bowel management

# data[].attributes.headline
At risk of contractures, respiratory deterioration, dental problems, skin breakdown, nutrition complications (NG/peg), problems with decision making and need for BIM decisions, difficult for their families. 

# data[].attributes.subject
At risk of contractures, respiratory deterioration, dental problems, skin breakdown, nutrition complications (NG/peg), problems with decision making and need for BIM decisions, difficult for their families. 

# data[].attributes.headline
post experienceing a specific disorder of consciousness patients may experience psychological distress and require interventions to help them with this. 

# data[].attributes.subject
post experienceing a specific disorder of consciousness patients may experience psychological distress and require interventions to help them with this. 

# data[].attributes.headline
inability to mobilise, therfor having a reduction in muscle mass, and will need physical therapy to prevent contractures and respiratory interventions to prevent chest infections

# data[].attributes.subject
inability to mobilise, therfor having a reduction in muscle mass, and will need physical therapy to prevent contractures and respiratory interventions to prevent chest infections

# data[].attributes.body
Skin care. Repositioning often to reduce risk of pressure sores. Stretching.

# data[].attributes.headline
chest care - cough assist, manual techniques, suction - people who are less or immobile are more prone to chest infections and problems, but often won't be able to produce an efficient cough independently 

# data[].attributes.subject
chest care - cough assist, manual techniques, suction - people who are less or immobile are more prone to chest infections and problems, but often won't be able to produce an efficient cough independently 

# data[].attributes.headline
24 hour postural care plan - avoid deformities, contractures, pressure sores, discomfort and pain 

# data[].attributes.subject
24 hour postural care plan - avoid deformities, contractures, pressure sores, discomfort and pain 

# data[].attributes.body
They may have reduced motor function due to injury or neurological damage therefore one of their needs might be sedation or to be bedbound. This may create secondary complications like muscle wastage, muscle shortening, contractures, pressure sores, dehydration, malnourishment, infections, respiratory intervention, negative effects on mental health.

# data[].attributes.headline
Communication diary to record any meaningful communication when emerging from PDOC - also a care diary from the start of their care and continuing on through rehabiliation.

# data[].attributes.subject
Communication diary to record any meaningful communication when emerging from PDOC - also a care diary from the start of their care and continuing on through rehabiliation.

# data[].attributes.body
Require to consider a 24 hour postural management plan to be implemented by all within the MDT to optimise positioning to minimise risk of contracture, to support the management of chest and prevent pressure areas.

# data[].attributes.body
Many patients have spiritual or cultural needs which should be honoured and respected as a part of their continued "personhood".

# data[].attributes.body
Energy needs gradually decline with a reduction of muscle mass, requiring lower calorie enteral nutrition to achieve an appropriate body weight, but need to ensure adequate protein and micronutrients for optimum health

# data[].attributes.body
in VS -- grinding the teeth
teeth need to be protected

# data[].attributes.headline
Feel lost when they may be back to full consciousness condition

# data[].attributes.subject
Feel lost when they may be back to full consciousness condition

# data[].attributes.body
Need therapy in bite size chinks. Use of visual timers for each task. Use of alternative communication aids

# data[].attributes.body
verbal stimulations from significant others

# data[].attributes.headline
Additional vitamin supplementation if feed volume and energy requirements are low

# data[].attributes.subject
Additional vitamin supplementation if feed volume and energy requirements are low

# data[].attributes.headline
Consideration for additional protein requirements depending on skin integrity

# data[].attributes.subject
Consideration for additional protein requirements depending on skin integrity

# data[].attributes.headline
Assessment of  nutritional requirements via PEG feeding according to individual need

# data[].attributes.subject
Assessment of  nutritional requirements via PEG feeding according to individual need

# data[].attributes.body
Whilst some level of physical adjustment to focus may be estimated by an optician, the level to which a person with PDoC might be able to perceive,  interpret, or respond to visual stimuli is difficult to ascertain. Patients may be unable to track moving objects, and the different hemispheres of the brain might not be working together to process the physical image seen through
the eye.

# data[].attributes.body
Cognitive difficulties
Communication difficulties
Swallowing and secretion management difficulties
Visual impairment
Motor impairment
Issues with tone
Issues with pain
Airway management difficulties

# data[].attributes.body
Ensuring that respiratory function remains optimal assessment and treatment.

# data[].attributes.headline
Visual impairment - to varying degree, patients often can have altered movement of eyes causing double vision which may impact on responses. Can be cortically blind.

# data[].attributes.subject
Visual impairment - to varying degree, patients often can have altered movement of eyes causing double vision which may impact on responses. Can be cortically blind.

# data[].attributes.headline
variety of significant cognitive/perceptual deficits such as poor intiation, dyspraxia, poor attention, poor memory, inattention etc

# data[].attributes.subject
variety of significant cognitive/perceptual deficits such as poor intiation, dyspraxia, poor attention, poor memory, inattention etc

# data[].attributes.headline
Need time - need patience and extra time to respond as responses can be very delayed

# data[].attributes.subject
Need time - need patience and extra time to respond as responses can be very delayed

# data[].attributes.headline
Treatment escalation – this should be discussed at an early stage giving considerations to likely success of treatment interventions and any advance planning in place

# data[].attributes.subject
Treatment escalation – this should be discussed at an early stage giving considerations to likely success of treatment interventions and any advance planning in place

# data[].attributes.body
Contractures. Due to less mobility they are faced with these issues. They are more at risk for further injuries and makes them even sensitive to the environment

# data[].attributes.body
Leisure activities. These patients are human whether they have an initial reaction or understanding, it is still their need to experience leisure activities.

# data[].attributes.headline
Family support - psychological support for family members/children. Their lives have been changed for ever, not just the patient's; they need support and knowledge be be able to manage the situation and make the right decisions.

# data[].attributes.subject
Family support - psychological support for family members/children. Their lives have been changed for ever, not just the patient's; they need support and knowledge be be able to manage the situation and make the right decisions.

# data[].attributes.headline
It’s important that, where available, stimulatory interventions are used to create as natural a context as possible, so that the pt has the best chance of demonstrating their potential and awareness

# data[].attributes.subject
It’s important that, where available, stimulatory interventions are used to create as natural a context as possible, so that the pt has the best chance of demonstrating their potential and awareness

# data[].attributes.body
People with PDoC can have impairments in vision, perception, cognition, mood, mobility, sensation, praxis, continence, communication, language, movement , breathing, eating,  sleeping, which impact on their ability to participate in their valued occupations.    They may require some to maximum assistance with  activties (physical, cognitive, social, spiritual) and need support with decision/choice making.

# data[].attributes.body
Need for appropriate environment. Need to control sensory stimulation.

Postural management - maintanence of body shape. Prevention of deformity/maladaptive biomechanical changes.

Continence

Swallowing difficulties/secretion management/chest care/sialorrhea

Spasticity management - consideration of the most appropriate treatment apprroach - consideration needs to be given to the overall systemic impact of oral antispasticity medications particularly on arousal levels.

Communication impairments

Skin care/pressure management

Somatosensory impairments

May have visual/hearing impairments

Nutrition and feeding considerations

# data[].attributes.body
Use of neuro stimulants to increase the patient alertness and to have a better sleep-awake cycle.

# data[].attributes.body
Patients all most all the time come with an indwelling catheter, TWOC for reducing care.

# data[].attributes.body
Often those in PDOC are on a range of medications - to address a lot of the other topics mentioned here. Some of these could have a detrimental effect on their alertness and more - this needs to be fine tuned as a priority and monitored by the MDT to ensure the best outcome...

# data[].attributes.body
Sometimes due to pain or infection, may require specialist equipment to support posture and seating.

# data[].attributes.body
communication needs
skin integrity management
pain
sleep/wake routine

# data[].attributes.headline
MDT management of secretions / swallowing difficulties. 

# data[].attributes.subject
MDT management of secretions / swallowing difficulties. 

# data[].attributes.headline
Complex communication needs. Can take a great deal of assessment to establish a reliable means of communication.

# data[].attributes.subject
Complex communication needs. Can take a great deal of assessment to establish a reliable means of communication.

# data[].attributes.body
Consideration/ax of whether underlying factors (e.g. eyesight, hearing) may be masking awareness

# data[].attributes.body
hygiene + possible bladder washout / monitor / treat infection
or management using incontinence pads

# data[].attributes.headline
Bowel management - establish programme may involve invasive procedures 

# data[].attributes.subject
Bowel management - establish programme may involve invasive procedures 

# data[].attributes.headline
Awareness of over stimulation, sleep/wake cycle, rest time and daily routine. 

# data[].attributes.subject
Awareness of over stimulation, sleep/wake cycle, rest time and daily routine. 

# data[].attributes.body
Maintenance of respiratory function - physio adjuncts e.g. cough assist, Clearway, MI:E

# data[].attributes.body
Maintaining soft tissue length, ROM, best positioning for respiratory function, skin integrity, social interaction

# data[].attributes.body
consider analgesics & pregablin/gabapentin,
Desensitisation ,
Facial oral tract therapy to enable adequate oral care
Wean trache/ Ng

# data[].attributes.body
immobility and prolonged postures leave out patients at high risk of skin breakdown. Regular monitoring, specialist equipment, 24 hour posture management plans and treatment of at risk areas is required.

# data[].attributes.body
Craniectomy helmets/planning surgery for replacing bone flap.

# data[].attributes.body
May have fractures/lacerations etc that need planned management.

# data[].attributes.body
Sleep wake cycle is often disrupted and MDT input is required to normalise this (e.g. structured timetable with regular times sitting out and accessing the outdoors, minimise interventions overnight as much as possible, potentially medication such as Melatonin).

# data[].attributes.body
Close monitoring for medications that may cause a sedative effect which may impair responses. This needs skilled input as anti spasticity medication may be required but can often be sedating
Consideration of the use of neurostimulants

# data[].attributes.body
Co-ordinated team work to ensure optimum respiratory management, including management of oral secretions and MDT input to wean tracheostomy when possible

# data[].attributes.headline
Routine/ daily timetable Opportunities for meaningful activity. Involve MDT rehab, time with family member and rest periods 

# data[].attributes.subject
Routine/ daily timetable Opportunities for meaningful activity. Involve MDT rehab, time with family member and rest periods 

# data[].attributes.body
People in PDoC are usually put on a lot of medication in the acute phase. This needs rationalising and minimising to reduce harmful side effects

# data[].attributes.body
Often overlooked in this patient group but spasticity and contractures can cause significant pain especially in the MCS plus population

# data[].attributes.body
Pre-existing conditions need to be effectively managed to optimise possible awareness

# data[].attributes.body
Need for 24 hour postural management to include specialist seating and bed positioning. The need for standing should be assessed on an individual basis and not be a routine part of therapeutic input

# data[].attributes.body
Optimise continence management to minimise risk to skin integrity and infections

# data[].attributes.body
Consider if artificial nutrition and hydration is in a patient's best interest

# data[].attributes.body
People in PDoC lack capacity to make decisions and so ALL decisions should be made in their best interest following a legal framework

# data[].attributes.body
Visual, Auditory, Proprioceptive, Sensory, Tactile

# data[].attributes.body
Full assistance with washing and incontinence needs

# data[].attributes.headline
ACPs to understand pt background, likes and dislikes to enable them to make decisions for them

# data[].attributes.subject
ACPs to understand pt background, likes and dislikes to enable them to make decisions for them

# data[].attributes.headline
Appropriate custom seating. Standing program - levels of arousal and awareness at their highest in standing.  

# data[].attributes.subject
Appropriate custom seating. Standing program - levels of arousal and awareness at their highest in standing.  

# data[].attributes.headline
Need for behavioural assessment e.g. CRS-r/WHIM/SMART from appropriate team members

# data[].attributes.subject
Need for behavioural assessment e.g. CRS-r/WHIM/SMART from appropriate team members

# data[].attributes.headline
Patients with or without tracheostomy are at risk of retained secretions and may need suction and/or respiratory physio input

# data[].attributes.subject
Patients with or without tracheostomy are at risk of retained secretions and may need suction and/or respiratory physio input