A Scoping Review Examining Rehabilitation Practice for Individuals Within Disorders of Consciousness

Abstract

Background

Disorders of consciousness (DoC)—including coma, unresponsive wakefulness syndrome, and minimally conscious state—may occur following severe traumatic brain injury (TBI). Occupational therapists (OTs), physical therapists (PTs), and speech-language pathologists (SLPs) play essential roles in recovery; however, discipline-specific evidence to guide assessment and intervention remains limited.

Objective

To map existing evidence related to OT, PT, and SLP interventions aimed at improving arousal and supporting emergence in adults with DoC following TBI.

Methods

Guided by the Arksey and O’Malley framework and a pre-published protocol, ten databases, PEDro, and gray literature were searched. Eligible studies included adults with TBI-related DoC and reported OT-, PT-, or SLP-led interventions targeting arousal or emergence outcomes. Data extraction was completed independently by two reviewers, with third-party verification.

Results

Of 54,832 records screened, 77 studies met inclusion criteria. PT-focused interventions accounted for 46.8% (n = 36) of studies, OT for 32.5% (n = 25), and SLP for 14.3% (n = 11); 32.5% (n = 25) addressed all three disciplines. Sensory stimulation was the most common intervention, followed by verticalization approaches. The Coma Recovery Scale–Revised was the most frequently used outcome measure.

Conclusions

Evidence supports individualized sensory stimulation and early mobilization to promote arousal and emergence; however, interventions targeting DoC have changed little over 55 years. Substantial gaps remain, particularly for self-care and SLP-specific interventions, highlighting the need for stronger discipline-specific research and standardized reporting. The trends described in this scoping review demonstrate areas where evidence is limited or only attributed to one discipline, which is important for guiding future research priorities.