Conditions & Treatments

Disorders of Consciousness (DOC) Program


The Spaulding Rehabilitation Network Disorders of Consciousness (DOC) Program provides a continuum of care specifically designed for individuals with severe acquired brain injury who have yet to regain the ability to follow instructions, communicate reliably or perform basic self-care activities.

The DOC Program is organized into three levels of care, each designed to address specific clinical needs associated with a different phase of recovery.

  • Level I focuses on individuals who have not yet recovered consciousness
  • Level II – focuses on those who have recovered consciousness but are unable to communicate reliably
  • Level III focuses on individuals who can communicate but remain confused and require assistance for self-care activities 

Our program objectives include:

  • Determine level of consciousness using evidence-based assessment protocols.
  • Identify physical and cognitive barriers preventing effective communication and environmental control.
  • Establish prognosis and monitor rate of recovery.
  • Delineate long-term care needs.
  • Implement data-driven treatment protocols.
  • Prevent secondary complications (e.g., contractures, skin breakdown, and infection).
  • Maximize arousal, alertness and response consistency through the use of medications and assistive technologies to promote recovery of communication.
  • Maximize capacity to independently perform self-care activities.
  • Provide education, support and informational resources for patients, family and other supportive personnel.
  • Provide opportunities for participation in cutting-edge research on novel evaluation and treatment techniques that may not yet be available in clinical settings.

Approach To Care

Increasing evidence from carefully designed research studies indicates that individuals with DOC recover over a longer period of time than previously thought, and many regain the ability to function independently. For those who survive severe brain injury, there is a marked variability in medical, cognitive and physical needs. Spaulding provides a specialized 8-week rehabilitation program for individuals with DOC to help ensure that treatment services are appropriately matched to the current level of function and immediate care needs. The overarching objective of the program is to optimize functional recovery through the application of evidence-based assessment and treatment procedures.

Specialized neuromonitoring and clinical intervention programs are located at Spaulding Rehabilitation Hospital Boston (SRH) and Spaulding Hospital Cambridge (SHC). SHC provides specialized rehabilitation services for patients who continue to require complex medical management. Assessment strategies and rehabilitation goals are developed and modified based on systematic, standardized protocols implemented throughout the course of the program. Progress is monitored weekly using validated outcome measures that address cognitive, linguistic, physical and functional status. A comprehensive, data-based Patient Profile is generated for all program participants that charts progress toward treatment goals and guides clinical decision-making. Continuation of care following discharge is available through our preferred provider relationship with select skilled nursing facilities.

Leadership and Expertise

Patients admitted to our DOC Program are evaluated and treated by an interdisciplinary team composed of specialists in the following disciplines: physiatry, neurology, internal medicine, nursing, neuropsychology, behavioral psychology, speech language pathology, physical therapy, occupational therapy, recreational therapy, social work, case management and neurotrauma outreach. On-site medical consultation services are available through neurology, pulmonology, infectious disease and psychiatry.

All the clinicians on our interdisciplinary teams have specialized education and training in assessment and treatment procedures designed specifically for individuals with DOC.

The Disorders of Consciousness Program is led by Joseph Giacino, PhD, internationally recognized for applying an evidenced based approach to the assessment and treatment of patients with disorders of consciousness. Dr. Giacino works to assess and develop interventions designed for persons with severe acquired brain injuries. His work in assessment has focused on developing neurobehavioral and functional neuroimaging methodologies to characterize the pathophysiologic, neurocognitive, neurobehavioral and functional sequelae of severe acquired brain injuries.


Related Services

Find a Service

Please call for more information or to make a referral

Inpatient: 1.617.952.5350

Outpatient: 1.888.SRN.4330

Best Hospital 2018/2019

Spaulding is ranked 2nd in the country among rehabilitation hospitals by US News & World Report.

Learn More