Implementing best practice neuro-behavioural assessment for patients with disorders of consciousness post-acquired brain injury

Mrs Emma Hays1, Miss Lauren Davies1

1Melbourne Health, Parkville, Australia

Patients frequently present with disorders of consciousness (DOC) post acquired brain injury (ABI). The neuro-behavioural assessment of DOC by speech pathology (SP) and occupational therapy (OT) staff at a tertiary trauma centre was perceived to be inconsistent and without a strong evidence base.

Optimise the neuro-behavioural assessment of patients with a DOC following an ABI.

A literature review, tertiary trauma centre benchmarking and a staff survey were conducted to identify gaps between current and recommended practice. This data informed the development of a clinical guideline for SP and OT use. Following a six month pilot of guideline usage, staff knowledge and practice was evaluated via file audit and survey.

Baseline survey data showed over 90% of staff were unfamiliar with best practice assessment of DOC and 96% of staff requested the development of a clinical guideline. Minimal high level evidence exists to guide best practice neuro-behavioural assessment, however the JFK Coma Recovery Scale – Revised is the most valid and reliable tool available. Post-project survey data showed 79% of staff agree that they can now provide consistent and evidence-based assessment of DOC using the clinical guideline. A file audit conducted six months following guideline introduction showed 100% compliance with assessment tool choice and 90% compliance with recommended frequency of assessment.

Implementation of a clinical guideline for SP and OT use with patients presenting with a DOC has enhanced the delivery of best practice and consistent neuro-behavioural assessment.


Emma is a Grade 3 Occupational Therapist working within the acute Trauma and Neurosurgery units at The Royal Melbourne Hospital. Emma is passionate about working with the traumatic brain injury population and providing person-centred, holistic care in the acute setting. Emma has experience working across a number of major tertiary trauma centres both here in Australia and the UK and regularly sees individuals presenting with a disorder of consciousness as part of her clinical caseload.

Lauren is a Grade 2 Speech Pathologist working within the acute trauma unit at The Royal Melbourne Hospital. She has worked for over eight years in the acute setting and has over four years of experience working with trauma patients presenting with disorders of consciousness at RMH.

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