A Prolonged Disorder of Consciousness (PDOC) is a condition resulting from severe brain injury, involving complex physical, cognitive and communication impairments.

At STEPS Rehabilitation, an interdisciplinary approach is used to analyse and evaluate their presentation and behavioural responses to a variety of stimulus through structured observational assessments, objective setting and monitoring. 

The interdisciplinary team support with the management of secondary complications with clients in PDOC and optimising the environment and conditions which could impact on responses. A structured timetable is provided which consists of a range of care and therapy interventions, activities and appropriate rest periods. 

Examples of interventions provided at STEPS Rehabilitation include;

  • Medical management and review 
  • Personal care assessments
  • 24 hour postural assessments and programmes
  • Spasticity management
  • Sensory stimulation programmes
  • Communication assessments 
  • Bowel and bladder management 
  • Nutrition management
  • Swallow assessments and management
  • Tracheostomy management 
  • Formal structured observational assessments and analysis 
  • Equipment provision and recommendations
  • Long term care planning

At STEPS Rehabilitation, we understand the importance of the clients family and friends involvement in their care and intervention, promoting an environment to support this. 

Our Transition of Care team works alongside the interdisciplinary team to facilitate a seamless transition into community living.

Formal structured observational assessments and analysis as recommended within the RCP Prolonged Disorder of consciousness clinical guidelines, are used to monitor behavioural recovery, outcomes and assess treatment effectiveness.  

These include the Coma Recovery Scale-Revised (CRS-R), Wessex Head Injury Matrix (WHIM) and the Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC). 

  • The MATADOC is a standardised diagnostic music-based measure validated for use with adults with prolonged disorders of consciousness (PDOC). The MATADOC provides a rigorous assessment and evaluation for use with people whose awareness is difficult to assess clinically due to complex clinical presentations that compromise motor, cognitive and communication functioning. 
  • The MATADOC must be carried out by a registered Music Therapist who is also MATADOC trained. 
  • The MATADOC should be cross-referenced with the SMART, WHIM and CRS-R to gain an accurate representation of patient’s awareness. Multi-disciplinary input into these assessments is paramount. 
  • Purpose of the MATADOC: 
  • It contributes to the assessment of the patient’s current responsiveness, identifying areas of strength and deficit to formulate appropriate goals and tailor-made music-based interventions. 
  • It contributes to interdisciplinary diagnosis of awareness state. (Note: STEPS is not a diagnostic facility so the MATADOC amongst other assessments would not lead to an official diagnosis.) 
  • Repeated measures using the MATADOC over time can demonstrate change in a patient’s status contributing to ongoing evaluation. 
  • It provides a structured behavioural and evaluation tool for measuring behavioural responsiveness during musical stimulation. Behaviours are rated in response to music-based procedures outlined in a defined protocol. A detailed record of behaviours are made within a musical context, thereby facilitating demonstratable links between musical stimulus and resultant behaviours. Higher lever analysis and interpretations can be made from these recordings. 
  • Assessment Process: 
  • FOUR formal assessment sessions are carried out over a 10-day period with pre & post session observations. It diagnoses vegetive state, minimally conscious state or emerging state. 
  • The assessment comprises THREE parts: 
  • Section 1 - assesses Musical Stimuli, Auditory Stimuli, Arousal Levels, Visual stimuli and Verbal commands (for motor response). This principle assessment category carries diagnostic utility. 
  • Section 2 – assesses musical parameters and behavioural responses. (Responses to musical elements: pulse/rhythm, melody/pitch, timbre, dynamics, phrasing/anticipation/silence, tempo, mood of music. Behavioural responses to music: changes in facial gesture, eye direction/eye contact, physical movement, vocalisation, respiration, arousal.) This assessment category informs treatment planning, specifically for music therapy. 
  • Section 3 – assesses specific clinical information (Vocalisation, Non-verbal Communication, Choice-making, Motor Skills, Attention to task, Intentional Behaviour and Emotional Response). This assessment category informs goal setting and the evaluation of responses for global treatment planning.