Brain Injury and Disorders of Consciousness


Each year, an estimated 2.5 million people in the U.S. sustain a traumatic brain injury (TBI). Unfortunately, Alaska has one of the highest TBI rates in the nation. Every year, more than 800 Alaskans are injured seriously enough to be hospitalized or die from a TBI and about 3000 more are released from the emergency rooms with what is considered a mild TBI. What happens following the injury or illness can make a critical difference in the recovery and outcome.


An injury to the brain can occur as a result of trauma, a tumor or a disease. Each brain injury survivor has a unique set of medical, cognitive and physical needs. Brain injuries often result in physical disabilities as well as significant changes in language, memory, thinking, behavior and personality.

A disorder of consciousness (DOC) is a condition of altered consciousness in which patients have severely impaired levels of awareness and wakefulness. It is often seen following a severe traumatic brain injury, an anoxic brain injury or stroke. Examples include patients are in coma, a vegetative state, or a minimally conscious state.

It remains difficult to predict how well someone who has a brain injury will recover. Prognosis often depends upon factors other than initial severity, including prompt diagnosis, early intervention and treatment, prior level of function, family support, aggressive rehabilitation therapy, and supportive therapy to prevent infection,  malnutrition and other factors that can prevent a patient from a speedy recovery. The Glasgow Coma Scale maybe used in the emergency room to determine the initial severity of the brain injury. Later comprehensive assessment by the team may include standardize tools such as the JFK Coma Recovery Scale (Revised), the Rancho Los Amigos Scale of Cognitive Functioning (Revised), the Disability Rating Scale and the Cognitive Linguist Quick Test. As a patient improves to a higher level of physical and cognitive functions, there is a variety of formalized tools used to track a patient’s recovery.

We know that families consider the news of a family member being in a coma offer to be devastating and overwhelming. At St. Elias, we feel that incorporating the family into the care team often helps them to adjust to the suddenness of the illness or injury and also can be therapeutic for them and the patient who is recovering. Family members are encouraged to observe, participate and attend educational sessions regarding the patient’s therapy.


The goal of treatment at St. Elias is to help the patient function as independently as possible as a bridge to the next step in the rehabilitation. By including the family as part of the care team, we can ensure that their loved one’s therapy is personalized and meets their unique needs. This individualized approach helps the patient as well as the family. St. Elias provides specialized education and support for patients and families following brain injury. Additionally, we provide creative early mobilization, sensory stimulation, and cognitive and linguistic stimulation to patients with low levels of consciousness. The comprehensive team approach is beneficial to both the patient and family.

The St. Elias Team

The Interdisciplinary Team at St. Elias is committed to expert care to meet the unique needs of patients with brain injuries. Upon admission, the team members will meet with the family to coordinate a plan of care that will be implemented during the patient’s hospital stay. At this point, discharge planners also meet with the family to help discuss the patient’s plan for discharge and to help the family prepare for the patient’s potential home arrival.

TBI experienced physicians

  • Highly specialized nurses
  • Occupational Therapists
  • Speech-Language Pathologists
  • Pharmacists
  • Physical Therapists
  • Registered Dietitians
  • Discharge Planners
  • Social Workers
  • Spiritual Care
  • Respiratory Therapists

St. Elias has many success stories with our traumatic brain injury patients. Most patient rooms are private and have very large windows. While the hospital is one of the most beautiful in Alaska, it is the staff that makes the TBI program at St. Elias so unique. We have a very small ratio of staff to patients. It is rewarding for us that so many of our patients and their families choose to stay in touch w