title: The natural history of continuing improvement in an individual after a long period of impaired consciousness: The story of I.J.
abstract: OBJECTIVE
  Recovery of consciousness and recovery of function among patients with prolonged disorders of consciousness rarely occur. Those patients who do regain consciousness typically remain with severe disability. The aim of this retrospective study is to suggest that continuing improvement is possible in a survivor of catastrophic brain injury after being in a prolonged state of disordered consciousness.
  
  
  METHODS
  This retrospective single case study follows the progress of a 29 year old man, I.J, who sustained a severe traumatic brain injury following an assault in October 2011. He was in a vegetative state for 15 months and in a minimally conscious state for a further 4 months. This was followed by a slow and steady recovery of motor and cognitive functions. At 3 years post-injury I.J is considered to be moderately disabled. He is now living in the community with continuing outpatient support. On the disability rating scale his level of functioning is rated as mildly dependent.
  
  
  CONCLUSIONS
  This study shows that continuing recovery to a level of moderate disability is possible, even after a prolonged disorder of consciousness. Intense multi-disciplinary long-term rehabilitation and cranioplasty may be contributing factors for such an unexpected recovery.
authors.affiliation: a The Raphael Medical Centre , Kent , UK.
authors.forename: Samira Kashinath
authors.initials: SK
authors.lastname: Dhamapurkar
authors.affiliation: a The Raphael Medical Centre , Kent , UK.
authors.forename: Anita
authors.initials: A
authors.lastname: Rose
authors.affiliation: a The Raphael Medical Centre , Kent , UK.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Florschutz
authors.affiliation: a The Raphael Medical Centre , Kent , UK.|b Oliver Zangwill Centre , Cambridgeshire , UK.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000534:rehabilitation*; D003071:Cognition / Q000502:physiology; D003243:Consciousness; D003244:Consciousness Disorders / Q000534:rehabilitation*; D004185:Disability Evaluation; D006801:Humans; D008297:Male; D018458:Persistent Vegetative State / Q000503:physiopathology; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies
keywords: Vegetative state; continuing improvement; cranioplasty; hydrocephalus; long period of impaired consciousness; minimally conscious state; traumatic brain injury