The term “disorder of consciousness” (DoC) describes a group of conditions that involve difficulty with awareness that includes:

A person with a DoC may or may not appear to be awake with their eyes open. Even when they appear to be awake, they may not be aware of themselves or their surroundings. They may be unable to interact with others. They may be also unable to react to things happening around them. DoC includes coma, unresponsive wakefulness syndrome (also known as the vegetative state), and the minimal conscious state.

Facts About the Vegetative and Minimally Conscious States After Severe Brain Injury 
From Model Systems Knowledge Translation Center
This factsheet describes the features of each DoC (coma, unresponsive wakefulness syndrome / vegetative state, and minimal conscious state). It also has advice on what to look for when choosing a place of care for your loved one, tips from other families, and more.

Disorders of Consciousness and Brain Injury Recovery
From Craig Hospital
This webpage was created for family caregivers of persons with DoC. It includes videos that describe the different DoC. The videos show live examples of behaviors typically seen at each level of recovery after severe TBI. There are also suggestions to help you participate in your loved one’s care.

What types of brain injuries can cause a DoC?

A DoC can be caused by severe traumatic brain injury (TBI). A TBI happens when there is a sudden blow or jolt to the head or when an object goes through the skull and brain tissue. Common causes of TBI are car accidents, falls, assaults, and sports accidents. A DoC can also be caused by other (non-traumatic) injuries that affect the brain, like strokes, tumors, heart attacks, drowning accidents, and infections.

Family Caregiver Curriculum (PDF pages 63-68)
From Traumatic Brain Injury Center of Excellence
Defense and Veterans Brain Injury Center (DVBIC)
This guide was created for family caregivers. It has helpful information for anyone who wants to learn more about the different causes and types of TBI. It also describes diffuse axonal injury, a common cause of DoC in TBI.

Brain Injury Severity
From Brain Injury Association of America
This website provides information about the types of severity of brain injury: mild, moderate, or severe. DoC occurs after a severe brain injury.

Brain Injury Overview
From Brain Injury Association of America
This resource describes the different types of brain injury that may cause a severe brain injury, resulting in DoC.

Types of Brain Injury (PDF)
From Shepherd Center

If you want to learn more about other types of brain injury, the last section of this document describes “non-traumatic” causes of brain injury that may result in a DoC.

Features of Coma

  • No eye-opening
  • Unable to follow instructions
  • No speech or other forms of communication
  • No purposeful movement

Features of Unresponsive Wakefulness Syndrome (UWS) / Vegetative State (VS)

  • Return of a sleep-wake cycle with periods of eye opening and eye closing
  • May moan or make other sounds especially when tight muscles are stretched
  • May cry or smile or make other facial expressions without apparent cause
  • May briefly move eyes toward persons or objects
  • May react to a loud sound with a startle
  • Can’t follow instructions.
  • No speech or other forms of communication
  • No purposeful movement

Please note: The medical community is transitioning from the use of the term "vegetative state" (VS) to the adoption of the term "unresponsive wakefulness syndrome" (UWS).

Features of Minimally Conscious State (MCS)

  • May follow simple instructions.
  • May indicate yes or no by talking or gesturing.
  • May speak some words or phrases that others can understand.
  • May make automatic movements. These may include scratching their head, crossing their legs, or moving their hair out of their eyes.
  • May respond to people, things, or other events by:
    • ⚬ Making sounds or gesturing
    • ⚬ Reaching for objects
    • ⚬ Trying to hold or use an object
    • ⚬ Keeping the eyes focused on people or things for a sustained period of time whether they are moving or staying still
    • ⚬ Crying, smiling, or laughing

People in the MCS can do one or more of these things, but not consistently. For example, a person may follow a simple instruction one time; another time, they may not follow any instructions at all. This may make it hard to know if a person is in the UWS/VS or the MCS. People in the MCS need a lot of care just like people in the UWS/VS.