In this video, Joseph Giacino, PhD, explains why integrated care across the ICU and rehabilitation settings is essential for improving outcomes for people with disorders of consciousness.
Dr. Giacino discusses how fragmented, siloed healthcare systems can fuel pessimism and nihilism about recovery—especially when providers only see patients in the acute phase and never witness long‑term improvement. He explains how Traumatic Brain Injury Model Systems address this gap by creating strong communication between acute care and rehabilitation teams, allowing clinicians to understand recovery across days, months, and years. The video also highlights the importance of engaging patients and families as partners and expanding research support to counter outdated assumptions about severe brain injury and consciousness recovery.
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How does integrated care improve outcomes for people in disorders of consciousness?
With Joseph Giacino, PhD
Lower Third
Joseph Giacino,PhD
Project Director
Spaulding-Harvard Traumatic Brain Injury Model System
I think the thing that's most frustrating to me having been in the field for 35 years is the fact that this nihilism, pessimism, if you will, continues to persist. And it's not just in the uneducated, the public who we don't expect to be educated about this, but also among providers. If you are operating out of the ICU and you never see or do follow up on patients who leave your ICU, potentially still unconscious, you don't know that one in five of those people can come prancing back to say hello to you in a year and tell you about the work they're doing. That's not placing blame. It's that we continue to be fairly siloed in the way we work — the acute care hospital, the rehabilitation hospital — unless they have made efforts to integrate.
Our system has done that. We have very good communication between the ICU acute care hospitals and our inpatient rehab hospital. That's what a TBI model system requires, by the way. That's essential because we can exchange information bilaterally. So I have a good understanding of what's happening in those first days. My colleagues in the ICU have a good understanding of what's happening weeks, months, years down the line so we can tell a more educated, longer story. But there's many places in the country that simply aren't built that way.
You can ask the question of why do we have this continued information dearth? I think that that's partly driven by the fact that there's not a lot of funding support for research in this population. How much of that is driven by the pessimism that exists? Should we put our money in a different place where people have a much greater chance of getting back to work? Maybe? I don't know that answer. But I think it's much harder to get research funding for patients who have severe brain injury and disorders of consciousness than it is, for example, mild traumatic brain injury.
Our best approaches to dealing with this nihilism, pessimism is to engage the primary stakeholders, the people who have had severe brain injury and their families, as our partners.
Produced by the Model Systems Knowledge Translation Center (MSKTC), this story is part of the Recovering from Disorders of Consciousness Hot Topic Module. The content of this video is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Traumatic Brain Injury Model System (TBIMS) centers, funded by the National Institute on Disability, Independent Living, and Rehabilitation Research, as well as experts from the Polytrauma Rehabilitation Centers (PRCs), with funding from the U.S. Department of Veterans Affairs. The content of the video has also been reviewed by individuals with TBI and/or their family members.
Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider about specific medical concerns or treatment. The contents of this video were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPKT0009). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this video do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.
Copyright © 2026 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.
About the author: Model Systems Knowledge Translation Center (MSKTC)
The Model Systems Knowledge Translation Center (MSKTC) is a national center operated by the American Institutes for Research® (AIR®) The MSKTC collaborates with Model System researchers to translate health information into easy to understand language and formats for people living with spinal cord injury (SCI), traumatic brain injury (TBI), and burn injury and those who support them.
