ArticlePloS one2022
"Fluctuation is the norm": Rehabilitation practitioner perspectives on ambiguity and uncertainty in their work with persons in disordered states of consciousness after traumatic brain injury.
Article in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed, 20 citations in OpenAlex.
- Factors influencing clinical decision-making in inpatient rehabilitation: A scoping review.Clinical rehabilitation · 2026Article
- Updates in Management of Acute Disorders of Consciousness After Traumatic Injury.Brain sciences · 2026Review
- Disorders of consciousness diagnosis, interventions, and prognostication for the intensivist: Report of the 2025 ISICEM roundtable.Intensive care medicine · 2026Review
- Developing a data visualization tool for adults with disorders of consciousness: Qualitative analysis of user perspectives.Learning health systems · 2025Article
- Behavioral Fluctuation in Disorders of Consciousness: A Retrospective Analysis.Archives of physical medicine and rehabilitation · 2025Observational
- Navigating uncertainty in low back pain care through an ethic of openness: Learnings from a post-critical analysis.Health (London, England : 1997) · 2025Article
- Characterization of responders to transcranial direct current stimulation in disorders of consciousness: A retrospective study of 8 clinical trials.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025Article
- Exploring professional reasoning in occupational therapy: A scoping review of recent research.The British journal of occupational therapy · 2025Review
- Altered Mental Status at the Extreme: Behavioral Evaluation of Disorders of Consciousness.Seminars in neurology · 2024Review
- Cognitive Motor Dissociation in Disorders of Consciousness.The New England journal of medicine · 2024Article
- A New Process Model for Relationship-Centred Shared Decision-Making in Physical Medicine and Rehabilitation Settings.Health expectations : an international journal of public participation in health care and health policy · 2024Article
- Interpreting Change in Disorders of Consciousness Using the Coma Recovery Scale-Revised.Journal of neurotrauma · 2024Article
- Exploring bispectral index as an alternative to polysomnography for long-term sleep monitoring in disorders of consciousness.Frontiers in neurology · 2024Article
- Feasibility and Validity of the Coma Recovery Scale-Revised for Accelerated Standardized Testing: A Practical Assessment Tool for Detecting Consciousness in the Intensive Care Unit.Annals of neurology · 2023Article
Corrections and comments
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Authors and funding
6 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The purpose of this study is to describe the clinical lifeworld of rehabilitation practitioners who work with patients in disordered states of consciousness (DoC) after severe traumatic brain injury (TBI). We interviewed 21 practitioners using narrative interviewing methods from two specialty health systems that admit patients in DoC to inpatient rehabilitation. The overarching theme arising from the interview data is "Experiencing ambiguity and uncertainty in clinical reasoning about consciousness" when treating persons in DoC. We describe practitioners' practices of looking for consistency, making sense of ambiguous and hard to explain patient responses, and using trial and error or "tinkering" to care for patients. Due to scientific uncertainty about diagnosis and prognosis in DoC and ambiguity about interpretation of patient responses, working in the field of DoC disrupts the canonical meaning-making processes that practitioners have been trained in. Studying the lifeworld of rehabilitation practitioners through their story-making and story-telling uncovers taken-for-granted assumptions and normative structures that may exist in rehabilitation medical and scientific culture, including practitioner training. We are interested in understanding these canonical breaches in order to make visible how practitioners make meaning while treating patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.