Emergence from PDOC - a linguistic ethnographic study
Research type
Research Study
Full title
An exploratory linguistic ethnographic study to capture how adults emerging from a Prolonged Disorder of Consciousness (PDOC) interact in a range of natural contexts.
IRAS ID
290721
Contact name
Amy Pundole
Contact email
Sponsor organisation
The Royal Hospital for Neurodisability
Duration of Study in the UK
2 years, 2 months, 1 days
Research summary
The purpose of this project is to investigate how individuals emerging from PDOC interact in a range of natural contexts using linguistic ethnography.
Following a severe brain injury some patients are left in a PDOC, with little or no awareness of themselves or their surroundings. The current criteria to determine emergence from this state are narrow and a range of tasks and stimuli are used. Patients may find these tasks difficult due to motor, cognitive and language impairments.Researchers have found that patients are at risk of being misdiagnosed as still being in PDOC when they are not. Accurate diagnosis is vital when making complex decisions in a patient’s ‘best interests’ such as whether to continue with Clinically Assisted Nutrition and Hydration (CANH).
In a recent UK survey of current opinion and practice among clinicians experienced in assessing emergence, the majority of respondents (78.6%) reported that they worked with patients who they considered to have emerged, but who were unable to demonstrate it based on the current criteria (Pundole et al., 2020). When asked what they would do in this situation, respondents highlighted assessing the patient in functional every day contexts and involving family members.
This study uses a linguistic ethnographic framework to examine the interaction behaviours demonstrated by patients emerging from PDOC during a range of everyday activities. Three patients, who are considered to be emerging from PDOC by their treating teams, will be recruited at a specialist post-acute assessment centre. Patients will be observed and data collected during daily grooming and therapy activities with clinical staff and during a family visit or Occupational Therapy art session. Field notes, video recordings and documents will be analysed using Ethnography and Conversation Analysis.
Findings will be disseminated and used to inform national guidelines, support clinical practice and develop further research.
REC name
London - Harrow Research Ethics Committee
REC reference
21/LO/0022
Date of REC Opinion
17 Feb 2021
REC opinion
Further Information Favourable Opinion