Disorders of consciousness present some of the most difficult diagnostic and therapeutic challenges in brain rehabilitation. Within the spectrum of these disorders, diagnosis remains clinical and depends on the response to various stimuli in the environment rather than objective physiological markers. In recent years, various cases have been reported in the medical literature in which patients with such diagnoses reacted to various stimuli indirectly. Spasticity is a common sequela of brain injury and may significantly impair a patient's ability to respond to stimuli in their environment.

A case study of a patient in a state of minimal reactivity demonstrating significantly improved responses to their environment following intrathecal injection of Baclofen.

A 59-year-old man who was admitted for rehabilitation following subarachnoid hemorrhage secondary to anterior coronary artery aneurysm (ACA) requiring subsequent periventricular shunt placement. At admission, the patient presented in a vegetative state. During hospitalization, there was a temporary improvement in level of consciousness until the appearance of infection along the VPS drain necessitating removal of the shunt. Upon completion of treatment, the patient returned to our department with inconsistent, minimal reactivity on exam. Due to severe spasticity in all four limbs unresponsive to oral treatment and local injection, a one-time intrathecal injection of Baclofen was administered. Directly following treatment, the patient demonstrated decreased tone and immediate improvement in responsiveness and ultimately the production of a number of intelligible words and phrases.

In evaluating patients suffering from disorders of consciousness, it is important to recognize that limited responsiveness results not only from the impairment of information reception, processing, and response initiation, but also from tonal disturbances that may be causing difficulty in performing such movements. This case study supports previous literature demonstrating improved communication following cellophane pump implantation following severe head injury.