CBIS Section 4 Master Guide: Cognitive &
Behavioral Insights | Fully Verified 2025
DOC stands for... - ✔✔Disorders of consciousness
Number of people per year in a vegetative state - ✔✔4,200
Number of people per year with a DOC - ✔✔315,000
3 classifications for DOC - ✔✔Coma, vegetative state, MCS
Coma - ✔✔no behavioral evidence for arousal
no voluntary response to internal or external stimuli
Might see reflexes
lasts about 2-4 weeks
,Vegetative state - ✔✔complete absence of awareness for self and environment,
but there is spontaneous stimuli-induced arousal
sleep/wake cycle
eyes are open sometimes
can last months or years
MCS - ✔✔minimally conscious state; severely altered consciousness where there
isn't much behavioral evidence for awareness of self or environment
intermittent behavioral reactions
localized responses
Arousal - ✔✔involuntary responses and reflexes to external stimuli
System responsible for maintaining arousal - ✔✔RAS
,Awareness - ✔✔taking in sensory information; needed for voluntary actions;
coordinated by the cortical areas of the cerebrum
The 2 criteria to emerge from DOC - ✔✔functional communication using words or
gestures for yes and no responses
OR
functional use of 2 or more objects
Central apnea - ✔✔lack of signals from the brain to the muscles that control
breathing
Metabolic distress - ✔✔abnormal hormone responses that lead to increased
energy demands
Dystonia - ✔✔involuntary muscle contraction that causes slow, repetitive
movements or abnormal postures; extreme tone or stiffness
, Goals for medical management of DOC - ✔✔maintain physical stability in order to
participate in daily life as much as possible
prevent medical complications
provide opportunities for stimulation to the neurological system
Challenges for medical management of DOC - ✔✔Skin breakdown, respiratory
issues, bowel or bladder dysfunction, autonomic dysfunction syndrome
Skin breakdown due to DOC - ✔✔pressure sores, friction related irritation, bowel
and bladder incontinence, pressure from splints and braces
Respiratory issues from DOC - ✔✔dependence on a trach, sleep apnea
(obstructive or central), tracheal aspiration (entry of foreign matter)
Behavioral Insights | Fully Verified 2025
DOC stands for... - ✔✔Disorders of consciousness
Number of people per year in a vegetative state - ✔✔4,200
Number of people per year with a DOC - ✔✔315,000
3 classifications for DOC - ✔✔Coma, vegetative state, MCS
Coma - ✔✔no behavioral evidence for arousal
no voluntary response to internal or external stimuli
Might see reflexes
lasts about 2-4 weeks
,Vegetative state - ✔✔complete absence of awareness for self and environment,
but there is spontaneous stimuli-induced arousal
sleep/wake cycle
eyes are open sometimes
can last months or years
MCS - ✔✔minimally conscious state; severely altered consciousness where there
isn't much behavioral evidence for awareness of self or environment
intermittent behavioral reactions
localized responses
Arousal - ✔✔involuntary responses and reflexes to external stimuli
System responsible for maintaining arousal - ✔✔RAS
,Awareness - ✔✔taking in sensory information; needed for voluntary actions;
coordinated by the cortical areas of the cerebrum
The 2 criteria to emerge from DOC - ✔✔functional communication using words or
gestures for yes and no responses
OR
functional use of 2 or more objects
Central apnea - ✔✔lack of signals from the brain to the muscles that control
breathing
Metabolic distress - ✔✔abnormal hormone responses that lead to increased
energy demands
Dystonia - ✔✔involuntary muscle contraction that causes slow, repetitive
movements or abnormal postures; extreme tone or stiffness
, Goals for medical management of DOC - ✔✔maintain physical stability in order to
participate in daily life as much as possible
prevent medical complications
provide opportunities for stimulation to the neurological system
Challenges for medical management of DOC - ✔✔Skin breakdown, respiratory
issues, bowel or bladder dysfunction, autonomic dysfunction syndrome
Skin breakdown due to DOC - ✔✔pressure sores, friction related irritation, bowel
and bladder incontinence, pressure from splints and braces
Respiratory issues from DOC - ✔✔dependence on a trach, sleep apnea
(obstructive or central), tracheal aspiration (entry of foreign matter)
