Date Completed
Spring 2026
Abstract
Patients with disorders of consciousness (DoC) following critical illness often experience prolonged hospitalization, delayed functional recovery, and limited access to early rehabilitation services. In acute care settings, occupational therapy (OT) plays a critical role in sensory stimulation, positioning, caregiver education, and the promotion of arousal and participation; however, interventions are often delayed or inconsistently implemented. A retrospective review of patient data at Concord Hospital identified low rates of early OT involvement among mechanically ventilated patients with OT orders, highlighting a gap in standardized rehabilitation practices for this medically complex population. The purpose of this doctoral capstone project was to develop an evidence-based OT intervention protocol to support earlier, more consistent rehabilitation for patients with DoC in the acute care environment. Project objectives included evaluating current service delivery trends, reviewing the existing literature on DoC and early mobilization, collaborating with stakeholders, and creating practical clinical resources to guide occupational therapy practitioners. This project utilized retrospective chart review, literature synthesis, staff collaboration, and departmental education to inform protocol development. Clinical outcome data from mechanically ventilated patients were analyzed to identify patterns in OT referral timing and service utilization. Findings were integrated with current evidence and site-specific needs to create a comprehensive OT protocol and educational toolkit for implementation within the rehabilitation department. Results demonstrated that although a majority of eligible patients eventually received OT services, only a small portion received intervention within the early stages of hospitalization, suggesting missed opportunities for early sensory-based and functional rehabilitation. In response, a structured protocol was developed outlining patient identification criteria, intervention recommendations, progression guidelines, and interdisciplinary considerations to improve consistency of care. This capstone project addresses an important clinical gap in acute care rehabilitation by promoting earlier OT engagement for patients with DoC. Implementation of a standardized protocol can improve therapist confidence, enhance interdisciplinary collaboration, and support better patient outcomes through timely, intentional occupational therapy intervention.
Document Type
Capstone
First Advisor
John Wilcox
Second Advisor
Lisa Owen
Third Advisor
Lesley Herold
College or School
CHHS
Department or Program
Department of Occupational Therapy
Recommended Citation
Brian, Jessie D., "Bridging Evidence to Practice: Development of an Evidence- Based Occupational Therapy Protocol for Early Rehabilitation of Adults with Disorders of Consciousness" (2026). OTD Capstones. 5.
https://scholars.unh.edu/otd_capstones/5