Following severe traumatic brain injury (TBI), many patients experience coma — an unresponsive state lacking wakefulness or awareness. Coma rarely lasts more than two weeks, and emergence involves passing through a state of wakefulness without awareness of self or environment. Patients that linger in these Disorders of Consciousness (DoC) undergo clinical assessments of awareness for diagnosis into Unresponsive Wakefulness Syndrome (no awareness, also called vegetative state) or Minimally Conscious State (periodic increases in awareness). These diagnoses are notoriously inaccurate, offering little prognostic value. Recovery of awareness is unpredictable, returning within weeks, years, or never. This leaves patients’ families with difficult decisions and little information on which to base them. Clinical studies have made significant advancements, but remain encumbered by high variability, limited data output, and a lack of necessary controls. Herein we discuss the clear and present need to establish a preclinical model of TBI-induced DoC, the significant challenges involved, and how such a model can be applied to support DoC research.

严重创伤性脑损伤 (TBI) 后，许多患者会经历昏迷——一种缺乏清醒或意识的反应迟钝的状态。昏迷很少持续超过两周，苏醒意味着经历一种对自我或环境没有意识的清醒状态。陷入这些意识障碍 (DoC) 的患者接受临床意识评估，以诊断无反应觉醒综合症（没有意识，也称为植物人状态）或最低意识状态（意识周期性增强）。众所周知，这些诊断不准确，几乎没有什么预后价值。意识的恢复是不可预测的，可能会在几周内、几年内恢复，或者永远不会恢复。这使得患者家属难以做出决定，而且几乎没有什么信息可以作为他们做出决定的依据。临床研究已经取得了重大进展，但仍然受到高变异性、有限的数据输出和缺乏必要的控制的阻碍。在此，我们讨论了建立 TBI 诱导的 DoC 临床前模型的明确且当前的需求、所涉及的重大挑战，以及如何应用这样的模型来支持 DoC 研究。