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Helpful (and Hopeful!) Facts About Coma After Brain Injury

Having a loved one fall into a coma after brain injury is one of the most frightening things that can happen to you.

To help you through this difficult time, this article is here to explain what a coma means for brain injury patients and their families. We’ll also look at what sorts of treatment are available to people in comas.

While we do not want to encourage any false sense of hope, you should not give up on seeing your loved one wake up again just because they are in a coma.

With that said, here is some helpful information concerning comas after brain injury.

Coma After Brain Injury: Definition and Stages

To understand what a coma is, we need to understand the two components necessary for consciousness: wakefulness and awareness.

Wakefulness involves basic reflexes such as opening the eyes or swallowing, but no higher cognitive functions.

Awareness, as the name implies, means you are aware of your surroundings and can respond meaningfully to them.

A fully conscious person is both awake and aware.

This means a person can be awake without having knowledge of what is around them, in which case doctors still consider them unconscious.

In fact, being awake but not aware is one of the four stages of consciousness that a person usually passes through as they recover from a coma after brain injury.

We’ll discuss each stage in more detail below.

Stage 1: Coma

coma after brain injury

A coma is the deepest state of unconsciousness.

While in a coma, a person is unresponsive and cannot wake up, even when stimulated.

In nearly every coma, no matter what triggered it, the same event occurs: The brain swells, pushes up against the skull, and damages the Reticular Activating System, (RAS) the part of the brain stem that controls arousal from sleep.

The defining characteristics of a coma are:

  • No eye opening
  • Lack of speech or other forms of communication
  • No purposeful movement

An actual coma rarely lasts over four weeks. Instead, most patients unconscious for long periods have progressed to the next stage of consciousness.

Doctors call this the vegetative state.

Stage 2: The Vegetative State

the vegetative state looks a lot like a coma after brain injury, but it is in fact quite different.

If a person has eye movement but no other signs of consciousness, then they have most likely entered a vegetative state.

In the vegetative state, a person is awake but not aware. Their eyes can open and close, they can even react to loud noises, but these are not signs of true consciousness.

Instead, these actions are caused by autonomic responses of the brain that have healed themselves enough to let the person wake up but not regain full consciousness.

Vegetative states can endure for months, even years, before the patient regains consciousness.

Once the patient starts to communicate, they enter the next phase: the minimally conscious state.

Stage 3: Minimally Conscious State

minimally conscious state is one step away from fully waking up from a coma after brain injury

As the person recovers, they may regain a reduced sense of awareness of the world around them.

This means they are no longer in a vegetative state; instead, they are minimally conscious.

A minimally conscious person can follow instructions most of the time, but there will be times when they cannot.

Once the patient can consistently respond to instructions and communicate, they have entered the last phase of coma recovery.

Stage 4: Post-Traumatic Amnesia (Delirium)

post-traumatic amnesia is a normal part of recovering from coma after brain injury

After the patient emerges from their coma, they will experience post-traumatic amnesia.

In this state, a person has no memory of where they are or how they got there, and they have no continuous memory of day-to-day events. They usually will not recognize family members right away.

Sometimes the person will exhibit violent or aggressive behavior. As distressing as this is to witness, it is actually a good sign. It means their brain is adjusting to being more fully conscious.

Virtually every coma patient who reaches this state will make a functional recovery.

Patients who transition from a vegetative state to minimal consciousness within eight weeks are the most likely to reach this state and regain higher functions.

Once the amnesia passes, there may still be residual cognitive problems, but you can treat these through a combination of cognitive exercises and a proper brain injury diet.

It’s important to note that a person’s progression between the four stages is not always linear. Recovery can cease at any of these stages, and sometimes the person will skip directly from a coma to post-traumatic amnesia.

Factors that Affect Coma Recovery

These are the factors that affect recovery from coma after brain injury

Doctors will consider a variety of factors when assessing a coma’s severity.

These elements include the duration of coma and physical signs.

The less severe the coma, the easier a person’s recovery will be.

1. Length of Coma

How long a coma lasts will affect the likeliness of someone regaining full consciousness.

A person in a persistent vegetative state can regain awareness as late as 12 months after injury.

Beyond that, the odds of recovery become much lower. In general, the shorter the coma lasts, the better the chances of making a full recovery.

2. Neurological Symptoms

Certain symptoms after a brain injury can help predict recovery from a coma. If brain stem reflexes remain present, for example, the chance of recovery is higher than if these responses are absent.

Another reflex doctors will check for is the pupillary light response. If bright light causes the pupil to shrink, that is another strong sign that the person may recover.

With that said, people who are missing these reflexes early after their injury have also regained consciousness. So just because a person does not immediately show promising signs does not mean they will never recover.

Treatment for Coma After Brain Injury

surgical procedure for coma after TBI

Doctors mainly address comas through surgery to remove secondary brain injuries.

Examples of secondary injuries are hematomas that cause a buildup of pressure inside the skull.

Sometimes, relieving the pressure in the brain is enough to wake a person from their coma. If this happens, these patients have a fantastic chance of making a full recovery!

If the person does not wake up after their surgery, some drugs can help reduce brain swelling. Many times that alone is enough to wake someone up.

Unfortunately, no other available treatments can rouse a person out of a coma. The only thing you can do is wait and hope for the best.

Advice for Interacting with a Loved One in a Coma After Brain Injury

Best ways to interact with a loved one in a coma after TBI

Even though they can’t respond, try to talk to your loved one as normally as possible.

Not only will it let you stay more connected to them, but it might even help the person recover.

One study found that familiar sounds, such as a loved one’s voice, improved responsiveness in people in comas.

And many patients who recovered from their comas reported that they heard what people in their room were saying.

Physical touch, such as massaging the hands and face, can help as well, though you will want to avoid overstimulating them.

Final Thoughts on Coma After Brain Injury

While it’s impossible to force someone out of a coma, you should never despair. Even if it’s been several months, there is always hope they will wake up.

And when they do, they will need your help to make a full recovery.

After a person exits a coma and regains consciousness, physical therapy exercises for brain injury and other cognitive rehabilitation exercises will be crucial in their recovery.

These activities are great ways to engage neuroplasticity and help their brain start healing.

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