Having a loved one fall into a coma after brain injury is one of the most frightening things that can happen.
To help you through this difficult time, this article is here to explain what a coma means for brain injury patients and their families. While we do not want to encourage any false sense of hope, you also should not give up on seeing your loved one wake up again.
With that said, here is some helpful information concerning comas after brain injury.
Coma After Brain Injury: Definition and Stages
A person in a coma does not show intentional response or movement. Their eyes remain closed, they cannot be awakened, and they do not obey commands.
However, sometimes people in comas will groan or move around, and can even react to pain. This can lead family members to believe their loved one is waking up, when that is not usually the case. Therefore, it is more appropriate to refer to grades or stages of comas, rather than an all-or-nothing state.
In fact, doctors typically divide comas into four stages based on the patient’s level of responsiveness. We’ll discuss each stage in more detail below:
Stage 1: Coma
A true 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 who remain unconscious for long periods have progressed to the next stage of consciousness.
Stage 2: Post-Coma Unresponsiveness
If a person has eye movement but no other signs of consciousness, then they have entered a wakeful but unconscious state known as post-coma unresponsiveness.
With this state, formerly known as a persistive vegetative state, the person has regained a normal sleep/wake cycle. 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 that have healed enough to let the person wake up but not regain full consciousness.
Post-coma states can endure for months, even years, before the patient regains consciousness. But once the patient starts to communicate, they enter the next phase: the minimally conscious state.
Stage 3: Minimally Conscious State
As the person recovers, they may regain a reduced sense of awareness of the world around them.
This means they are technically no longer in a coma; instead, they are considered minimally conscious.
A minimally conscious person can follow instructions most of the time, but there will be times when they cannot.
When the patient can consistently respond to instructions and communicate, they have entered the last phase of coma recovery.
Stage 4: Post-Traumatic Amnesia (Delirium)
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.
Virtually every coma patient who reaches this state will make a functional recovery.
In fact, patients who transition from a coma to minimal consciousness within eight weeks are the most likely to reach this state and regain higher functions.
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.
Measuring the Severity of Comas
Doctors will consider a variety of factors when assessing a coma’s severity. One of the most common tools a doctor might use is the Glasgow Coma Scale (GCS).
The Glasgow Coma Scale is a simple test that gauges the severity of a TBI and is used to predict the outcome of an injury.
The scale consists of 15 points total, with points used to measure various functions such as eye opening and verbal response. The higher the points, the higher the level of function, which means a higher likelihood of making a full recovery.
Coma Recovery Signs
Most coma patients who recover display a certain pattern of signs. These signs indicate preserved brain function.
For example, the presence of neurological reflexes is often an excellent sign of possible recovery. Some neurological signs that doctors look for in coma patients include:
- Pupillary reactivity. The doctor will shine a light on the patient’s eyes. If the pupils shrink in response, then their brain stem is intact.
- Oculocephalic response. When the person’s head is turned to the left, their eyes should turn the opposite direction, to the right.
- Gag reflex. The person should gag or cough if a cotton swab or endotracheal tube is placed down their throat.
If the patient retains these reflexes, that is an excellent sign that they will recover.
With that said, the initial absence of these reflexes does not always indicate a poor recovery. Some patients without brain stem reflexes do go on to make a functional recovery.
Advice for Interacting with Loved Ones in a Coma After Brain Injury
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. In addition, 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. But try to avoid overstimulating them.
Final Thoughts on Comas 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.
These activities are great ways to engage neuroplasticity and help their brain heal.