Severe Brain Injury and Coma

Severe brain injury occurs when a prolonged unconscious state or coma lasts days, weeks, or months. Severe brain injury is further categorized into subgroups with separate features. These subgroups of Severe Brain Injury are discussed below:

• Coma
• Vegetative State
• Persistent Vegetative State
• Minimally Responsive State
• Akinetic Mutism
• Locked-in Syndrome

COMA

When persons experience a brain injury, they can become unconscious. When the unconscious state is prolonged, it is termed a “coma”. Coma is defined as a state of unconsciousness from which the individual cannot be awakened, in which the individual responds minimally or not at all to stimuli, and initiates no voluntary activities.

• A coma is a continued unconscious state that can occur as part of the natural recovery for a person who has experienced a severe brain injury.
• While in a coma, a person can continue to heal and progress through different states of consciousness.
• Persons who sustain a severe brain injury and experience coma can make significant improvements, but are often left with permanent physical, cognitive, or behavioral impairments.
• A coma can last days, weeks, months, or indefinitely. The length of a coma cannot be accurately predicted or known.
• Physicians may not be able to state how long a person will be in a coma or what the person will be like when they come out of the coma. There is no “treatment” physicians can use to “make” a person “come out of” a coma. Likewise, there is no test physicians can use to “predict” when a person will come out of a coma or what a person’s recovery will be like.
• If the person with a brain injury remains in what seems like a comatose state, and there is no clear cut reason for this, it is imperative to get a good evaluation! The evaluation is to differentiate someone who is truly not responding at all to the environment, and someone who is responding in some manner.

Appearance

• Persons in a coma may appear to be “asleep” because they cannot be awakened or alerted.
• While in a deep coma, a person may not move at all, even to painful stimuli. The person may be unable to produce any voluntary actions or meaningful responses.
• Persons in a coma can show various levels of non-purposeful movements. The person may respond minimally or not at all to stimuli.
• A person in a coma will not be able to talk to you.
• Talk to the person in your regular tone a voice with the assumption that the person can understand what you are saying and discussing while the person is nearby. Some people who have emerged from a coma report remembering the conversations of others.