COMA: A Treatable Symptom of Brain Injury

Evidence is clear that if vigorous medical treatment of the early phases of coma - in the first two to three weeks - is combined with a course of intense multisensory stimulation and intense physical activity over a long enough period of time (months, not weeks), the majority of individuals surviving the first week will recover and few will progress into the prolonged phase of coma, or persistent vegetative state, or coma vigil (which all really mean the same thing). The only special requirement in this early phase of management is a careful adaptation of the program to avoid increasing and already elevated intracranial pressure and to protect other injuries in victims of multiple trauma. The difficulty in implementing an early program with significant family involvement relates to the need to educate care providers in the benefits of family involvement and the most important ultimate benefits to the patient. In those institutions where such benefits have become clear, there are no difficulties encountered in permitting family participation in the patient care and in initiating an early program of intense multisensory stimulation and intense physical activity with happy results.

Individuals who have remained in coma for more than three months despite good early medical care, but without the benefit of a prolonged intense course of therapy are said to have a less than 1% chance of recovery. With an I.C.R.I. program, the rate jumps to 35 % or over one- third of all individuals treated. In addition, over 92% have been aroused from the state of coma.

Unfortunately, it is impossible to determine for any one individual what the outcome will be and though all individuals on program have an excellent chance of coming out of coma, it is impossible to predict which ones will recover to independent activity. A major problem remains with respect to those who are no longer in a coma, but who have not reached independent functions and who appear to have plateaued or have leveled off in a state of relative or complete dependence. The staff of the International Coma Recovery Institute long felt that these individuals would benefit from the expertise of rehabilitationists around the country. Unfortunately, rehabilitation centers have been caught by surprise with a population of patients whose progress is painfully slow and who do not fit into the patterns of their customary patients. As a result they have not been able to deal with the problem. In recent years, cognitive therapists have attempted to meet the needs of the more advanced patients in an effort to help them cross the very last bridge between dependent and independent activity. No one has been able to address the problems of all the others. Should these individuals and their families learn to live with permanent handicaps? Or, can they expect further progress in the future and ultimately look forward to the same recovery as the one-third who have achieved independence?

The International Coma Recovery Institute has always stated that as long as progress is observed, even if slow, there is room for more progress, and that the potential for recovery is huge. The staff of the Institute will continue to explore ways to improve recovery and, if possible, to accelerate recovery in the hope that one day all individuals aroused from coma will achieve independent activity.

Mihai D. Dimancescu, M.D.