Brain Injury: Understanding Coma

Coma is common with severe brain injuries, especially injuries that affect the arousal center in the brain stem. Understanding coma can be difficult because there are many levels of coma. In general, coma is “a lack of awareness” of one’s self and what is around one. A person in a coma can’t sense or respond to the needs of his body or his environment.

A person in a coma:
• May or may not have their eyes closed all the time.
• Cannot communicate.
• Cannot move in a purposeful way, such as following instructions like “squeeze my hand, or open your eyes.”

Because their eyes may be closed, many of us think of someone in a coma as being asleep. The difference is that you can get someone to open their eyes when the are asleep. But you can’t get someone in a coma to open their eyes. Their eyes are closed because the normal sleeping and waking pattern has been disrupted. (Sometimes the eyes are taped shut to protect them from injury and drying out.)

They cannot follow directions or communicate because their brain doesn’t process information the way it used to. It is also common for breathing and blood pressure to be affected; if so, proper care will be needed to help control breathing or blood pressure for them.

There is no set pattern of recovery from coma, but there are signs that may mean improvement (coming out of a coma). Signs of coming out of a coma include being able to keep their eyes open for longer and longer periods of time and being awakened from “sleep” easier—at first by pain (pinch), then by touch (like gently shaking of their shoulder), and finally by sound (calling their name).

Emerging From Coma and Signs of Improvement

Not everyone who has a brain injury emerges from a coma. If they do, they may follow a common pattern. Emerging from a coma is not like waking up from regular sleep.

When your loved one first starts to “wake up” from or come out of the coma, he may not be able to focus his eyes. He may or may not be able to respond to you. He may look as if he is staring off into space. Part of this is from the injury; part of it may be from medicine. Movement can be another sign of improvement. At first, movements may be random like flailing arms, then may progress to semi-purposeful (such as pulling at tubes) and possibly moving in response to instructions (“Squeeze my hand.”). The patient’s awareness of self and his surroundings increases as he improves and gets better.

Visual and auditory tracking is another sign of improvement—following sights and sounds. Tracking is when your loved one watches you as you move around the room or turns their head toward you when they see you or hear your voice.

The next stage of improvement is when your loved one begins to follow some commands intermittently and is also consistently tracking sights and sounds. Following commands intermittently means they won’t “squeeze your hand” every time you ask. As they get better, they will follow commands more regularly.

Mother of 16 y/o with TBI from skateboard fall
“When someone on television comes out of a coma they’re just fine. We thought that would happen for Sam. But when the doctors looked at the second CAT scan, they didn’t know how serious the effects of the injury would be. Now more than a month later, they still don’t.”

– Mother of a 16-year-old injured when thrown head first from a skateboard.

Comments

  1. My Friend decided to take an overdose of cocain to kill himself, almost dead he’s in a coma two days ago. He was on heroin before, but nothing of that was found in his bloodstream, just the cocain. Today doctors say he had some lines in the monitor, meaning that a tiny hope is raising for him, because his brain is responding a little. I hope he gets better with no brain damage. I’m praying

  2. My son in law had a heart attack and he fell on the ground 2 weeks back.The brain was affected and he became unconscious. Now he is opening his eyes and moving his hand..Please pray for his complete recovery

  3. Barbara Martin says:

    Oddly there is a pattern..my first brain injury was 2001.. I was in a coma for 6 days induced woke up like a 4 year old..yes there is no way of knowing what will be..and brain injuries can be cookie cutter cut outs yet outcomes can be different..I rehabbed within 2 weeks after my 8 day bleed the high level areas were limbic, corpus collosum, frontal lobes and left side..so went to JFK..intense therapy then outpatient..long process..not an easy road..literally one vocal cord was paralyzed but I did my speech therapy..extra speech homework and it popped back and my vocals got lower..met a lady who stayed high in vocals and still has the cord paralyzed..my brain slowed down through cognitive..hers is still a bit fast..so is it a pattern..she was comatose longer…It is something I wonder about because mine is severe..so is hers…yes I have residuals but I learned to cope with them..I researched about my injuries to be proactive to make them my friend to learn about what does not work to enhance what does..,and the brain injury fund is available in some states for people without coverage but a lot of insurances now have riders for anything related to the brain…I am glad to know the brain never stagnates..sometimes I think we get comfortable and tired of fighting..But brain injury is a fight..You can come back…It does depend on all of your body and how it is reacting to the trauma that happened, where the injury happened, the age of your body, your motivation to rehab, and time..lots of time and GOD…And yeah you are a different person after this..it is finding who you are and embracing the old with the new….Caregivers are saints and there are support groups all over Facebook with live people helping…you are not alone in this battle and the state brain injury association as well..Good luck to you all…

  4. Williams Ishaya says:

    My Doughter has been in coma for the passed four days after a brain injury which surgery was made to remove some clothed blood from the brain am just confuse she is still in coma and blood is still coming out from her head from a tube

  5. My friend has been in a coma for 3 months and 5 days today. Please pray he is stil young and is a brave man he has so much on his bucket list .

  6. Teresa Watts says:

    I suffered tbi in a coma for 23 days after being in a vebicle accident in 2010. I am not sure that i have fully recovered from that. I still have memory loss. After 6 years of recovering i am very thankful that i am doing as good as i am by the grace of God.

  7. Lorraine Browning says:

    I was in a coma for 23 days after a car accident. My friends thought I was dead after they had covered my body, but after checking in the ambulance they got a pulse and rushed me to hospital. I finally woke up completely from the coma with injuries of fractured skull and totally paralyzed. At first all I could do was see people. I could not feel any part of me I felt like a pair of eyes looking out. The things that went through my head, I thought I had not been born and the people who looked at me were looking for a new baby. I could see parts of the ward I was in, I don’t know how, but I remember this. I did not even recognise my own family to start but when my brain started to repair I just got better and better with your own determination you help the process. I am now with 3 children and I was told so many times because of the brain injury and damage you will never be able to do things. Every time I was told you will not be able to stand, read, walk …etc., ever, I made that my challenge. I was 19 years old and I wanted to recover back to what I was before the crash. I am happy my guardian angel saved me.

  8. Farhat Zabin says:

    my mother is in a persistant vegetative state since 2 and a half months hope is still on and faith on allah will always remain inshaallah she will definite wake up and survive a normal life with us AMEEN

  9. My daughter was drugged my a girl friend of my grandson. She has total body pain. She was in the hospital IV unit for a little over a month. I don’t know if she medically induced or how she was in a semicomA for several months . When she woke up she could not walk. The back of her feet don’t touch the floor. She uses a walker in home ,will chair outside. Pain doctor told her to see a nuerotherapist because she has a brain injury. Also her left eye wonders. She’s had eye doctor and pain in tell her to see one. Is there away to help her walk at home. She took therapy and it help . But her insurance only pays for a few days. More I want to know if she will ever walk again.When she left hospital she went a respiratory clinic she was there for about 8 months on respiratory therapy.Any when she came out she can’t walk. Can you give me advice please.

  10. My mother went into acoma January 23, 2016.please pray for her Alfae Nobles

  11. My husband is in a coma right now, hoping and praying he will wake up soon or show signs of improvement. Please pray for him.

  12. The medical community encourages family members to continue talking to a comatose patient. Music can play a role because doctors think hearing is still functioning.

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