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.

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