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COMA: When a Person Has Brain Injury by Ron Savage, Ed.D and Marilyn Lash-Cluett, M.S.W.

Written by Ron Savage, Ed.D. and Marilyn Lash-Cluett, M.S.W.

This article helps family members, friends and visitors to understand what “coma” means and to respond and give comfort to the person with brain injury.

Brain Injury and coma-an interruption in living

What Does Coma Mean?

Being told that your family member, friend or relative is in a coma can be confusing and frightening. Seeing the person unconscious for the first time usually is an emotional  shock.  The  first  questions  asked  are often, “What  is  a  coma?  How  long  will  it  last? Can he hear me?” Watching and waiting for your relative to respond and become more alert can be emotionally and physically exhausting.

A coma is a state of unresponsiveness that can last for hours, days, weeks, or even months. It affects the person’s response to sound and light, ability to follow commands, speech, and awareness of surroundings.  Movies  and television often show a person in a coma lying very still and quiet as if sleeping and then suddenly waking up and becoming alert. This is not accurate.

No one really knows how much sound, information and activity filter through while a person is in a coma. A person may move or groan and respond to sounds, touch or pain. Family members often believe that the person hears and responds to their voices. These  signs may be reflexes – like squeezing a hand  or sucking in response to touch. It is hard for families to sort out which responses are reflexive or automatic actions and which are planned or intentional.

A brain injury is usually described as mild, moderate or severe. The length of time that a person is in a coma is one of many factors that determines the severity of an injury.

       Brain Injury    Length of coma

The length of a coma varies for each person because each brain injury is different. Professionals can not predict precisely how long a coma will last. This is frustrating for many families, but the brain is very complicated. Much is still unknown about what happens after it is injured.

Measuring the depth of a coma is complicated because there are many levels of awareness and response. It is not as simple as being asleep or awake. The depth of a coma can even vary during the day. Examiners can differ in how they evaluate a person’s responses to sound, light, touch and commands. Two scales are often used in hospitals and rehabilitation.

Glasgow Coma Scale

This scale helps medical staff evaluate the person’s level of consciousness. It is based on three measures that each have numbered scores:

The overall score has a high of 15. When the score  is 13-15, the brain injury is considered mild; 9-12 indicates a moderate brain injury; 8 or less reflects a severe brain injury.

The Glasgow Coma Scale is used with children (ages 4+) and adults. There is  a  modified  scale  for  younger children.

Rancho Los Amigos Scale

This is a more detailed scale that describes the behaviors  and  abilities  of  a  person  who  is  gradually coming out of a coma. It is often referred to as the Rancho Scale. It includes 8 levels of response that describe a person’s awareness and response to light, sound, touch and commands.

The basic Rancho Scale is for children (age 14 years +) and for adults. Although this scale has been adapted for younger children, it is not as widely used with them.

Understanding the scales

Ask a doctor or nurse if the Glasgow or Rancho scale has been used to evaluate your relative. If the answer  is yes, ask staff:

Brain is healing

Early Stages of Coma Recovery

A person does not just wake upfrom a coma. It is a gradual process of becoming more responsive and aware of people and surroundings. Rarely do individuals progress directly through the different levels of consciousness. There is usually some overlap, or back and forth between stages.

Your relative may become confused, not recognize you, talk and behave strangely, swear, become angry, and even be violent. This is a normal stage of coma recovery and it is usually temporary.

Noise, touch, light, and movement may either calm or upset the person. Post-traumatic amnesia is common as the person(s) regains consciousness. This means that the person may not remember being hurt or what happened after injury.

Tips for families to help your relative:

Tips for helping children…

Too often children with a parent or sibling in a coma feel left out and receive little information. Efforts to protect them may increase their fears and anxiety about what has happened to their mother or father, brother or sister.

Tips for family members…

Waiting is hard

Waiting and watching are the two words most often used by family members to describe what this time  was  like  for  them. The  stress,  worry  and  anxiety may  feel overwhelming  at  times.  It  may  be  hard to concentrate or do even the simplest things. This period of coma is among the most difficult for family members because of its seriousness and uncertainty.

Each person in a family reacts differently to stress but these are suggestions offered by families who have gone through this experience.

Conclusion

This is a difficult time for everyone in the family. Patience, support, information and help from staff, relatives and friends will help you through this uncertain time.

Reference

Hammond, F. & Guerrier, T. (2010). Brain Injury: It is a Journey. Wake Forest, NC: Lash & Associates Publishing/Training, Inc.

This ARTICLE was part of a Tip Card series on brain injury among children, adults and veterans. For MORE INFORMATION, contact Lash & Associates Tel: (919) 556-0300 or visit our web site www.lapublishing.com

 This ARTICLE is not intended as a substitute for the medical advice of your physician. Consult your doctor regularly about matters concerning your health, particularly regarding symptoms that require diagnosis or immediate medical attention.

Copyright © 2010, 2nd edition by Lash & Associates Publishing/ Training Inc.

This material is copyrighted by Lash & Associates and cannot be reproduced in any form without permission.

Published by: Lash &Associates Publishing/Training Inc.

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