A coma is a state of unconsciousness brought on by trauma to the brain. A comatose patient is not responsive to people and activities around him. Although he may appear to be in a deep sleep, he cannot be aroused, even with pain.
Lack of oxygen to the brain, a blow to the head, drug or alcohol overdose, seizures, strokes, and infection of the brain can all result in a coma.
In general, most people who lapse into comas come out of them within a few weeks. Others, however, never fully emerge. Some patients have remained comatose for years, surviving only with the help of others for their most basic of needs. This condition is referred to as a persistent vegetative state. A patient in this state is able to breathe on his own, experience normal sleep patterns, move his limbs and sometimes even smile or cry. However, due to damage to the cognitive centers of his brain, he cannot think or reason.
Television and movies generally portray a victim emerging from a coma alert and able to communicate coherently with family and friends. The reality of coma recovery, however, is far different. Most people emerge from a coma in stages that range from totally unresponsive to confusion to full awareness and functionality.
Two standardized methods are used to assess the stages coma patients pass through. One of these is the Glasgow Coma Scale, used to evaluate eye-opening, verbal responses and movement. A score from three (signifying a severe brain injury) to fifteen (signifying a mild brain injury) is assigned to each of these areas.
The Rancho Los Amigos Scale is a more detailed guide with eight levels to measure a patient’s progress. With this tool, physicians are able to track a patient’s recovery from a coma beginning with no response at all to stimulation. It moves on to three states of confused responses to his environment. In the last stage, a patient is able to respond purposefully and appropriately to people and happenings around him. At this level, a patient is both alert and able to manage everyday life, though he may still struggle with social, intellectual, and emotional deficiencies. His response to stress may also cause continuing problems.
Many coma patients require therapy to relearn basic tasks of life and to overcome physical, behavioral and cognitive difficulties.
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