Facts About Vegetative and Minimally Conscious States After Severe Brain Injury

Mark Sherer, Ph.D., Monica Vaccaro, M.S., John Whyte, MD, Ph.D., Joseph T. Giacino, Ph.D., and the Consciousness Consortium, Model Systems Knowledge Translation Center
Facts About the Vegetative and Minimally Conscious States After Severe Brain Injury

Severe brain injury causes a change in consciousness. Consciousness refers to awareness of the self and the environment. Brain injury can cause a wide range of disturbances of consciousness. Some injuries are mild and may cause relatively minor changes in consciousness such as brief confusion or disorientation.

The most severe injuries cause profound disturbance of consciousness. Twenty to 40% of persons with injuries this severe do not survive. Some persons who survive have a period of time of complete unconsciousness with no awareness of themselves or the world around them. The diagnosis given these people depends on whether their eyes are always closed or whether they have periods when their eyes are open. The state of complete unconsciousness with no eye opening is called coma. The state of complete unconsciousness with some eye opening and periods of wakefulness and sleep is called the vegetative state. As people recover from severe brain injury, they usually pass through various phases of recovery. Recovery can stop at any one of these phases.

Characteristics of coma

  • No eye-opening
  • Unable to follow instructions
  • No speech or other forms of communication
  • No purposeful movement

Characteristics of the vegetative state

  • Return of a sleep-wake cycle with periods of eye opening and eye closing
  • May moan or make other sounds especially when tight muscles are stretched
  • May cry or smile or make other facial expressions without apparent cause
  • May briefly move eyes toward persons or objects
  • May react to a loud sound with a startle
  • Unable to follow instructions
  • No speech or other forms of communication
  • No purposeful movement

Persons in coma or vegetative state require extensive care that may include:

  • Feeding using a feeding tube
  • Turning in bed to prevent pressure sores
  • Special bedding to help prevent pressure sores
  • Assistance with bowel and bladder relief using catheter and/or diapers
  • Management of breathing such as suctioning of secretions; this may include care for a tracheostomy tube
  • Management of muscle tone (excessive tightness of muscles)
  • Special equipment that may include a wheelchair or special bedding to help with proper posture and decrease muscle tightness
  • Management of infections such as pneumonia or urinary tract infections
  • Management of other medical issues such as fever, seizures, etc.

What happens after coma and vegetative state?

When people start to regain consciousness, they may:

  • follow simple instructions from others such as, “Open your eyes,” “Squeeze my hand,” “Say your name,” etc.;
  • communicate by speaking words or by indicating yes or no by head nods or gestures; and/or
  • use a common object in a normal way such as brushing hair with a brush, using a straw to drink, holding a phone to the ear, etc.

Persons with brain injury transition through the period of unconsciousness and subsequent stages of recovery at a slower or faster rate, largely depending on the severity of injury. Those with less severe injuries may transition through these stages more rapidly and some of the stages described here may be poorly recognized or not occur at all. Those with very severe injuries may stall at one or another stage and not be able to make the transition to a higher level of recovery.

For persons with more prolonged periods of unconsciousness, emergence from unconsciousness is a gradual process. Coma rarely lasts more than 4 weeks. Some patients move from coma to the vegetative state but others may move from coma to a period of partial consciousness. It would be very rare for a person to move directly from coma, or vegetative state, to a state of full consciousness.

Persons who have shorter periods of unconsciousness likely had less severe brain injuries initially. Consequently, they are likely to go on to make better recoveries than persons who had longer periods of unconsciousness.

Traumatic brain injury refers to damage to the brain caused by external force such as a car crash or a fall. About 50% of persons who are in a vegetative state one month after traumatic brain injury eventually recover consciousness. They are likely to have a slow course of recovery and usually have some ongoing cognitive and physical impairments and disabilities. People in a vegetative state due to stroke, loss of oxygen to the brain (anoxia) or some types of severe medical illness may not recover as well as those with traumatic brain injury. Those few persons who remain in a prolonged vegetative state may survive for an extended period of time but they often experience medical complications such as pneumonia, respiratory failure, infections, etc. which may reduce life expectancy.

People who have a slow recovery of consciousness continue to have a reduced level of self-awareness or awareness of the world around them. They have inconsistent and limited ability to respond and communicate. This condition of limited awareness is called the minimally conscious state.


Characteristics of the minimally conscious state

  • Sometimes follows simple instructions
  • May communicate yes or no by talking or gesturing
  • May speak some understandable words or phrases
  • May respond to people, things, or other events by:
    • crying, smiling, or laughing;
    • making sounds or gesturing;
    • reaching for objects;
    • trying to hold or use an object or
    • keeping the eyes focused on people or things for a sustained period of time whether they are moving or staying still.

People in a minimally conscious state do these things inconsistently. For example, one time the person might be able to follow a simple instruction and another time they might not be able to follow any instructions at all. This makes it difficult to distinguish the vegetative state from the minimally conscious state.

While in a minimally conscious state, people need extensive care similar to that needed by people in a vegetative state.


Emergence from the minimally conscious state

Once a person can communicate, follow instruc tions, or use an object such as a comb or pencil consistently, they are no longer in a minimally conscious state. Some people remain minimally conscious indefinitely, but many improve. The longer a person remains in a minimally conscious state, the more permanent impairments he or she is likely to have. This is because vegetative and minimally conscious states are caused by severe damage to multiple brain areas. Following emergence from the minimally conscious state, people almost always experience confusion. Sometimes people move directly from coma to this confusional state.


Comparison of Coma, Vegetative State, and Minimally Conscious State

 

Coma

Vegetative State

Minimally Conscious State

Eye Opening

No

Yes

Yes

Sleep/Wake Cycles

No

Yes

Yes

Visual Tracking

No

No

Often

Object Recognition

No

No

Inconsistent

Command Following

No

No

Inconsistent

Communication

No

No

Inconsistent

Contingent Emotion

No

No

Inconsistent


Characteristics of the confusional state

  • Disorientation (inability to keep track of the correct date and place)
  • Severe impairment in attention, memory and other mental abilities
  • Fluctuation in level of responsiveness
  • Restlessness
  • Nighttime sleep disturbance
  • 6. Excessive drowsiness and sleeping during the day
  • Delusions or hallucinations

As with the vegetative and minimally conscious states, the rate and extent of recovery from the confused state vary from person to person. However, almost all people who reach the confused state go on to make further progress. The main factors that determine the eventual degree of recovery are the initial severity of the brain injury and some types of additional medical problems. The shorter the time the person is in the confused state, the better the eventual recovery will be. Mild medical complications such as sleep disturbance or urinary tract infection may prolong the confused state but do not necessarily influence the final outcome.

Once the confusional state resolves, people are usually much better able to pay attention, orient themselves to place and time, and retain memories for day to day experiences. Nevertheless, they are very likely to have some significant cognitive problems such as impaired memory or slowed thinking. These cognitive problems are likely to continue to improve as time passes. Some people make limited progress, while others make a good deal of progress.


Patterns of recovery after very severe brain injury

Some individuals rapidly emerge from coma and briefly remain in the minimally conscious state before recovering a higher level of consciousness with mild impairments. Others may have a longer period in the minimally conscious state after emerging from the vegetative state and then usually have a greater degree of long-term impairment. Occasionally, persons remain in the vegetative or minimally conscious state for an extended period of time and, in rare cases, these conditions may be permanent.

What treatments are used with people in the vegetative or minimally conscious state?

Currently, there is no treatment that has been proven to speed up or improve recovery from the vegetative or minimally conscious state. However, there is general agreement that the primary focus of medical care is to prevent or treat any factors that might hinder recovery (such as hydrocephalus, a build up of fluid on the brain, or use of sedating drugs for other conditions), and to preserve bodily health (such as treating infections or stiffness of joints). Medical facilities and clinicians vary in the extent to which they try various treatments such as medications or sensory stimulation to promote recovery of consciousness. Because the amount of recovery from disorders of consciousness varies so greatly, it is difficult to judge the value of these and other treatments outside of research studies. You can inquire about your physician or program’s philosophy about using these types of treatments.

Transitions to different levels of care

At various points in the process of recovery, persons in the minimally conscious or vegetative state may receive care in a wide range of settings. Initially, the person with severely impaired consciousness is most likely to be treated in an acute care hospital where the focus is primarily on saving his/her life and stabilizing him/her medically. Once that is achieved, the next focus is on recovery of function to whatever level is possible. Sometimes this happens in an acute rehabilitation hospital, which provides a high intensity program of rehabilitation services, including physical therapy, occupational therapy, speech and language therapy, recreational therapy, neuropsychological services and medical services.

Some patients do not transition from the acute care hospital to an acute rehabilitation program. These people may go directly to a skilled nursing facility, a sub-acute rehabilitation program, a nursing home, or even home with family. Persons discharged from an acute rehabilitation program usually go to one of these places as well. Skilled nursing facilities, sub-acute rehabilitation programs, and nursing homes vary widely in the quantity and quality of medical management, nursing care, and rehabilitation therapy services they provide.

Many factors influence decisions about where a person with severe impairment of consciousness or other severe impairments may go after discharge from the acute care hospital or discharge from the acute rehabilitation program. Some of these factors are the person’s medical condition, health insurance coverage and other benefits, the person’s ability to tolerate rehabilitation therapies, the doctor’s philosophy about where people should go to continue to recover after severe injuries, the family’s ability to care for the person at home, the family’s wishes, and practical matters such as that the distance the family has to travel to visit the person at the facility.

The names used to describe levels of care and the settings in which they are provided, vary across the country. It is helpful to work with a social worker or case manager in the facility where your loved one is currently receiving services to plan whatever transitions are necessary. Do not be afraid to ask questions to make sure that you obtain the information you need to help you make the best possible decision.

Things to look for when considering a setting to care for your loved one:

At various points in the process of recovery, persons in the minimally conscious or vegetative state may receive care in a wide range of settings. These include in-patient rehabilitation facilities, skilled nursing facilities, and long-term acute care facilities. The following are some considerations for selecting a place for care:

  • Your family member’s current treatment team has had good experiences with the program when they have referred others there.
  • The staff at the facility makes you feel comfortable, is accessible to talk with about your concerns, and answers your questions.
  • The program and medical staff have experience working with the same kinds of problems that your family member has.
  • The facility is informed about the specifics of the care your loved one needs and is able to meet these care needs. You can have a role in ensuring that a detailed nursing plan of care is developed.
  • The program includes case management to assist in planning for the next level of service, whether it is transition to a rehabilitation program, a facility for long-term care, or home.
  • The program provides education and training for future caregivers.
  • The program uses specific procedures to measure progress.

If support services can be arranged, some persons in the minimally conscious or vegetative state can be cared for at home.


Thoughts from families who have been there

Family members who have a loved one in a minimally conscious or vegetative state have identified a number of important issues:

  • Communicating with healthcare providers
    Be sure to ask questions, share your observations, and express your opinions.
  • Managing medical equipment and supplies
    It is important to be knowledgeable about your loved one’s equipment and supplies, and know how to communicate with the companies who provide these items.
  • Providing care
    Family members often provide some of the care for their loved ones. The amount of care you provide will depend on your role in providing care (this can range from providing most of the care yourself to simply directing the care provided by others), the people such as sitters, attendants, nurses, and family members who are available to help you with providing care, the setting (this could be your home or a skilled nursing facility), and the guidance you receive from health care providers. It is desirable to obtain as much training as possible to provide whatever elements of care you chose to provide and are able to manage. These might include bathing, grooming, bowel and bladder management, mobility, range of motion, and other medical issues that your loved one may have.
  • Learning about financial resources
    You may initially feel overwhelmed when you start to learn about various financial resources that may be appropriate for your loved one. However, with patience, persistence, and some help from others, you will be able to figure out which programs apply and find your way through the application processes.

    Programs you will want to learn about include:

    • Healthcare programs such as Medicare and Medicaid.
    • Income replacement or financial assistance programs such as SSDI (Social Security Disability Insurance), SSI (Supplemental Security Income), or possibly disability insurance policies that you loved one may have had through work.
    • Services to help with community living such as state agencies that assist people in these areas.

    It might not be possible to find someone who knows everything about how to access these various services and programs. The key is to keep asking questions and following up to make sure that you and your loved one get all the benefits that are available. People who may be helpful to you are social workers, therapists, case managers, the local social security office, your state brain injury association chapter, family members or friends who are disabled or who have family who are disabled, or the human resources (personnel) department at your loved one’s employer.

  • Guardianship
    Since your loved one is not able to fully make decisions for himself or herself, it may be helpful for you, or someone else, to be appointed guardian. This may make it easier to handle medical decision making or management of your loved one’s financial matters. If you think that your loved one may need to have a guardian appointed, you will need to contact an attorney to get assistance. Guardianship can be reversed when it is no longer needed.

How to interact with your loved one who is unconsciousness or at a low level of responsiveness

The most natural way of interacting is to talk to your loved one, even though he or she may not respond or understand. Simple things like telling him or her about recent events in your life, what is going on in your family or neighborhood, or the latest news might make you feel a sense of connection. Talking with your loved one about what you are doing as you provide care can increase your comfort with the process of care giving. For example, telling your loved one that you are going to move his or her arms and legs to help prevent joint tightness might make you feel more comfortable with this task. Only do this “range of motion” type activity if you have been instructed to do so by the doctor, nurse, or therapist.

Physical touch is another way of having a sense of connection. Some family members have said that the act of giving a massage or applying lotion to the hands or face helps them to feel close to their loved one. It is also important to avoid the risk of overstimulation as this may result in rapid breathing, tightening of the muscles, grinding of the teeth, restlessness and fatigue.


Taking care of yourself and other family members

Family members of a person in a vegetative or minimally conscious state often feel a sense of loss or grief for the relationship they had prior to the injury. There can be a number of ways to cope with these feelings. A person in a minimally conscious or vegetative state may make very slow progress or go for periods of time with no apparent progress. Sometimes keeping a journal of the changes you have observed may be comforting. This may give you a chance to look back and see ways in which he or she is more able to respond than he or she was at an earlier point in time.

Having a loved one who is in a vegetative or minimally conscious state can be physically and emotionally draining. Managing this alone can be too much to ask of one person. It is important to rely on support from others, looking to existing supports and developing new ones. You might find help from supports you have relied on in the past, such as family, friends, and religious groups.

Other resources to consider include support groups, support agencies, and the Internet. A good way to learn more about these possible supports is to make a contact with the Brain Injury Association of America’s National Brain Injury Information Center (www.biausa.org, 1-800-444-6443) and obtain contact information for the closest state brain injury association (BIAA) chapter. Health care providers such as doctors, therapists, social workers and others can be good sources of information about supports available to you.

Even the most committed caregiver needs to have some private time. If your loved one is at home, this can range from having a friend or family member give you a 2 hour break to go do something for yourself to having full time caregivers for a week or having your loved one spend a brief time in a nursing care facility or hospital. If your loved one is still in the hospital or living in a nursing care facility, having a rotating visitation schedule can give you some breaks while giving other friends and family a chance to spend time with him or her.

When your loved one was first injured you were likely to be in crisis mode, focusing on the problems and putting the rest of life on hold. As time goes by, you will need to shift from crisis management mode, and begin to take care of the concerns of everyday life such as paying bills, maintaining relationships with other family members, and taking care of your own physical and mental health. While it is natural to focus on your injured loved one, other members of your family will have needs too. For some people, formal counseling with a therapist or member of the clergy can be an important part of making adjustments to life changes that have occurred as a result of your loved one’s injury.

While caring for a person in a vegetative or minimally conscious state is an enormous challenge, use of appropriate resources, as described above, can be a big help. Each person will respond differently to this challenge, but almost everyone can cope and move forward. Many family members have a deep sense of personal satisfaction in making life as comfortable and pleasant as possible for a loved one who has sustained a severe injury.


VS-MCS brochure authorship and acknowledgement:

Written by: Mark Sherer, Ph.D., Monica Vaccaro, M.S., John Whyte, MD, Ph.D., Joseph T. Giacino, Ph.D., and the Consciousness Consortium. Members of the Consciousness Consortium include:

  • JFK Johnson Rehabilitation Institute, NJ (Lead Center)–Joseph T. Giacino, Ph.D., P.I.
  • Moss Rehabilitation Research Institute, PA (Co-Lead Center)–John Whyte, MD, Ph.D., P.I. and Sooja Cho, MD, Site P.I.
  • Methodist Rehabilitation Center, MS–Stuart A. Yablon, MD, P.I.
  • Braintree Rehabilitation Hospital, MA–Douglas Katz, MD, P.I.
  • Sunnyview Hospital & Rehabilitation Center, NY–Paul Novak, MS, OTR, P.I.
  • Bryn Mawr Rehab Hospital, PA–David Long, MD, P.I.
  • Texas NeuroRehab Center, TX–Nancy Childs, MD, P.I.
  • Fachkrankenhaus Neresheim, Germany–Bernd Eifert, MD, Ph.D., P.I.

Acknowledgements: Funding for writing and publication of this brochure was provided by National Institute on Disability and Rehabilitation Research grant #H133A031713 (A Multicenter Prospective Randomized Controlled Trial of the Effectiveness of Amantadine Hydrochloride in Promoting Recovery of Function Following Severe Traumatic Brain Injury).

The Brain Injury Association of America (BIAA; www.biausa.org) provided feedback from the consumer perspective for the content of this brochure and is assisting with dissemination of these materials.

Several family members of persons with TBI generously gave their time and valuable insights to assist with the writing of this brochure.

Posted on BrainLine March 25, 2010. Reviewed March 28, 2019.
About the Authors

The Model Systems Knowledge Translation Center is operated by American Institutes for Research (AIR) and is funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) under grant number 90DP0082. Four additional organizations support AIR in executing the work of the MSKTC, including George Mason University's Center for Chronic Illness and Disability, WETA's BrainLine, University of Alabama, INOVA, and American Association of People with Disabilities.

Sherer M, Vaccaro M, Whyte J, Giacino JT, & the Consciousness Consortium. Facts about the Vegetative and Minimally Conscious States after Severe Brain Injury 2007. Houston: The Consciousness Consortium. Copyright © 2018 by University of Washington/MSKTC. 

Please check the MSKTC site for any recent updates on this article.

Comments (227)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

My prayers are with you and your family. My father is in vegetative state for more than 1 month now due to stroke with movement and no eye opening. We are still praying that he will wake up soon. Our hopes are with God

Hazel

My aunt is in a vegetative state after suffering a Subarachnoid Hemorrhage in Aug of `15. Only time will tell and I only hope that she is comfortable, not in pain, and dreaming of wonderful things. I feel guilty because I know she would not want to be like this.  You are all in my thoughts tonight and I send good vibes to everyone reading.

Has anyone recover from this vegetation state if so how long did it take ...and is there anything they can do different or take

I suffered traumatic brain injury after a coma, I was in coma for three months, I suspect being active afterwards is most important, not like a victim but try to be a person again, my website which covers many of my issues is http://mathewhomberger.wordpress.com

I found my mom unresponsive and not breathing 6 days ago. We did CPR until EMS came and they worked on her for about 20 min and finally got a pulse. When she got to the hospital she had pneumonia, sepsis from aspirating, and renal failure. She has had COPD for a few years now. They have the pneumonia under control but she is in a vegetative state. CT scans and EEG show normal brain function but she just will not respond to us. All the the medical issues are now under control except for the vegetative state. With all the brain scans showing normal brain activity I just don't understand why she hasn't responded yet. We are all praying that she will start to come back to us soon. It has only been almost a week so we are trying to stay positive. It is so hard to see your loved one going through this. It is so hard to understand and to know she would absolutely never want to live this way is even more difficult to deal with. If anyone can offer any advice, coping mechanisms, or just wants to share their experiences my email is kristygermany@hotmail.com. I am praying for everyone who is having to deal with this and I pray for your loved ones who are ill as well!

PLEASE be patient with your mom and her recovery. She has a lot going on in “only a week”. It’s very hard to see our loved one’s in such a vulnerable state, yet your patience and love and support mean more to her recovery than you realize.
Pardon the saying, ‘ Rome wasn’t built in a day’, so it’ll take time (weeks, maybe longer) to fight her medical issues and respond. Keep communication open with the doctors.
I wish you the best and send you positive thoughts for a speedy recovery for your mom. (( hugs ))
My large family are all going through a serious/critical situation with my stepson now. It feels like an emotional roller coaster ride. Been 20 days and after induced coma, he still isnt responding. Collasped lungs ( on respirator only 12 hrs per daynow) broken facial bones and severe brain i jury , all from riding his motorcycle into a deer. It is an exhausting time, yet everyone heals at their own pace. The hardest thing is waiting to know if he will be in this vegetative state for long period or forever.
I read a lot online of his condition and found relief in knowing what can be expected and understanding all hospital is doing. Waiting for my stepson go excrete all the drugs they gave him and healing is stressful to him as well as his family. Yet if being patient gives him more time to heal, then his recovery has better chance.

tissue plasminogen activator (tPA, also known as IV rtPA, given through an IV in the arm) may save your loved one from a non communicative state but it has to be given within 3-4.5 hours of a stroke MAX and your local hospital may not be able to keep it ready to go. Ask your local hospital and pharmacist if they can prepare a dose for you at all times, it cost like $3000 usd or so for one dose.  I am looking at moving to the countryside of Paraguay and trying to find out if tpa can be stocked somewhere nearby for my mother who had a stroke and may have another one, who knows.

My brother r has a multiple fractures and brain injury that required extensive monitoring and rehabilitation .. what is this ??

Prayers to all of you that have loved ones with TBI or anoxic brain injuries.  The love of my life suffered an anoxic brain injury on August 23 of this year after a failed tracheotomy while we were on vacation.  The hospital wanted me to remove her from life support after one week.  I prayed to God for guidance.  I did not remove her from life support. We were able to have the tracheotomy successfully done.  She has since been medi-flight back to our home state.  She is now off the ventilator and breathing on her own.  She follows commands inconsistently, and goes through sleep awake cycles, but she is alive.  I am looking at hyperbaric oxygen therapy as a way to re-stimulate dormant brain cells.  God is a healer!!!

Could you please give me an update on her condition? Did you ever do the hyperbaric oxygen therapy?

Amen...God made the oxygen that we need and are required to have to be able to breath and keeps us alive. God Bless you and your love ones. I believe your prayers have already been answered. Amen!!

My mother is 71 years old and she had suffered a cardiac arrest 5 years ago. As a result she lost oxygen to the brain and was diagnosed with anoxic brain injury. The MRI showed that the cortex of her brain is very damaged. The neurologists tell us that she will not recover from this vegetative state because her brain is too damaged.it is for 5 years that our family is serving her and we are very very hopeful that she will awake any time.inshAllah. quts32@yahoo.com

God Bless you! It's a devastating thing to experience in a friend or loved one

Dear same happened with my mom to, now she is persistent vegetative state. Most claim zolpidem work for comatose patients,but as per me its not true. She is having infarct at temporal lobe. All we both can do ,just take nice care of our moms. Thanks Ashwani India

My father has been in a minimally conscious state since 4 weeks.He suffered 3 major strokes and his entire brain has gone through good amount of damage.Since last week,my father is slowly gaining consciousness and following instructions but the recovery has been very slow.He is being fed through feeding tube and also has a tracheostomy tube.He was in the critical care unit for 40 days I.am very positive and believe things would change and his condition would improve.I am trying my best to make his life as comfortable as possible. I will pray for all the other families who are going through similar pain.

Reading all of your stories took me back to my experience with my father. He was the innocent victim of an assault that took place on May 15th of this year. He sustained traumatic brain injury, his spinal cord was detached from his brain stem and he was paralyzed from the shoulders down. He was on a ventilator which was doing all of the breathing for him and he had a feeding tube. The doctors told my family & myself that there was no hope for him and the best thing to do was take him off of life support. I, being his next of kin, made the decision to leave the situation in God's hands and support my father in any and every way possible. I went to the hospital every day for four months and talked to him, joked with him, told him stories from when I was growing up, bathed him, groomed him, read the Bible to him and most importantly, I prayed for him in hopes that he could hear every word I spoke to him and feel every act of love and kindness that showed him. The doctors were claiming that my father was brain dead and that he would die in two weeks, but he fought for four months and would respond to certain things as well as certain people who would go see him and talk to him. I mean, he wouldn't talk or squeeze our hands, but he would cry when certain people would go see him or talk to him, he would follow shadows and if his eyes were closed and we called his name or walked in the room, he would open his eyes. If the nurses positioned him a certain way and it made him uncomfortable, he would push back or move his leg(s) back to the position that it was originally in. He would respond to pain and tickling of his underarms, stomach and feet. I truly believe that my father fought as long and as hard as he did because he knew that I was there with him every day and he didn't want to let me down. Three days before my father passed away, the doctor came in his room and was talking to him, asking him questions and he looked at me and said, "he's beginning to respond to my commands, he hasn't done that since he's been in the hospital". I had noticed myself, but could never get the nurses or doctors to confirm what I was seeing, so him telling me that made me feel like I wasn't seeing things because I wanted to see them. My father passed away on September 9th of this year, but if I had to spend the entire four months in the hospital with him every day all over again, I would. I want to encourage those of you who are in similar situations to stay strong and encouraged in knowing that God is in control and that everything you do to support your family member, friend or loved one, is not in vain no matter what the outcome may be. Appreciate the time that you have with them, make every day with them count. Don't talk to them or treat them any different than you would have if they weren't in the situation they are in. Tell them how much you love them and encourage them to continue fighting the good fight. They're still here and fighting for their life for a reason. I pray for strength, courage, piece of mind and a sound heart for all of you as well as your family member, friend or loved one who are living similar situations. Here is my email address if any of you need encouragement, prayer or a friend to talk to. God bless! proudmommyof386@gmail.com My name is, Stephanie

My son -n- law fell off a 2 story building it happen in a small town in Georgia and they took him to the hospital and then had to fly him to Grady memorial in Atlanta Georgia he broke the bone in his leg the biggest bone in a persons body and his pelvis and his lower back but he had very bad brain injury and a brain bleed he’s still in the hospital and he open his eyes Saturday looking at pictures of his 4 year old twins but he did try to say something but he couldn’t we are praying he will make it through this and come home but I think they will be sending him to the shepherds hospital in Atlanta to work with the brain and maybe physical therapy , could you please pray for us and may god bless you , I am so sorry about your dad , we live in hazel green Alabama

Thank you so much Stephanie for the words of encouragement, my mom is in exactly the same position as your dad was. Its been almost 2 yrs and my sister and I visit her every day . She does alot of what your dad was doing, so I still have faith. I tell everyone only G-d can make the decision for us.

My father was the innocent victim of an assault that took place on May 15th of this year. He was kicked in the back and flew face first into the concrete. He sustained traumatic brain injury, his brain stem and spinal cord were instantly disconnected upon impact. He was on a ventilator, had a trach and a feeding tube for four months. The doctors told my family and myself that he was brain dead, but he would respond to certain things as well as certain people. He wouldn't talk or squeeze our hands or anything like that, but he would cry when certain people would go see him and talk to him. When the doctors and nurses would move him a certain way, he would push back at them with his feet or reposition his leg(s) back to the position that it was moved from. Three days before my father passed away his doctor came in his room and was talking to him, trying to get a response and he looked at me and said, he's beginning to respond more than he ever has. That gave me so much more hope because he was responding to us in certain ways too, but the doctors and nurses never seemed to acknowledge it. I share my story to say this, don't give up on someone that you love no matter how bad or hopeless a situation might seem. Doctors told me that my father would die in two weeks and he hung on for four months! I spent every single day with him and talked to him, sang to him, listened to music with him, told him stories about him & I from when I was growing up, bathed him, groomed him and most importantly, prayed for him and read the Bible to him every single day in hopes that he heard and felt every act of love & kindness that came from me. I believe my presence is what kept him going. Unfortunately, my father succumbed to his injuries on September 9th of this year, but I would do it all over again if I had to. If you're in a similar situation, I encourage you to stay strong, pray and most importantly, never give up no matter what the outcome. I guarantee you that everything you do, is not done in vain. If anyone may be going through a similar situation and need prayer, words of encouragement or a friend to talk to, here is my email address: proudmommyof386@gmail.com Take care & God bless!

My grandpa 87 one day was slumped over and couldn't move and by the time ambulance came he was able to smile raise his hand and one arm slightly drifted down.but he passed the other stoke test the ambulance guy asked him to do. But they still brought him to the hospital and next day he's in a deep sleep and won't wake up after couple days they said he had a stoke on both sides of his brain and 3 siezers in a row. After a week feeding tube is put in still no contiousness or anything. 4 days later the doctor says there taking tube out that his intestine isn't working.and that they assume he is in pain so the give him pain meds. And that they gotta make him comfortable and wait . I don't want them to take the tube out I belive he can get better. Please prey for him

Struggling with life as so many others in this same position of loved ones in varying stages of consciousness. 2 years post injury and i still research, pray and look for treatments for my son. When I gave Jamie 10 mg of zolpidem he spoke and said i missed you mum. When give very large doses of fish oil this aided the swelling and allows signals to get through. My son is classed in a permanent vegitive state. He has extensive brain injury and is cared for by myself at home. He was unable to protect his airway and required constant suction. After starting madapar for Parkinson he now has swallowing control and no longer requires suction. If anyone is interested in any of the treatments I've tried or researched for Jamie my email is Daphnejean_F@hotmail.com if anyone would just like to chat or bounce ideas around I'm good for that too. If anyone is interested in seeing a man with no brain activity speaking you can go to Jamie Manuele facebook page. The EEG reports are also on his page stating distinct lack of cortical activity. Jamie had a harrowing journey these past 2 years. He has suffered many set backs and further injury to his brain twice with the over draining of his brain from a shunt/value issue resulting in his brain tearing from his skull and his head filled with blood. He has been abused by staff and neglected by hospitals but still he struggles on. When God calls my boy home i will feel relief for the end of his suffering and enormous grief for the loss of my beautiful son. However everyday is different with many different ideas and feeling. This condition has so much unresolved grief attached to it, sometimes it feels like the day before the funeral but no one has died. No one has the answers we seek as no one knows enough about the human brain. Miracles are all around us. While there is life, there is hope. Don't listen to closely to how things are supposed to progress as you'll find yourself believing this is as good as it gets. If the brain believes it, the body can do it. Don't let any one speak negative in front of your loved one. Don't let anyone define them. Never let anyone say they can't do something. They kept saying Jamie was blind. But now they relies they were wrong. He says it's still blurry but he 100% sees. I pray for your strength because this is the main component of helping your love one in progress. Daphnejean

My husband is suffering with bacterial meningitis. He also has ITP. He is also a paraplegic from a spinal stroke on January 8, 2015 and he got sick from a bed ulcer on his tailbone. He got meningitis and sepsis and MRSA. He was in a stupor in ICU for 6 weeks and now a week in a room. They told me he is brain damaged and would not survive. He did not have an MRI because of pacemaker. He now opens eyes and sometimes looks panicked and is just now following with his eyes and opening his eyes when spoken to. He cannot use his arms and hands now and cannot yet speak. He was on ventilator for 20 days then a trach/vent and still has trach but breathing without vent FOR 10 days and 30% oxygen but still does not respond to commands. His bed ulcer had caused him osteomyelitis and he is on multiple antibiotics and antifungals. He is a pastor. I would appreciate your prayers for a miraculous healing as you have experienced. We have only been married a year. His first wife of 46 years died of ALS in 2012. He cannot have any vaccines because he had Gilliam barre 15 years ago. He is 71. Thank you.

I feel so bad for all who are suffering as my family is during this difficult time.  My father had a serious brain injury (Subarachnoid hemorrhage) almost 2 months ago.  He was on life support but slowly came off it, now he has a tract.  After about a month he was able to open his eyes but nothing else.  He doesn't move, move eyes etc.  It is so hard to see him this way as i know he would never want this. After about a week and half after the injury the doctors said they expect some "purposeful" recovery, but of course  no guarantee.  I hope he make a recovery... My prayer's are with all.

HI! my wife 24 years old she has been semi conscious from 70 days and when we took MIR the it show ischemic stroke and block her brain vein it that will be recover and how much she will be semi conscious if you inform me thankd

This is the most helpful thing I have ever read, have been struggling to understand all of the technical stuff about a family members brain injury for the past year and this has mad it so much clearer, thank you very much

My mum is currently in hospital she had a brain aneurysm the bleed was very bad she is breathing on here own but no body movement its been 10 days now she will open here eye when asked but not looking to words u, I'm so worried we are not getting told much on what will be the outcome. I'm praying every night .

My huband can wiggle toe follow commands. Can i obtain a power of atty. If he acknowledges thats his wish?

Hi everyone, Reading these comments break my heart. My mother suffered a brain aneurysm last October. She was on the road to recovery but 5 days later, suffered vascospasms (stroke) which put her in a minimum vegetative state. These past 8-9 months have been the most difficult times of mine and my families lives! Some days, she does well and other days she declines. I've read so many of your stories and my heart goes out to EVERYONE here! I just recently read that ambien can help some people in a vegetative state become more aware and conscious. If anyone would like to talk, or if anyone needs a friend or needs someone who is going through something similar, please feel free to email me. KARYNALBERTO@ICLOUD.COM

Thanks for providing this info I have a 21 daughter who is in pvs and i look for help only find that their is not any.

My love was in a terrible car accident June 20th 2015 and has been in a vegetative state since he's has made progress but very little ! He always told me he never wanted to live like that not knowing it would happen to him so now we're facing a difficult choice on letting him go or keeping him in the hopes that he will get better. It's a very hard thing to go through. Keeping everyone in my prayers

Thank you very much for the given knowledge. One of my friend is now on persistent vegetative stage. It happened due to a blood colt during a Thyroid surgery. Now its more than 2 months. I hope for the best recovery of her. Is there any thing we can do for her??

My father sadly passed away in hospital April 16th 2015 after treating a blood clot in his lungs the blood thinners apparently gave him a stroke in the brain which left him in a vegatative state, they took out his feeding and dehydration tube and died 9 days later. Still cannot fathom what has happened.

I have a sister who is in vegetative state for a month now. she has amniotic fluid embolism, a very rare case for pregnant women with the data 1:80,000 who is about to deliver their baby. after the emergency CS doctors need to remove her uterus because of continuous bleeding. after the 2 operation she was transferred to the ICU for her recovery but after 2 hours she had cardiac arrest. it was  very hard, she has 2 beautiful daughters who is waiting for her and misses her. my prayers is for all families who is experiencing the same way. always trust in the Lord coz He is the real doctor, a healer and we should always hold on His promise that He will never leave nor forsake us.

One of my close friends just passed away on yesterday at the age of 24 after being in a coma for several days after a terrible head injury obtained while having a seizure. Thank you for the very helpful informative information. I was able to gain sight of this condition. Thanks!

This information has been very helpful.I share the suffering all those loved ones are going through.My nephew 35 year old had a serious  head injury in Fiji when his rental truck was hit by a government vehicle on 26 april.He was airlifted to Auckland hospital on life support.After 5 days he was again air lifted to vancouver canada on life support.Four weeks ago he start breathing on his own.He is opening his eyes and started to move left arm and leg.No movement on right side According to the doctors his brain had been jolted badly.Now he is in the grace of god  sal vancouver canada

Thank you for the straightforward information. I am 21 years old and am my mom's only next of kin. My mom has been in the hospital for 5 months now and I hope that she will recover. My heart goes out to everyone who is in a difficult time in their lives right now.

My father suffered anoxic brain injury on May 7, 2015. Its been 6 weeks and after a period of no eye opening, he opens his eyes a little more now. He grunts and says things like "uh uh" while his eyes are open. He stares at my mother and follows voices in the room with his eyes. He cries when I play certain songs. Is he in a vegetative state or is minimally conscious? Thank you all for giving me any feedback. P.S. He moves his left arm a lot, but can move his right hand. If I tickle his feet, he doesn't like it. Doctor is very negative and telling me its all reflex.

The doctors also told me it's a relfex but I don't thing so. All the doctors I have dealt with after my father's stroke have been very negative.....I try not to let them get to me and keep praying.....I know and feel inside that it's not just reflex

My heart goes out to these people who are suffering like me

Stay strong. My father went thru this and recovered far beyond what even the doctors expected or could understand. It is a long road for recovery but working with Dad he has come very far. God works in mysterious ways. I wish you the best with your mother. Saying a prayer for you.

May God will be done in our lives. My mother have been in a vegetative state since 4/8 2015 . Our family also believe in miracles. Its in God hand let miracles continue for God is the same who performed all great things long ago. Prayer also changes things also let love take you through. Family who also trust and stand on faith.

God bless you all. You and your families are in my prayers. Stay positive and keep your heads up

I understand your thoughts of not wanting your loved one to suffer. My husband is in a vegetative state and tomorrow hes being moved to a long-term care facility. My heart hasn't ever felt so hollow. Prayer is powerful so are miracles. I hope we both get one. Be encouraged!!! My husband's name is Cedric.

My brother is on life support right now with minimal brain activity the doctors said there's no chance of him waking up because of the severe brain trauma and I can't seem to give up on him. I don't know what to do the doctors said there's no hope. But I want to leave it in God's hands because I seen him make miracles but then I don't want him to suffer

My mother had a massive stroke yesterday, she is 63. She had her first massive stroke back in 1984, an aneurysm, and survived after being comatose for over 6 months. Originally her stroke was on the right side of her brain which affected and paralyzed her left side of her body. However yesterday's stroke happened on the left side of her brain which is now affecting her rights side of her body along with her speech. Currently she is in a vegetative state, but I see it more as a coma. She has no periods of being awake or responsive to anything. I am a 34 year old single mom and I have spent the last 31 years taking care of my mom. There's nothing I wouldn't do to be able to continue caring for her. However, I just want my mom to no longer suffer or be in pain. I want my mom to be in peace. Unfortunately today I had to sign a DNR and honor her wishes...it nearly destroyed me. But at the same time my mom deserves to be at peace. Please pray for my mom, Pat. We could use all the help we can get. Thoughts and prayers to all who are going through or have gone through this.

My condolences to all of the people caring for loved ones in the above-described states.  About 30 years ago I was in a serious car accident that led to a TBI and a lot of broken bones, including a cracked skull and 3 broken vertebrae.  Due to my head and back injury (I think), I was kept sedated for at least 1 week.  I'm writing to share that I had some level of consciousness even though I could not communicate, and it may be helpful to consider that with your loved ones, too. During my stay in ICU, I remember a doctor told my dad I might be vegetative or paralyzed, that they just did not know.  I later confirmed with my dad that this happened.  It's been very challenging since that time in a lot of ways, but I was able to get through school (including a master's program) by working harder than most of the people I knew to just get by in my classes. 

I learned later that a good friend stayed at the hospital throughout this period, only leaving to return home for a shower and change of clothes.  She read to me, talked and acted as though I was awake and responsive.  I'm no expert in TBI, but believe that some of my recovery was a direct result of her care and attention to my mind while ICU staff cared for my body.

Very good description... My Mom is in Vegetative state.. and it almost 2 months of her Brain Surgery (Subarchanoid Haemorrage).. We all are praying for her better recovery.

God bless you

My husband had a vehicular accident last november 13, 2014 and until now he is in a vegetative state.the doctor refuse to make an operation to him because of the place of his blood clot.it is in the center of his brain.now he is in our home, we just take care of him and do our best to help him and let him feel that we love him very much.we hope and pray that he will recover for his three children.please email me if you can share your thoughts if you experience the same case as mine.thank you ang God bless us all.. jackyjeth_08@yahoo.com.ph

My father is in Vegetative Stage now...2 months of unconsciousness..he had a diabetes for many years, badly brain damage from unable to control sugar level ...I am still hoping for the miracle ...wishing for recovery ...

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