Coma and Persistent Vegetative State
Coma / Vegetative State
A coma is a profound or deep state of unconsciousness (consciousness being the awareness of the self and the environment). People in a state of coma are alive but unable to move or respond to their environment. Coma may occur as a complication of an underlying illness or as a result of an injury, like a brain injury.
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Advice for Families with a Loved One with Severe Brain Injury
I often say to families when someone is very severely injured to keep a journal, to take videos, to begin to chart steps and progress. It's a very slow journey, and families get discouraged as well as the individual. But keep looking back and see where you've come. The most important thing is try not to think you can do this alone. You have to seek help. You have to seek peer support help, you have to seek help from professionals, and you just have to be patient.
Why Predicting Outcomes After Traumatic Brain Injury Can Be Limiting
In terms of long-term outcomes, the--it's really fairly hard to predict, and there's more generalities, and they don't necessarily apply to every case. So you have to be really careful when you start talking about things like that. But as a general rule, the more severe the injury, the less good the outcome is. Having said that, I can show you families in which the child was injured when he was 6, was in a coma for 4 weeks. But because of his family and his therapy, he went home 6 weeks after the acc--well, no--another 6 weeks after he came out of the coma, and the family was superb. And they were able to work with him. And although it took him a long time and he got into high school and the high school said, "No, no, you're going to go through the basic program and just learn life skills," he said, "No, I want to get my degree--you know--my diploma." So he came back and he went back into the general program, and it took him like 8 years to get it instead of the 5--it was 5 at that point in Canada. And he got it, and he's now in a community college, becoming an educational assistant. And he competes for Canada in the Paralympics, because he has a mild weakness down one side. And he speaks. And he's, like, totally awesome. He was depressed. He had major learning problems. He got angry really easily. But his parents, with the support of everybody, was able to channel and teach him how to control those things, give him his self-esteem back. And as he says, he never thought that he was going to be an educational assistant and work with kids with disabilities, when he was 6, but he's really pleased that that is what he's doing now and that he's different than what he was, but he's happy with what he was. And I think that's going to be the real key is if you end up being happy with who you are you end up being successful, and that's true for all of us. It doesn't matter whether you've had an injury or not. So he was successful. I have another kid, same age, who was injured when he was 6, who was not even in the intensive care unit, who has not done well. And partly because he comes from a family where there isn't that kind of support, organization, ability to help contain him and direct him into where he needs to go, and--you know--he's ended up in jail and will probably end up in jail off and on for the rest of his life. So--you know--just because-- The first one had a very severe injury; he's ended up doing quite well. So severity is not always the factor. There's severity of injury. Usually the younger you are the less good the outcome. But there's a number of other factors: how much--sort of--family and community support there is, how much do they accommodate and adjust and teach and train makes a big difference. Whether you develop other comorbid problems--I talked about depression as being a really prevalent problem in 70% of the kids, or adults, for that matter, get depressed. Well, you might expect an adult to get depressed, but a lot of people don't think of children as getting depressed. So we don't think of a 5- and a 6-year-old as being--that maybe what's happening is this child is depressed. And sometimes the kids actually get to the point where they try and kill themselves before somebody goes, "Oh. This is a problem here." So being aware that depression could be an issue and that you need to treat the depression if you want to be successful. Anybody who's really depressed is not going to do very well, so you need to be looking for other--you know--concomitant problems. You need to be able to recognize if the child is having a seizure and treat the seizures so that, again, that they can do better. So you need to look at medically how they're doing. You want to look at helping the family function and cope. You want the schools to be able to learn and cope. And you want to be able to instill in that child a sense of being happy for doing what they're doing. And I think those are the factors that make you most--you know--the better outcomes. I think that we're starting to find ways of minimizing the injury which are going to improve outcomes. But there's still a long way to go, and there's a lot of things that can be done by families and by communities that will make a big difference to their child's outcome.
"I Am Not a Vegetable, I Am a Person"
About half of all Parkinson's patients have significant emotional and cognitive deficits. [Paul Aravich, PhD; Professor, Eastern Virginia Medical School] So therefore, the person who has a moderate-to-severe traumatic brain injury in Afghanistan or Iraq is indeed at increased risk for cognitive problems associated with Parkinson's and associated with Alzheimer's down the road. But we don't want to say that's inevitably the case. It's kind of like having high cholesterol. You have cholesterol; it doesn't mean you're necessarily going to get a stroke or a heart attack. It means you're at increased risk. So we don't want people to think because they have a moderate or severe traumatic brain injury inevitably they're going to have Parkinson's, inevitably they're going to have Alzheimer's disease. And we like to say if you've seen one brain injury, you've seen one brain injury. And so insofar as comparing one person to another is concerned, very difficult to indicate what's going to happen. We bring to my medical students people from the Brain Injury Association of Virginia and the foundation that I work with called The Mary Buckley Foundation. This past--couple of weeks ago, we brought in a person who was-- said to be--going to be a vegetable. That's what the neurosurgeon said, "You're going to be a vegetable." And he stood in front of my students twenty years later and said, "No, I'm not broccoli. I am not a vegetable. I'm a person." And so it's very difficult to know who is more at risk or who is less at risk. What we know is that what harm is there to have a healthy lifestyle. And we know, for example, Alzheimer's disease risk factors are highly correlated with, among other things, cardiovascular disease risk factors. And so if you're using a heart-healthy lifestyle, what do you have to lose? It's going to be potentially good for your heart and who knows, it may be good for your Alzheimer's itself.
