State of Unconsciousness: Dealing with Victims of Traumatic Brain Injury

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State of Unconsciousness: Dealing with Victims of Traumatic Brain Injury

There is no eye-opening or purposeful movement, and there is no external interaction when a person is in coma / Photo by Getty Images

 

Following a traumatic brain injury, surviving patients will often fall into a physical state of minimal to no consciousness. The state of prolonged unconsciousness is commonly referred to as a comatose state. However, there are actually three common states of unconsciousness: coma, vegetative, and minimally conscious. The differences in the various states are characterized mostly by the unconscious behavior of the patient and their response to external stimuli.

 

27 years of unconsciousness

Munira Abdulla is a woman from the United Arab Emirates who awoke from a comatose state after 27 years. She was picking up her son from school in 1991 when a tragic car accident occurred. Although she was able to protect her 4-year-old son at the time by cradling him, she suffered a serious brain injury and fell into a comatose state. She was diagnosed with a minimally conscious state in a hospital in London and was hospitalized for nearly three decades in the United Arab Emirates. She would transfer from hospital to hospital amid insurance constraints until April 2017 when the Crown Prince Court gave the family a grant to move Abdulla to Germany for a more comprehensive care program.  Almost a year later Abdulla awoke from her stupor and is now on the road to recovery.

Comatose state

The most common cause of comatose state is traumatic brain injury that happens to an estimated 69 million individuals annually. There are various causes of head injuries and in varying degrees of severity, with motor vehicle accidents becoming the primary culprit. A study was conducted from 2003 to 2006 on the incidence of head injuries in Al-Ain in the UAE, and it was found out that among the patients, 88.3% had mild cases, 5.7% moderate injuries, and 12.1% had severe injuries. Road traffic collisions were the biggest cause at 67.1% followed by 11.9% caused by falling from heights. Severe injuries, which often lead to a period of unconsciousness, only have a 20% to 40% survival rate.

Diagnosis of unconscious states will commonly result in one of the three types as mentioned previously. Of the three states, coma is the most unresponsive. There is no eye-opening or purposeful movement, and there is no external interaction, such as responding to instructions or to any form of communication, verbal or otherwise. While a vegetative state also does not show meaningful cognitive function, there are some unconscious responses to external stimuli at times. Patients in a vegetative state can experience a sleep-wake cycle with periods of eye-opening, during these times they may briefly move their eyes to persons or objects. Loud sounds may cause vegetative patients to become startled and stretching tight muscles might generate a moan or other sounds, but in general, the reactions are mostly unconscious behavior and reflect little conscious effort.

Observation and prevention are important in caring for comatose patients, as they will not be able to express their discomfort / Photo by Getty Images

 

Minimally conscious patients show more cognitive interaction, as compared to the other two states, however, they are still considered comatose as interactions are usually inconsistent. These patients will sometimes follow simple instructions and may even communicate yes/no through the use of gestures. Less severe cases may even speak understandable words and phrases and respond to people, things, and events by showing some emotions, gesturing, or even keeping prolonged eye contact. Although these actions do happen, they are usually very inconsistent.

 

Caring for comatose patients

Given the unconscious nature of their illness, observation and prevention are important in caring for comatose patients, as they will not be able to express their discomfort. Feeding will be conducted via feeding tubes while bladder and bowel relief can be resolved with a catheter and/or diapers. Special bedding and periodic turning of the body is required to prevent pressure (bed) sores as a form of skin care. Management of muscle tone through stretching and movement is also important as the lack of movements and use of the muscles can lead to muscle atrophy, or the wasting away of the muscle. Lastly, treatment of infections and medical conditions, such as fever, seizures, etc. are crucial and require good observation of the patient’s health.

Guardians and family of the patient

As much as the patient may be suffering, those who are taking care of a comatose patient will also suffer in their own way and should not be neglected. The emotional stress can be quite taxing to the guardians or family of a patient. From losing contact with a loved one to the helplessness and apparent lack of progress in the recovery of the patient can really burden the caregiver and sometimes lead to harmful coping mechanisms. Take care to avoid these behaviors and find healthy outlets, such as keeping a recovery journal to record the smallest victories to dreams of life after recovery. Talking and getting advice from others who have experienced the same is also very helpful. One may be able to get some solace or closure and even get some advice on dealing with the financial struggles that inevitably accompany prolonged hospitalization.

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