Attn Qagdop, picnurse, and all other medical dopers…
I’m writing a story (more of an epilogue, really) about someone who wakes from a four to six month coma, resulting from a gunshot wound to the chest, which is (possibly) complicated by infection. What type of recovery would he expect?
Is it true, that most coma victims need to learn all basic functions again, like brushing teeth, tying shoes, even going to the bathroom?
How long would it take for the patient to leave the hospital? Would they wait until he was nearly functional (i.e. walking & talking) or could he return home while still invalid?
Neurological damage – what should be expected? (For story purposes, I’m assuming it’s limited to memory loss, but little personality change…makes the story more convenient to write. :D)
What methods are used in helping coma patients recover? (e.g. physical therapy)
Assuming full recovery, how long before the patient is 90-100% back to normal?
First of all, the likelyhood of a long term coma from a chest injury is unlikely, unless there was significant hypoxia (oxygen deprivation), causing brain injury. In that scenario, the brain damage would most often be permanent.
The type of coma people awaken from after months or years are those caused by infections, such as encephalitis, (inflamation/infection of the brain) and meningitis. (inflamation/infection of the membranes surrounding the brain.) Both viral and bacteral infections can cause long term unconsciousness that they may or may not recover from. These patients sometimes wake up all at once. They still need physical rehab, but most of the time they still have their perviously learned abilities.
If your character were shot in the head, or had any type of tramatic head injury, he could gradually awaken over several months. A rule of thumb for this type of patient is, for every day of unconsciousness, the patient will need one month of rehabilitation.
These people may have to relearn everything, depending on the area of the brain damaged. They may understand language, but be unable to speak, or write, for example.
They would also need physical rehab due to being bedridden. No matter how much passive exercise they get, they have muscle wasting. One needs some resistance to keep muscles strong.
As far as changes to the individuality and intelligence, head injured patients may get most of their personality and intelligence back, but many don’t. They may rehab to a certain point then make little or no progress. Many head injured people need some level of care for the rest of their lives.
Of course, it all depends on the amount and area of injury.
I hope this helps.
I missed one thing, memory. Head injured patients will most often have some retrograde amnesia, never remembering the period surounding their injury. If they have frontal lobe damage, they may lose all short term memory. Long term memory seems to be hardier.
My own brother has this problem. His long term memory is fine. It seems strange, but he seems to store things in long term without being able to access it for several years. While at our father’s funeral, he couldn’t remember who I was, ( I hadn’t seen him since his accident 4 years earlier) but now, when I see him, he remembers me from the funeral, but not after.
As far as leaving the hospital, they would probably move to a separate rehab center, or to an extended care facility. If the family has the stamina and resources, they could go home, but that puts a big strain on loved ones.
Rehab has to be intensive. Basicly, every waking hour has to be used to redevelop needed skills.
If your patient were to have 100% recovery, a four to six year period of unconsciousness would require about 120-180 years of rehab.
I’m afraid, you’ll have to use some artistic license for the scenario you want.
One thing I noticed from my SIL who was in a coma for two or three weeks, the respirator tube totally ruined her voice. I don’t think that happens all the time, but her voice was never right again. My other SIL, however, seems to have gotten her voice back after being on the respirator for a week.
One of my old best friends got hit by a train and recovered from a 3 month coma. He recovered enough to marry his long-time girlfriend and work as an air conditioner technician but other friends say “He is just not right in the head.” When I saw him for the first time in years and the first time since the accident, they were right. He could hold a conversation but he had a disturbing wild zombie quality about him.
Since we’re offering anecdotes at this point, I can offer two for personality changes.
The first is my grandmother, who by most accounts was a harsh, critical humorless woman for much of her life. Example: when my mother finally held onto a pregnancy (me) after years of miscarriages, she gave my grandmother a little photo album with “Grandma” written on it as a way of telling her. My grandmother threw it into the waste paper basket at her feet and told her she’d get a better one if she (my mom) actually managed to have this baby. ( :eek: )
Just before I was born, my grandmother fell down the concrete stairs to the basement and was unconscious for several days. When she “woke up”, she was an entirely different person. She was warm and sweet and affectionate. Still is, 31 years later. I simply cannot fathom that the cold, uncaring mother my mother tells me about could be the grandmother whom everyone now agrees is the most warmhearted sweetie you could imagine. (And it’s not just my mother’s POV - everyone who knew her before The Accident agrees.)
The second example is a guy I went to high school with. Bad boy druggie. Expelled for bahavioral problems. Became a heroin-and-everything-else addict. He was a real jerk, on top of it. Thrill seeking, addictive personality, spent time in and out of rehabs and mental hospitals and jail.
About five years ago, he got hit by a car while he was high on who knows what. He spent about six months in a coma. When he woke up, he had no memory of his tumultuous teenage/young adult years. Last he remembers, he was a boy scout. He was never told about his addictions or law troubles, and is now a respectable, stand-up churchgoer who holds a steady job and pays his taxes. He doesn’t even drink alcohol or smoke! He has no clue who he used to be. It’s really weird to see him around town now. He doesn’t remember anyone he used to know (in high school or after) and the whole town is under this sort of conspiracy of silence to prevent him from learning about what he was like, lest he return to that lifestyle. His parents believe God gave him a second chance at life by literally wiping his slate clean.
Thanks for the replies. Here’s what I’ve got so far:
(1) It’s the infection, not the injury itself, that causes the coma. Already wrote it that way, so I got lucky.
(2) We’re assuming the patient is a young, healthy male, with a VERY fast recovery, the type that doctors would describe as “miraculous”…however, I want to avoid as many “movie coma” cliche’s as possible.
(3) Neurological damage – I’ll leave up to artistic license, but I do want to avoid something so far off from reality, that professionals will read it and think, “Uh-uh, no way, never happen!”
I do need to know more about the physical recovery from muscle atrophy, since that’s what this story focuses on. (Astro’s link, unfortunately, didn’t address that part at all.)
picnurse – you say the general timeframe is “one month per day”…is that for full recovery, or does that mean it will take many months for the patient to even sit upright again??
Also, the breathing tube – would a coma patient always need one? And would a tracheotomy (instead of a tube down the throat) also have long-term effects on the voice?
I was in a coma for about a week due to a traumatic brain injury in 1995. The coma lasted about a week and it took me a month to become self-aware. That month I lived in a delusional dream-world, my family and friends tell me all kinds of things that I believed: I was on a submarine, I was on the starship Enterprise, I was being held prisoner in the Soviet Union, that they had removed my lungs and fitted me with artificial gills so that I could live underwater, etc, you get the picture. I believe that, being unable to understand the reality of my situation and unable to remember most of my life, I made shit up. Many of the scenarios I created could be traced to books that I had read and movies and TV shows that I had watched along and along throughout my life.
When I became self-aware, I had been moved to the rehabilitation ward where the stroke survivors were. Seven weeks after the accident I was able to walk out of the hospital by pushing one of them walkers on wheels. That was a realy big achievement, it would be two years before I had the mental capacity and the motor skills necessary to exist as an individual once again. I saw Dr. Cuddy, my nuerosurgeon, last year. He told me that at the hospital their goal was to keep me alive and rehabilitate me to the point that I could assist in my up-keep. In other words: stand while I was being dressed, take bites when food was being offered, move myself from one piece of furniture to another. I was not far beyond the capacity of a toddler. He would have never imagined that I would recover as I had.
Now for the pertinant facts about my injury and recovery:
My injury was not as bad as it could have been, my right-frontal lobe had been bruised, there were no broken bones and my wife insisted that they did not drill holes in my head (that was the best known treatment at the time).
I required full-time assisted care for nearly three years after the accident for the first six months I could not feed myself or take care of my own basic hygene.
I was 32 years old and in good health at the time of my accident, the organ procurement people met my wife at the door.
I have vague recollections of most of my life to the point that if there is not physical evidence or a reliable witness to an event, I do not know that it is not something I’ve dreamed up.
I did not have a strong will to live, for the first year after the accident, if I had had the motor skills or some suitable weapon, I would have put an end to my life.
Three years into my recovery I had an epiphany: If I did not do more to furhter my recovery, I would not get any better. I became driven.
A pal of mine in college was a sprinter. Almost world class, I mean he could absolutely fly. Got an olympic tryout and everything.
Then, during one summer his truck got hit from the side. He went through the windshield (along with another pal of ours). George went through forehead first. He was in a coma for a couple of months.
And when he came out he seemed to be fine. He slipped right back into his classes and made up some missed time. No worries.
But he wasn’t as fast. Ever again. He’d lost a step or three and it never came back. Whether that was some sort of neurological thing in terms of his being able to control his muscles as well or just the physical trauma of being out of training for so long I’ve never known.
KGS, the month per day is just a general time frame. The end point depends on the severity of the injury, the site of injury, the motivation of the people helping the patient, and the patient’s own level of motivation. Someone who really wants to get well, will usually get there a bit faster than average. Someone with little motivation, may never reach his full potential. It definately can take months, or even years to make progress.
The need for respiratory support, again, depends on the injury. A brain injured patient who goes to rehab with a trach because the respiratory center is damaged, will probably not fully recover. I say this, because it’s likely the “alarm clock” (the area in the brain that tells us to interact with the world.) is broken too, as they are physically close to one another.
During the critical period, it’s most often necessary to control the patient’s breathing, so they would have a breathing tube. After a week or two, the breathing tube is usually replace by a tracheostomy, a smaller tube in the neck, that is less likely to cause permanent injury, so can be used long term. Removing the trach is often part of rehab when it was only needed for that control. As far as the voice, it’s a bit of a crap shoot. If the person is very restless, and moves his head around constantly, he could rub even the trach tube around enough to cause permanent vocal changes. But most of the time, they have a sore throat for a while and have to speak softly, but it comes back over time.
Most likely by the time one goes to rehab, he’d be breathing humidified room air and without a ventilator.
The physical rehab starts with the therapist lifting a limb and asking the patient to try to resist. This kind of exercise might start in the ICU, if the patient can cooperate. It progresses to sitting in a chair, even if they must be lifted and placed in the chair. After an long illness, even that can feel like a marathon.
Every muscle needs to be strengthened, so things like squeezing a rubber ball for hand strength, shoulder shrugs, lifting one’s own arm, can be feats of strength that become milestones to recovery. It’s all about baby steps.
I’m sure a few people have wakened from very long periods in comas-what do these people report? Did they have any sense of the passage of time? Can you imagine going to sleep in 1918 and waking up in 1968? That would be an overwhelming change for you.
Do people in long comas dream at all?
There was a case last year, where a Buffalo firefighter woke up from a ten year coma. He was shocked when he talked to his youngest son on the phone, because he expected to hear a toddler, instead of a teenager.
Actually he (the firefighter) just died a couple of months ago.
From what I’ve read, waking from long-term coma (over a year) is extremely rare, and full recovery is pretty much impossible after that long. A recent show on the Discovery Health Channel showed a man who woke from a 15-year coma – he was bedridden, arms still in the typical “posturing” position, and while he was aware and could talk, his voice was nearly unintelligible. (He also kept making sexually inappropriate comments to his teenage daughter, thinking that she’s actually his wife.) The doctors called his recovery “unprecedented.”
Ok, back to the OP…I’m still a bit wooly on the exact time frame for recovery. What I have so far is this:
(1) Character gets shot, wakes from coma 2-3 months later (I shortened it a bit.)
(2) Seven months after shooting, he’s at home, able to sit upright and do small tasks like dressing himself, or dialing a phone; he can walk, but with great difficulty, and cannot stand for than 1-2 minutes at a time. Basically, he’s very weak overall (can’t open a Coke can w/o assistance, for example.) Parents are retired, and have resources for any therapy needed – would physical therapy still be 24/7 at this point?
(3) One month later (8 mos. after accident) he’s well enough to fly on a plane to NYC and appear on The Early Show to talk about the accident. He’s improved to the point where he can walk w/o assistance, although standing in line at the airport is a big problem. (He’s too proud to use a wheelchair.) Still weak, has a long way to go, but he’s on the mend.
I’ve heard of experimental treatments, like hyberbaric chambers, used for coma patients. Are they still used, and have they shown positive results?
Also…those rubber balls you squeeze to strengthen your fingers, is there another name for them? I just wrote a line where his mother said, “Don’t forget to squeeze your balls, honey” and it kinda killed the mood of the scene…
Per my earlier post, you’ve asked a specific question…a brand name for the rubber balls is “Thera-Balls”. Along that same line, to get my motor skills back on track after my brain injury, my wife made me stand with my back to the wall for balance and she would throw these balls made of rubber bands. Cush-balls, I think she called them. When I could catch them regularly, leaning against the wall, she had me stand away from the wall and try to catch them. It was a fun game. I looked forward to it.
About six months after my brain injury, I could walk about 20 feet without a walker and I would be flat on my face. I had physical therapy for six months, then the money ran out. My wife helped me do the excercises after that, it was repetative anyway.
I required supervision and assistance 24/7 for most of the first two years. Two years after my brain injury I made a one hundred mile bus trip by myself. A state agency put me on it to return home after a vocational evaluation. My wife was livid, she called the governor, “Does your people make it a habit to put brain damaged people on the bus alone!!!” she had told him. It was an adventure for me.
Thanks, hlanelee, for the answers. Your feedback is indeed helpful. Congrats on your recovery, btw.
Hope this isn’t too personal – at what point, would this person be able to use the bathroom unassisted? It’s a very active process, when you think about it – all that sitting, standing, wiping – and it would be a significant milestone for this character.
Also, were there any days, and how often, would you need to “take a break” from all the therapy, and do nothing at all that day except watch TV, passive stuff like that?
Again, a direct question. And a direct answer, I couldn’t wipe my own ass for about 6 months. I wish I had been pleasant every time I had to ask my wife to do it. I put it off as much as I could. I was able to make a peanut butter sandwich for my self two months after the accident, about three weeks after I got home. I ruined a whole loaf of bread doing it but I fed myself.
Passive stuff? I didn’t have the capacity to watch TV for nearly a year. I would forget things that happened if they were more than a few minutes apart. In other words I couldn’t keep track of the events on a half hour TV show. There were no breaks, everything I did was a therapy of some sort: practicing walking, playing memory games, trying to get dressed. I was a 32 year old man with the capacity of a toddler. A lot of things were familiar but EVERYTHING was new.
It was a great adventure…many times I wished that I had died on the highway. I got in the bathtub one time with a window fan. Would have worked if it work for the damned GFCI outlet.