Waking up from a coma can be a frightening and confusing experience. After days, weeks, or even months of unconsciousness, regaining awareness and cognitive function is a slow process. In this article, we’ll provide an overview of what it’s like to emerge from a coma and how the recovery process typically unfolds.
What is a coma?
A coma is a prolonged state of unconsciousness characterized by a lack of arousal and responsiveness. It is caused by injury or illness affecting the brain stem, which controls basic functions like breathing, heartbeat, and wakefulness. Some common causes of coma include:
- Traumatic brain injury from an accident or blow to the head
- Lack of oxygen to the brain (cerebral hypoxia) from heart attack, stroke, or near-drowning
- Infections like encephalitis, meningitis, or sepsis
- Drug overdose or poisoning
- Severe electrolyte imbalances
Coma is distinguished from brain death because breathing and circulation continue, though assisted by machines in some cases. Doctors assess the depth of an impaired consciousness using the Glasgow Coma Scale, which tests eye, verbal, and motor responses. Coma is considered the deepest state of unconsciousness.
Regaining consciousness
Coma rarely lasts longer than 2-4 weeks before some level of consciousness returns. The process of waking up occurs gradually, though often in fits and starts. As the swelling or structural damage causing the coma heals, areas of the brain may reconnect and reactivate.
The first signs of consciousness may include:
- Spontaneous eye opening and tracking movement
- Grimacing or reflexive movements to pain
- Increased periods of wakefulness
- Simple vocalizations like moaning
As the coma lightens, the person transitions into a vegetative state, wherein they have periods of eye opening and wakefulness but remain unaware of themselves or their environment. Recovery continues toward a minimally conscious state, showing inconsistent but clear signs of awareness like following commands, gesturing yes or no, and intelligible vocalizations. Full consciousness brings complete reawakening of awareness, memory, and cognition.
Cognitive and physical effects
Coming out of a coma is mentally and physically taxing. The longer the coma duration, the more profound the impairments may be. Common effects include:
- Confusion: Disorientation and confusion are nearly universal upon initial awakening. The person may be unsure of where they are, how much time has passed, what happened to cause the coma, and whether their perceptions are real.
- Memory loss: Memory problems are common both preceding and following the coma period. Retrograde amnesia may cause loss of memories leading up to the coma, while anterograde amnesia affects ability to form new memories following coma.
- Cognitive deficits: Attention, planning, problem-solving, processing speed, and communication abilities are often impaired after coma. If areas like the frontal lobe were injured, personality and behavior may also be affected.
- Physical disabilities: Coma patients often awaken to find themselves paralyzed or significantly weakened on one side of the body. Physical, occupational, and speech therapy are extremely important for recovery.
These deficits typically improve over the first 1-2 months but may persist long-term, necessitating months to years of rehabilitative treatment.
Regaining speech and communication
The ability to communicate often comes slowly due to muscle weakness, cognitive impairment, and throat irritation from ventilation. A speech-language pathologist can help gradually regain speech and language abilities through:
- Exercises to strengthen the lips, tongue, larynx, and diaphragm
- Practice making speech sounds and forming words
- Use of writing, typing, or assistive communication devices
- Training to improve word recall, sentence construction, reading, and conversational skills
Family members should avoid finishing the person’s thoughts or correcting errors, which can be discouraging. Using yes/no questions, providing multiple choices, and patiently allowing time to respond can aid communication.
Regaining movement
Paralysis, muscle atrophy, and spasticity from nerve damage are common physical after-effects of coma. Regaining motor function requires months of rehabilitation to:
- Prevent contractures with proper positioning and range-of-motion exercises
- Strengthen muscles with physical therapy
- Practice sitting, standing, and walking skills
- Train in everyday activities like eating, dressing, and self-care
- Learn to use mobility aids and orthotics
Assistive devices like braces, splints, or wheelchairs may be needed permanently for some if certain muscle control cannot be recovered.
Overcoming perceptual disturbances
Strange perceptual experiences often accompany recovery as the brain struggles to reorient. The person may suffer from:
- Hallucinations – false visual, auditory, or tactile perceptions like hearing voices or seeing things that aren’t there.
- Illusions – distortions of actual sensory input, like mistaking patterns in tiles for insects.
- Delusions – strong false beliefs the person thinks are absolutely real, often paranoid or persecutory ideas.
Reality orientation techniques can help ground the person to time, place, and situation. Explaining these experiences as misfirings of the brain rather than actual psychosis can provide reassurance.
Regaining independence with ADLs
Performing basic activities of daily living (ADLs) like feeding, bathing, dressing, and toileting independently is a major milestone. An occupational therapist helps recover self-care skills through:
- Muscle retraining and adaptive techniques or equipment to compensate for any paralysis
- Practicing personal hygiene like brushing teeth, washing, and grooming
- Dressing training with velcro closures or elastic waists to overcome limited mobility
- Adaptive strategies for eating, like specialized utensils or plate guards
Even if some assistance is always needed for certain tasks, restoring as much independence as possible is a key focus.
Coping with emotional and behavioral effects
The personality changes, emotional lability, depression, irritability, and behavioral disturbances that often follow coma have a neurological basis. But they also reflect the understandable frustration, grief, and vulnerability experienced. Counseling and support groups can help by:
- Listening and validating the emotional impact
- Teaching coping strategies
- Helping adjust expectations
- Identifying sources of meaning and hope
Medications may be warranted if there are symptoms like intense agitation or psychosis. But providing a compassionate human connection is one of the best things family and providers can do.
Recovery outlook and statistics
The prognosis for recovery depends heavily on the cause and severity of the initial brain injury as well as the person’s general health. Some key coma outcome statistics include:
- 10-20% of coma patients remain in a vegetative or minimally conscious state
- 20-40% recover with significant disabilities
- 10-20% recover with mild to no disabilities
- Mortality rates range from 30-50%
Younger age, shorter coma duration, and absence of structural damage all portend better functional recovery. But recovery can vary widely even with similar injuries due to individual differences in neuroplasticity.
Coma duration and recovery statistics
| Coma duration | Rate of functional independence at 1 year |
|---|---|
| Less than 1 week | 74% |
| 1-2 weeks | 62% |
| 2-4 weeks | 46% |
| 1-2 months | 32% |
| More than 2 months | 21% |
Early recovery gains are the most rapid as neuroplasticity is high. Longer rehabilitation may continue to yield gradual gains, but the most significant improvement typically occurs in the first 6 months.
Coping with adjustment difficulties
The transition from the hospital to home can be very rough. Problems like social isolation, relationship strain, role changes, and financial pressures often emerge:
- Joining a support group helps connect to others facing similar challenges.
- Relationship counseling assists couples with adapting to personality and intimacy changes.
- Vocational rehabilitation aids the return to work or finding new meaningful activities.
- Financial planning and assistance programs can ease the economic burden.
Seeking help to address these issues facilitates better adjustment.
Conclusion
Emerging from a coma can mean entering a world that feels unfamiliar in many ways. Patience, understanding, support, and rehabilitation are key both for the survivor and loved ones. Though recovery is often slow and frustrating, steady progress brings hope. With extensive therapy and support, many can regain fulfilling lives and relationships in spite of permanent disability.
