Learn about TBI - For Individuals and Families
Facts About Comas
Coma, a state of unconsciousness from which a person cannot be aroused, is common following a brain injury. It is difficult for health care professionals to predict how long it may last. Characteristics of a patient in a coma include the following.
- Eyes are closed; patient looks asleep
- Does not speak or respond when spoken to
- Does not follow spoken commands
- Unaware of surroundings
- Does not respond to touch, sound or light
It is not known how much a patient in a coma hears, understands or feels. Families, visitors and staff should talk and behave as though the person can hear and understand.
Early Stages of Coma Recovery
Emerging from a coma is a gradual process of becoming more responsive and aware of people and surroundings. As the awareness improves, confusion may increase. The patient may not recognize family members or close friends. The person may become angry, shout, swear and try to hit people. Noise, light, touch or movement may trigger extreme reactions. These are normal reactions as the person emerges from a coma and are usually temporary. They are signs of progress but can be very unsettling for families to observe.
How Families Can Help During Coma Recovery
- Keep talking, noise, touching and general activity to a minimum, as these things can increase the patient's confusion and agitation.
- Give reassurance. Briefly explain what happened and state where the patient is. Repeat this, as the patient may have difficulty taking in new information and remembering it.
- Tell what time of day it is, but keep it simple.
- State who you are and who else is there.
- Touch the patient when you speak to help him figure out who you are and where you are, if this does not cause agitation.
- Bring in something familiar, such as a picture, favorite blanket or tape of a special song.
- Avoid arguing.
- Give information instead of asking questions; tell the person what to do or what is happening.
- Give visual information to help orient the patient. Post a calendar and mark off the days. Use signs as reminders of where the patient is.
- Write a short description about your family member describing their interests, likes, dislikes, family, etc. This will help the medical treatment team to know the patient better.
Measuring Comas
Glasgow Coma Scale
The Glasgow Coma Scale is a general guide for measuring the depth of coma and the alertness and responsiveness of a patient after a brain injury.
The Glasgow Coma Scale is based on measuring:
- Eye opening
- Verbal or spoken responses
- Motor or physical responses
Here's what the Glasgow Coma Scale scores:
Eye Opening
4 = Spontaneously
3 = To voice
2 = To pain
1 = No response
Best Motor Response
6 = Follows commands
5 = Localizes to pain
4 = Withdrawal to pain
3 = Abnormal extremity flexion
2 = Abnormal extremity extension
1 = No Response
Best Verbal Response
5 = Oriented and converses
4 = Disoriented and converses
3 = Inappropriate words
2 = Incomprehensible sounds
1 = No response
Figuring out the Score
The Glasgow Coma Score is figured by adding one score from each category. Eye + Motor + Verbal = Total Score
| Brain Injury | Score |
|---|---|
| Mild | 13-15 |
| Moderate | 9-12 |
| Severe | 8 or less |
Rancho Los Amigos Scale
The Rancho Los Amigos Scale of Cognitive Recovery is an eight-stage scale that is widely used in hospitals and rehabilitation centers. It tracks recovery and is used to help design treatment goals.
There are eight levels of cognitive functioning in the Rancho Los Amigos scale:
- No Response
Patient appears to be in a deep sleep and is unresponsive to stimuli. - Generalized Response
Patient reacts inconsistently and nonpurposefully to stimuli in a nonspecific manner. Reflexes are limited and often the same, regardless of stimuli presented. - Localized Response
Patient responses are specific but inconsistent and are directly related to the type of stimulus presented, such as turning head toward a sound or focusing on a presented object. He may follow simple commands in an inconsistent and delayed manner. - Confused-Agitated
Patient is in a heightened state of activity and severely confused, disoriented and unaware of present events. His behavior is frequently bizarre and inappropriate to his immediate environment. He is unable to perform selfcare. If not physically disabled, he may perform automatic motor activities such as sitting, reaching and walking as part of his agitated state, but not necessarily as a purposeful act. - Confused-Inappropriate, Non-Agitated
Patient appears alert and responds to simple commands. More complex commands, however, produce responses that are nonpurposeful and random. The patient may show some agitated behavior in response to external stimuli rather than to internal confusion. The patient is highly distractible and generally has difficulty learning new information. He can manage self-care activities with assistance. His memory is impaired and verbalization is often inappropriate. - Confused-Appropriate
Patient shows goal-directed behavior, but relies on cueing for direction. He can relearn old skills such as activities of daily living, but memory problems interfere with new learning. He has a beginning awareness of self and others. - Automatic-Appropriate
Patient goes through daily routine automatically, but is robot-like, with appropriate behavior and minimal confusion. He has shallow recall of activities and superficial awareness of, but lack of insight into, his condition. He requires at least minimal supervision because judgment, problem solving and planning skills are impaired. - Purposeful-Appropriate
Patient is alert and oriented and is able to recall and integrate past and recent events. He can learn new activities and continue in home and living skills, though deficits in stress tolerance, judgment, abstract reasoning, social, emotional and intellectual capacities may persist.