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What is Coma?

    Coma may be defined as "a prolonged unconsciousness caused by disease, injury, or poison" (Gage Canadian Dictionary, 1983).  It is commonly known as a state similar to sleep, but in which the person cannot be aroused and does not respond to any type of stimulation.

     People in coma may still be able to hear and to understand what others are saying around them.  For this reason, it is important to be aware of what is being said in their presence.  It is recommended that friends, family, and staff refrain from speaking negatively about the patient or his progress.  It is also recommended that staff be encouraged to speak to the person and explain what they are doing to him or her.  For example, before conducting any type of test, explain that a test will be done, what it is, what they have to do in order to take the test, and why it is important.

Levels of Coma

    There are several levels of coma defined by the patient's increasing awareness to his surroundings. Professionals measure levels of coma by the Glasgow Coma Scale or the Rancho Los Amigos levels of cognitive functioning. Generally, there are four possible awareness states when coming out of coma.

1. The Comatose and Unresponsive State
In this state, the patient makes no response to stimuli.  He has no facial expressions and there is no movement of any kind.

2. The Comatose but Responsive State
In this state, the patient makes a response when his senses are stimulates (that is, sight, hearing, touch, smell, and taste).  His breathing rate may increase, his heart rate may increase, he may make facial expressions, or he may have some movement of his body.

3. The Conscious but Unresponsive State
This is also known as the "locked in" state.  The patient may be able to see, hear, touch, taste, and/or smell but is unable to respond.

4. The Conscious and Responsive State
The patient has emerged from his coma in this state and can respond to simple commands.

Coming out of Coma

    When coming out of coma, a patient may make incomprehensible noises and/or move one or both arms or legs in a random, uncoordinated, and repetitive movement.  They may often try to pull any tubes out, have facial expressions, groan, cry, or shout.  They may also try to move and may resist people doing anything to them.

     One belief in terms of why a patient may make such noises or movements is that he is attempting to express himself.  He may be expressing that he is trying to get better, that he doesn't like what has happened, or that he doesn't like what people are doing to him.  He may also be expressing that he wants out of the situation he is in.

References
Freeman, E.A. (1987). The Catastrophe of Coma: A Way Back. Queensland, Austrailia: David Bateman Ltd.

Ivan, L.P. & Bruce, D.A. (1982). Coma: Physiopathology, Diagnosis and Management. Springfield: Charles C. Thomas.

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