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.
Facts About Comas
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.
Coma Scales
There are several scales used to describe the level of response in individuals with brain injury. In acute care, the Glasgow Coma Scale is often used. The Glasgow Coma Scale rates eye opening, motor movement (movement of the arms and legs) and verbal response. Each response has a score. Total scores range from a low of 3 to a high of 15. The lower the score, the more complicated or severe is the brain injury.
Glasgow Coma Scale
Eye Opening Best Motor Response 6 = Follows commands |
Best Verbal Response 5 = Oriented and converses |
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
Rehabilitation centers and hospitals may use the Rancho Los Amigos Scale. The Rancho scale measures levels of cognitive or mental functioning.
There are eight levels of cognitive functioning in the Rancho scale:
- No response to stimulation
- Generalized response to stimulation
- Localized response to stimulation
- Confused, agitated behavior
- Confused, inappropriate, non-agitated behavior
- Confused, appropriate behavior
- Automatic, appropriate behavior
- Purposeful, appropriate behavior