When it comes to public perception, comas have reached an almost mythical status. Many believe that comas represent an irrevocable decline in physical and mental health. While comas are indeed serious, physicians still take measures to evaluate patient progress toward healing, as well as brain activity that may indicate whether the coma patient is capable of recovery. Normally, a coma is defined as unconsciousness that lasts more than six hours, during which a person cannot initiate voluntary actions or respond to stimuli such as light or sound. In some cases, the patient may appear awake, but will not be able to speak, hear, move, or feel. These symptoms are usually easily diagnosed, but the underlying causes may be varied and difficult to discern.
Physician evaluations typically begin with a general physical examination and a detailed individual and family medical history. Physicians then evaluate whether the patient is actually comatose or is still showing variable (if somewhat suppressed) signs of physical or mental activity. The Glasgow Coma Scale (GCS) is then used to assess how deep the coma patient’s unconsciousness may be, along with a score indicating their response rate. Perhaps unsurprisingly, the Glasgow Coma Scale is a more detailed physical examination specifically geared to measure the responsiveness of the central nervous system. A physician measures three primary response areas: 1) eye response (such as whether a coma patient’s eyes open in response to vocal cues or simply at random), 2) verbal response (such as whether a patient is able to produce sounds in response to cues) 3) motor response (where a coma patient is evaluated for their response to pain).
After patient stabilization and Glasgow Coma Scale assessment, physicians begin to plan a course of treatment. Naturally, this depends on the severity of the coma itself: coma patients who are in extremely deep unconsciousness may require extra measures for their own safety, given that they have less control over the muscles in their face and airway. This means that asphyxiation is a definite risk, so deep unconsciousness is often monitored closely with additional safeguards (such as plastic tubes) to reduce the incidence of airway blockage.
Recovery rates vary widely and are not easily predicted due to the highly variable original cause for the coma. Even when patients emerge from the coma they may be in a vegetative state, depending on the specifics of the injury or illness they originally sustained. For patients who regain full consciousness, their motor skills, speech, and memory may be impaired and require a course of treatment that incorporates physical therapy, grief counseling, and speech therapy. Physicians will often need to monitor the former coma patient’s progress closely (particularly during physical therapy sessions) to asses neurological progress.