Delayed Recovery from the Vegetative and Minimally Conscious States

Background: Severity of brain injury is determined by the depth and duration of coma. Most patients who recover from coma open their eyes by four weeks post injury. They are then no longer in coma. They may have recovered... [ view full abstract ]

Background:
Severity of brain injury is determined by the depth and duration of coma. Most patients who recover from coma open their eyes by four weeks post injury. They are then no longer in coma. They may have recovered full consciousness or they may still have reduced awareness/a disorder of consciousness (DOC). There is disagreement as to the percentage of patients who remain with a DOC after several months and then show some recovery.

Aims:
1.To identify patients who made a delayed recovery 12 or more months after remaining with a DOC. 2. To see if recovery was more likely for those who survived traumatic brain injury (TBI) and those who survived from other causes (mainly hypoxia).

Method:
All patients (N=26) with a disorder of consciousness, admitted to a rehabilitation centre over a three year period, were assessed with the Wessex Head Injury Matrix (WHIM) and the Disability Rating Scale (DRS) to determine if they had emerged from a DOC.

Results:
Three patients with hypoxic brain injury died. Eighteen patients remained with a DOC for 12 or more months (14 in the Vegetative State and 4 in the Minimally Conscious State. Five patients (19%) emerged from a DOC (showed delayed recovery). Of these 4 had sustained a TBI and 1 had hypoxic damage.

Conclusion:
We found that 19% of people who had a DOC for 12 or more month’s recovered consciousness and that survivors of a TBI were more likely to show delayed recovery than non TBI patients.