Care after coma, during coma and for coma keeps on going if the patient in coma is treated as a neurological patient in stead of a coma patient, that has mental activity that he can use to move if he is helped to do so.

 

DEFINITION COMA

Coma is the situation in which the person can not make movements that are visible.

This definition has been chosen because it covers the situation the patient is in when the diagnose "coma" was given.

 

CAUSE OF THE COMA STATE

The cause of the coma state is a life danger. The cause is not the accident, the fall, the operation, the trauma or the non-traumatic event after which the coma state was developed, but the life danger that came into existance.

To prevent that the physical body would stop to function and death would take over, the physical body has used all the energy available to keep the vital functions active which made moving impossible and that was a new life danger as not being able to move IS a life danger.

Without help from others this person will not be able to stay alive, because the skin needs movement to be able to protect the physical body for illness germs.

 

AWARENESS PATIENT NON RESPONSIV AWAKE SYNDROM; IN OR AFTER COMA; VEGETATIVE STATE; APPALLIC SYNDROM

If the awareness of the coma patient is measured with the Glasgow Coma Scale Test, the patient gets awareness points when he moves as a result of the tests that are done with him, which must give a false result because it is known, that such a patient can not move visibly.

It is also known that a coma patient does not get decubitus as fast as other patients, which is a sign that he moves. These movements can be felt if the patient is examined with "hands on" by taking him or her in the hands and feel how much or how little help is needed to make the movements wanted.

The Coma Science Group in Luik has proved scientifically that patients in coma have mental activity and if this activity is used to make it possible for the patient to move and make a normal movement possible, the patient can be helped to enlarge the invisible movements.

If a movement is found that the patient can make without hulp, every question can be answered with this, because that movement can be "yes, "no", "maybe", "both" or whatever. That has to be indicated for before the question is asked.

 

CONTACT

Everybody has contact with the patient what can be felt through the feeling that one has. One may feel sad, some other time very glad or thankful and if one looks inside, one can discover that this feeling is connected to the patient in coma.

If the loving sister has to go home after a visit of some days, that may be a very emotional situation for the paitent which makes that he starts to breath irregular and deep what a breath machine will judge as "not wanted" or "dangerous".

If the nurse that cares for the patient 24/7, reacts on the protesting machine by moving the patient, he is finally at that moment treating the patient the way that the patient should be treated 14 hours a day: the patient in coma must be helped to move normal.

 

TREATMENT

The starting point is usualy that there is no healing treatment for patients in coma known, a conviction that is based on the experience that the treatment that was given to patients in coma without the starting point that the patient is awake, can breath spontaneous and perceives what situation he is in and what happens in his surroundings, does not help the patient to be able to move visibly.

It is use to believe that the patient does not look active and that it is not possible to get contact with the patient, not even eyecontact and that there is no reaction on being spoken to. It is thought that groaning and moaning and the day- and night rhythm of the patient are without any goal or awareness as well as swallowing.

It is thought that the patient only makes reflex movements and that there is no communication possible. As the name "vegetative state" gives a negative idea and it has not been able to take away this negative idea, the name has been changed into "non-responsive wake syndrome" for the same state.

But this name too does not really describe the state the patient is in as he reacts, but his reaction will not be noticed if only the eyes are used to get aware of these movements. If all handling that is done with the patient in coma has the goal to make it possible for the patient to move normal, the patient will be able to move normal.

Medication also makes it impossible for the patient to function normal.

 

PROGNOSE

If the treatment of the patient in coma is changed, there is a big chance that the result will change. If it is the goal to make it possible for the patient in coma to function normal, another treatment will be given than if the conviction is that the patient will never move again.

The state of coma needs a special treatment and the neurological problems need a neurological treatment, as orthopedic problems need a orthopedic treatment a.s.o., but these treatments can not be disconnected.

 

CONSEQUENCES OF COMA

A coma state is connected to a shock state and IS a shock state. The patient has more or less stayed in the freezing state that is part of being in shock. The shock state is a situation in which all the filters that make that human being can support all the stimulus of daily life, have opened and they did not close properly again so the person is hyper sensible.

This hyper sensibility may concern light, sound, touch, smell, taste, but also the radiation of people. Without being aware all people react on the radiation of the people they meet.

 

WAKENING FROM COMA

If everbody wakes up from his or her coma, one will reflect and try to feel what the patient in coma needs to come into movement again.

One ex-patient tells that he has been like a big eye fastend to the ceiling that was noticing everything that happened with his body in the monthes that followed the life danger and he was treated as "patient in coma".

Another ex-patient does not remember anything from the period that she was treated being patient in coma. Her father tells that one time as he visited his daughter, a man asked him if his daughter was in coma, what the father confirmed.

The man asked for permission to talk with the 17-year old girl that was in bed and the father gave him this permission. The man whispered in the ear of the girl and the father could not hear what the man said to his daughter.

After the man had finished, he came to the father again and told him that the girl had listened to him and that the father would find out what was going to happen. Exactly three weeks later the father visited his daughter again as she suddenly opened her eyes and told her father: "Dad, I had a very good sleep".

The father asked her if she knew how long she had been asleep, but she did not know. She had been in coma for 5 years and could not tell anything that had happened in that time. Her father could imagine this as the treatment that his daughter had been given, had been painful in his eyes.

Another ex-patient could not recognize the nurse that had been reading for her from his journal every day that he had been on duty until his holiday, in which the patient "woke up", but she recognized his voice as he addressed to her. She told him what he had read to her when.

Movements cost energy and give energy. They give more energy than they cost if they are not automatic. That is the reason that movements have to be changed to continue to get energy out of it.

 

CHANCE OF HEALING

The chance to heal depends on the way the patient in coma is treated. If the starting point is that the patient will never be able to move again, the treatment will have that goal. If the starting point is that the patient will be able to move, the treatment will have that goal and movement will be found that the patient can make with minimal help.

"Guided movements" are needed to help the patient in coma to move and "normal movements" must be possible. This means that all "life saving deeds" like tube nutrition and breath stimulation must be finished, so normal movements will be possible.

The guided movements must be done in the speed of the patient. This speed is much lower than the speed that usualy is used to "move" the patient. Also must the resistance of the patient be respected because it is a sign that the movement that is asked, costs the patient more energy than it gives.

If it is the goal to help the patient in coma to come into movement again, prudence and sensitivity will be used and it will be strived after not to cause any pain.

If someone can not ungo pain, what is the case for the patient in coma because he can not move visibly so he can not give the person that causes the pain a clap so he will stop to cause the pain, he may get out of his body until the pain stops.

If the patient in coma feels everything 12x as strong as someone that is not in coma, it is clear what has to be taken care of. The bathing water easily can be too cold or too hot, a touch or sound can be painful and light can hurt too.

If you would imagion being treated the way you treat the patient in coma, would you like to be treated like that and will you still treat him or her that way?

Lots of ex-coma patients do not tell anything about their experiences because.....? Nobody sees the rests that disappear very slowly, if they disappear. The changes in behavior often are not understood by people that can not imagine how it is to live after a life danger.

"Act normal, that is strange enough"?