Prognosis
The prognosis for a patient with apallic coma is generally poor. Significantly less than half of the patients recover from this condition, since in most cases severe brain damage has preceded it. Nevertheless, there are various parameters that speak for a better prognosis.
These include a young age of the patient, less than 24 hours coma before the onset of the vegetative state and a traumatic event as the cause of the condition, while vegetative coma patients have a worse prognosis due to oxygen deficiency or reduced blood circulation. Factors that indicate a poor prognosis for the patient are the absence of brainstem reflexes after more than 24 hours, severe changes in the EEG, massive brain swelling, failure of the pupil to respond after 72 hours, and bilateral damage to the brainstem. As a rule, a complete recovery from the vegetative state does not occur – the patients need lifelong help in their everyday life.
If after a craniocerebral trauma there has been no improvement in the condition of the coma patient within 12 months, this is usually not to be expected after this period. There is no direct prophylaxis to avoid a coma vigil. The vigil coma is usually a consequence of heavy brain damage in the context of an accident or other not necessarily foreseeable events.
A foresighted way of life is therefore a basic requirement to avoid such conditions. In order not to develop illnesses that could one day lead to a coma vigil, such as strokes, a healthy lifestyle is the basis. Sufficient exercise and a healthy diet are the basic prerequisite for maintaining health, but cannot specifically protect a person from apallic syndrome.
Care
The care of patients in apallic coma is very different from one person to another and requires a lot of time and experience. Each patient is somewhat different in his or her needs. The care concept is therefore individually adapted to the individual case.
Also depending upon stage of the Wachkoma the measures which can be furnished differ. The patient must not only be cared for physically in his basic needs, but also motor and mental development must be encouraged. A coma vigil patient is therefore often cared for by a team of different personnel.
These include trained nurses and doctors on the one hand, and speech therapists, physiotherapists and occupational therapists on the other hand, and of course the relatives, who should also be included in the care of the patient. By addressing the patient in a targeted manner and repeatedly presenting various stimuli, for example music, tactile stimulation of the skin, the use of animals, lights or colors, brain regions of the patient can be addressed and activated. Some coma patients experience an improvement of their condition. Intensive care and support of the patient is therefore a basic prerequisite for their possible rehabilitation.
