Symptoms
Patients who are in a persistent vegetative state appear awake at first glance, but are not able to communicate with their environment. It is impossible for them to carry out everyday activities, to eat or drink independently. Typical symptoms are automated movements, bowel and bladder incontinence, spasms in arms and legs, and retained reflexes.
After a few weeks, a disorder of the autonomic nervous system often becomes apparent, which can manifest itself as sudden high blood pressure, heavy sweating, palpitations and sometimes muscle twitches. This condition usually stabilizes again soon. At the beginning of the coma vigil, the patient is usually dependent on artificial respiration.
After a few weeks in the intensive care unit, artificial respiration can usually be discontinued when the patient breathes on his own again. This is an expression of the recovery of the brain stem. In order to make a diagnosis of apallic coma, intensive observation of the patient over a longer period of time (weeks to months) is of crucial importance.
By determining the typical clinical symptoms, the suspicion of apallic coma can already be ruled out. However, it is important to distinguish between these patients and similar states of consciousness, such as locked-in syndrome or coma, since these patients require different therapeutic treatment. Imaging diagnostics (especially magnetic resonance tomography/MRI) is also important.
In the EEG, brain wave curves can be derived and checked to see whether the patient perceives stimuli from the environment. Evoked potentials (acoustic and somatic evoked potentials) work in a similar way, in which the brain‘s reaction to various presented stimuli is analyzed. Unfortunately, it is not always easy to distinguish the different forms of unconsciousness and the numerous differential diagnoses from the actual waking coma. Therefore, false diagnoses are not too rare.
Therapy
The therapy of coma patients is carried out in several steps depending on the current condition of the patient.In the early phase, when the patient is not yet able to breathe or swallow on his own, he is artificially ventilated and fed through the abdominal wall via a stomach tube. The urine is also drained artificially. In this way, the body functions are maintained.
Physiotherapeutic exercises that start early on are intended to prevent cramping and shortening of the muscles. In addition, it is important that the patient is sufficiently mobilized so that he or she does not suffer pneumonia under artificial respiration. Physiotherapeutic work is also done on the swallowing.
Once the patient is stabilized and his condition has improved, the next therapy stage can be continued. Here, the principle of basal stimulation is followed. The patient is offered stimuli of varying quality to improve his perception, mental and motor functions.
Examples of such therapy offers are music therapy, massages with different oils or materials, work with different colored lights as well as stroking animals. This phase of therapy is crucial, as it is during this phase that the patient’s progress is most likely to be seen, thus laying important foundations for his future. If his condition improves significantly, he can be guided further towards independence through further rehabilitative measures. If there is no improvement, care and response is continued through various stimulation concepts.
