Family voices and stories speed coma recovery
“Can he hear me?” family members are desperate to know when a loved one with a traumatic brain injury is in a coma.
A new Northwestern Medicine and Hines VA Hospital study shows the voices of loved ones telling the patient familiar stories stored in his long-term memory can help awaken the unconscious brain and speed recovery from the coma.
Coma patients who heard familiar stories repeated by family members four times a day for six weeks, via recordings played over headphones, recovered consciousness significantly faster and had an improved recovery compared to patients who did not hear the stories, reports the study.
The paper was published in the journal Neurorehabilitation and Neural Repair January 22.
“We believe hearing those stories in parents’ and siblings’ voices exercises the circuits in the brain responsible for long-term memories,” said lead author Theresa Pape. “That stimulation helped trigger the first glimmer of awareness.”
As a result, the coma patients can wake more easily, become more aware of their environment and start responding to conversations and directions.
Brain Injury: Understanding Coma
Coma is common with severe brain injuries, especially injuries that affect the arousal center in the brain stem. Understanding coma can be difficult because there are many levels of coma. In general, coma is “a lack of awareness” of one’s self and what is around one. A person in a coma can’t sense or respond to the needs of his body or his environment.
A person in a coma:
- May or may not have their eyes closed all the time.
- Cannot communicate.
- Cannot move in a purposeful way, such as following instructions like “squeeze my hand, or open your eyes.”
Because their eyes may be closed, many of us think of someone in a coma as being asleep. The difference is that you can get someone to open their eyes when the are asleep. But you can’t get someone in a coma to open their eyes. Their eyes are closed because the normal sleeping and waking pattern has been disrupted. (Sometimes the eyes are taped shut to protect them from injury and drying out.)
They cannot follow directions or communicate because their brain doesn’t process information the way it used to. It is also common for breathing and blood pressure to be affected; if so, proper care will be needed to help control breathing or blood pressure for them.
There is no set pattern of recovery from coma, but there are signs that may mean improvement (coming out of a coma). Signs of coming out of a coma include being able to keep their eyes open for longer and longer periods of time and being awakened from “sleep” easier- at first by pain (pinch), then by touch (like gently shaking of their shoulder), and finally by sound (calling their name).
“It’s like coming out of anesthesia,” Pape said. “It’s the first step in recovering full consciousness.”
Pape is a neuroscientist in physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine and a neuroscientist at Hines VA.
“After the study treatment, I could tap them on the shoulder, and they would look at me,” Pape said. “Before the treatment they wouldn’t do that.”
Being more aware of their environment means the patients can actively participate in physical, speech and occupational therapy, all essential for their rehabilitation.
A coma is an unconscious condition in which the patient can’t open his eyes. Patients usually progress from a coma to either a minimally conscious or vegetative state, and these states can last a few weeks, months or years. Every five seconds, someone in the U.S. has a traumatic brain injury. Troops deployed to wars zones are at an even greater risk for having a severe enough brain injury to cause a coma.
“It’s an incredibly common and devastating injury,” Pape said.
The familiar voices treatment also benefits families.
“Families feel helpless and out of control when a loved one is in a coma,” Pape said. “It’s a terrible feeling for them. This gives them a sense of control over the patient’s recovery and the chance to be part of the treatment.”
Such was the case for Corinth Catanus, whose husband, Godfrey, a former California youth minister, was a participant in the study after being in a coma for three months. “The stories I told him helped Godfrey recover from his coma, and they helped me feel I could do something for him,” she said. “That gave me hope.” (More on Godfrey and Corinth’s story below.)
The Brain Lit Up in Response to Family Voices
When patients like Godfrey Catanus in the study heard the voice of a family member calling their names out loud and reciting stories while they were in an MRI, their brains showed increased neural activity. This was indicated by bright yellow and red blobs of light in regions involved with understanding language and long-term memory.
“We saw changes in the blood oxygen level in their brain regions associated with retrieving long-term memory and understanding language,” Pape said. “That means they were using those regions of their brains.”
How the Study Worked
The randomized, placebo-controlled study, Familiar Auditory Sensory Training (FAST), enrolled 15 patients with traumatic closed head injuries who were in a vegetative or minimally conscious state. They were an average age of 35 (12 men and three women) with injuries caused by motorcycle or car accidents, bomb traumas or assaults. The FAST treatment began an average of 70 days after the injury.
How Do People “Come Out” of Comas?
How fast a person comes out of a coma depends on what caused it and the severity of the damage to the brain. If the cause was a metabolic problem such as diabetes, and doctors treat it with medication, he can come out of the coma relatively quickly. Many patients who overdose on drugs or alcohol also can recover once the substance clears their system. A massive brain injury or brain tumor can be more difficult to treat, and can lead to a much longer or irreversible coma.
Most comas don’t last more than two to 4 weeks. Recovery is usually gradual, with patients becoming more and more aware over time. They may be awake and alert for only a few minutes the first day, but gradually stay awake for longer and longer periods. Research shows that a comatose patient’s outcome relates very closely to his or her Glasgow Coma Scale score. The majority of people (87 percent) who score a three or a four on the scale within the first 24 hours of going into a coma are likely to either die or remain in a vegetative state. On the other end of the scale, about 87 percent of those who score between 11 and 15 are likely to make a good recovery.
Some people come out of a coma without any mental or physical disability, but most require at least some type of therapy to regain mental and physical skills. They may need to relearn how to speak, walk, and even eat. Others are never able to recover completely. They may regain some functions (such as breathing and digestion) and transition into a vegetative state, but will never respond to stimuli.
Pape and colleagues first did baseline testing to see how responsive patients were to sensory information such as bells or whistles, if they followed directions to open their eyes and if they were alert enough to visually track someone walking across the room. Their responses provided a benchmark to see if they changed or improved after six weeks of treatment. (A person in a minimally conscious state can occasionally follow directions.)
Scientists also had the patients listen to familiar and non-familiar voices tell different stories to get a baseline MRI of how the blood oxygen levels in their brains changed while listening.