People in Vegetative States may be awake in there

BigK · December 5, 2017

http://digital.olivesoftware.com/Olive/ODN/HoustonChronicle/shared/ShowArticle.aspx?doc=HHC%2F2017%2F12%2F04&entity=Ar00102&sk=360860D3&mode=text

This front page story in today's Houston Chronicle outlines medical advancements in the understanding of vegetative states and new research suggests that 67 percent of traumatic-brain-injury patients who receive inpatient rehab regain consciousness and that up to 21 percent eventually learn to speak again.

It's a long article that I recommend reading. Especially if you know somebody in a vegetative state.

Here's the Cliff Notes:

TIRR Memorial Hermann, originally the Texas Institute for Rehabilitation and Research, was established 60 years ago, at the height of the polio epidemic, to help the disabled learn to walk again. By the 1980s, the hospital had become a leader in rehabilitating people who, thanks to advances in trauma medicine, had survived spinal cord and brain injuries. In 2011, Rep. Gabrielle Giffords checked in, three weeks after being shot in the head in Arizona.

Year after year, TIRR has ranked among the top rehab hospitals in the country, drawing patients from around the world.

Far less attention, though, has been paid to a small unit on the hospital’s sixth floor. That’s not surprising, perhaps, given the low-key demeanor of Dr. Sunil Kothari, who established TIRR’s disorders-of-consciousness program three years ago. Today, it’s one of only a half-dozen such programs in the country and possibly the busiest, treating more than 50 severely brain-injured patients every year.

Not long after he welcomed Nick onto his unit last fall, Kothari met in a small conference room with a couple of medical fellows as part of their orientation. He pulled up a PowerPoint presentation on his laptop and began to explain how his team identifies signs of consciousness that other physicians miss.

He defined what it means to be minimally conscious — a phrase that didn’t even exist when Kothari graduated from medical school in 1995. After joining TIRR’s brain-injury program 17 years ago, Kothari had taken special interest in those patients who could hear, see or feel but could not easily show it.

Most never get a shot at therapy, Kothari explained, even as new research suggests that 67 percent of traumatic-brain-injury patients who receive inpatient rehab regain consciousness and that up to 21 percent eventually learn to speak again. Instead, those patients often are warehoused at adult care homes and treated like empty vessels. Many go without pain medication, and in some extreme cases are denied anesthesia for medical procedures because it’s assumed they cannot feel. In reality, they are just not able to cry out.

“It’s truly a nightmare scenario,” said Kothari, an assistant professor of rehabilitation at Baylor College of Medicine.

At TIRR, he estimates nine out of 10 patients who come to him with a vegetative label turn out to be at least minimally conscious, which means they display subtle but inconsistent signs of awareness. Some are fully conscious but too cognitively damaged to express it. A small number are suffering from a condition known as locked-in syndrome, an extreme form of paralysis that prevents fully aware people from doing anything other than blinking.