Rehabilitation, a way out for coma patients?

Compare this with the United States, where all coma patients undergo a Coma Stimulation Programme (CSP) or sensory stimulation programme.

This lacuna appears particularly stark in the euthanasia case, now pending as a petition before the Supreme Court. The petition had sought to end the life of Aruna Shanbhag, a Mumbai hospital nurse in coma for the last 36 years.

Although, there are no figures available that indicate the number of coma patients in India, the Bangalore Road Safety and Surveillance Report compiled by Nimhans and other collaborators, indicates that out of the 15 pc of severe road traffic injury cases, one pc go into coma.

Scope of recovery
“Coma is a state of unresponsiveness due to injury or illness. The patient is put through CSP after being in a comatose state for 72 hours,” said Dr Maheshwarappa B M, head physiatrist, Manipal Hospital, who was formerly with Nimhans. The patient is put through a lot of sensory stimulation and is evaluated after six months.

“Nearly 80 pc of the patients show a lot of functional improvement in the first four months. So, I strongly feel that rehabilitation will give a better life to coma patients,” he said. Even if the patient is discharged, he still goes through the process for two years.
 He explained that the patient is shown coloured objects and lights in visual stimulation, while auditory stimulation includes clapping and music. In tactile stimulation (skin), soft materials of different textures are rubbed on the patient's skin, apart from touching objects with varied temperature. Joint compression and vibrator, smell stimulation and gustatory oral stimulation (taste) are other components of the programme. The procedure is done in ICU twice a week for an hour and is even taught to the family members, who can then continue doing it on the patient. 

Unfortunately, not many are aware of this. For instance, while 99 per cent of the patients are referred to him by neurologists, the patients come after two or three months of being in that state. "By this time the rehabilitation potential comes down and the patient would have undergone a lot of complexities," he stated.

Deciding factor
"Maximum recovery happens within four months. After this, slow progress occurs in a span of four to 20 months. Even if there is an improvement after two years, it would only be five to 10 per cent. During this time, the patient contracts a number of infections, the medical expenses shoot up and quality of life declines," he said. Nearly 20 percent of the patients eventually die due to medical complications - nutritional deficiency, pulmonary embolism, bedsore infection, etc.

"Once the doctor feels that there is no improvement even after six months, the family can wait for two years. However, after that it is better to take the patient out of the ventilator as lying in coma without improvement for two years is not a dignified life," he said.
(With help from Dr Sujay Rao, a consultant neurosurgeon)