The Light at the End of the Tunnel

Confronting a Coma

The dictionary defines coma as a state of unconsciousness from which the patient cannot be aroused. At The Institutes for the Achievement of Human Potential, coma is defined as a state of unconsciousness from which the patient has not yet been aroused.

There is a world of difference between these two definitions.

For decades, parents the world over have successfully aroused their children from coma. Each parent does so by providing her child with visual, auditory and tactile stimulation with increased frequency, intensity and duration, in recognition of the orderly way in which the brain grows.

Any child needs stimulation to grow and develop his brain. However, the brain-injured child needs stimulation with increased frequency, intensity, and duration. He needs to receive stimulation more often, more strongly, and for a longer period than the average child requires.

The brain-injured child who is in a coma needs stimulation to each of the five senses with great frequency, intensity, and duration to bring him out of the coma. Many years of research has proven that parents are the best providers of this lifesaving treatment.

The lower levels of the brain are the spinal cord, medulla, pons, and the midbrain. These levels are responsible for the reflexes, the vital protective functions, and the appreciation of meaningful sights, sounds, and sensations.

The comatose child must begin using these lower levels of the brain first if he is to gain or regain function at higher levels. It is necessary to grow the sensory pathways so that the child is able to gain the ability to walk, talk, and use his hands.

If the stimulation is given with the correct frequency, intensity and duration, these lower brain levels will begin to function. Parents armed with a battery of everyday objects can stimulate the visual, auditory, and tactile pathways and bring about remarkable growth and development in the comatose child.

The Reflexive Stage

The mother takes her child into a completely dark room. She shines a flashlight into one eye and then the other. When she stimulates one eye, she covers the other eye and observes the reaction in the eye being stimulated. The pupil should react to the light by becoming smaller. When a movement in the pupil is observed, mother knows the light reflex has been stimulated.

Mother is directly sending a message to the brain using a simple flashlight. Each flicker of response observed in the pupil is proof that the message has arrived.

This session takes one minute. Mother provides one second of light stimulation with a flashlight to one eye. Then she waits five seconds. The purpose of this pause is to allow the light reflex to relax in the opposite eye. Even though it is covered and shielded from the light that is flooded into the first eye, it will have a sympathetic response. After the five-second wait, the second eye is stimulated. Mother alternates from one eye to the other for one minute.

Parents repeat this visual stimulation many times throughout the day.

It is important for parents to become keen observers so that they can measure the results they are achieving. Sometimes parents see a change in their child's response very quickly; sometimes change takes much longer. Parents learn that the solution is to persist. If parents do not observe changes, then the frequency of the stimulation is increased.

Parents also provide an environment in which it is easier for the child to see. At this stage the comatose child needs a black-and-white world. Parents cover the walls with a black-and-white checkerboard of squares twelve inches in diameter or larger. Parents also provide extra ambient light so that it is easier for the child to see the checkerboard. They double or triple the normal ambient light in the room where the child does his program. This simple change in the environment has a powerful effect on a child who has lived in a world with shades of gray.

Gray is the enemy of the comatose child, as he cannot see in this world. A black-and-white environment makes it easy for him to see. When he begins to realize there is something to see, he starts to use his vision. The more he uses it, the better it gets.

In addition to the stimulation of the visual pathway, the child needs stimulation to the auditory pathway.

Parents stimulate the startle reflex by using two wooden blocks. Parents bang the wooden blocks together loudly. They do so at a close but safe distance from their child's ear. In a well child this loud and sudden noise will cause the child to startle. The child's body will jump and become tense, or the child will blink in response.

It may require many sessions to create the startle reflex in the child. Increasing the frequency of stimulation will speed the process. Parents make sure that the sound is loud enough to arouse the child, and then they repeat this auditory stimulation throughout the day.

The child in a coma needs tactile stimulation as well. Parents can help their child develop or regain tactile sensation by giving tactile stimulation. The basic stimulation for an insensate child is non-abrasive scratching, pricking with a pin, and the use of hot and cold.

The most sensitive areas are usually the palms of the hands and the soles of the feet. In the beginning, the comatose child may not respond at all, even in the most sensitive areas. Sometimes the child responds immediately on those areas, and then begins to respond slowly on other areas. After repeated sessions of intense stimulation, the child may begin to respond all over his body. Parents stimulate the skin and measure the child's response. They then adjust the frequency, intensity, and duration of the stimulation according to the response of the child.

The Vital Stage

Once the child is responding at the reflexive level, the next step is to stimulate the vital responses. These are the classical responses that are used when the individual is in a potentially life-threatening situation.

With a functioning light reflex, the child may be ready to spot a bright light in a pitch-black room. Parents can provide the opportunity to do so by holding steady a penlight several inches from the child's face for several seconds at a time, giving him the time he needs to spot the intense pinpoint of light. Parents then observe the child's response. After several seconds, the flashlight is turned off, leaving the room in complete darkness, while the position of the penlight is changed. Then the penlight is turned on in its new position. Again the child is given time to find the light. Once the child can spot the light consistently, the light is moved very slowly horizontally and then vertically.

After parents have used wooden blocks or pots and pans to elicit a startle reflex in the child, they use those sounds to elicit a vital response. These sounds are those that will not only startle the average person but really frighten him. An air horn used at a safe distance has sufficient intensity to elicit a vital response.

It is possible that the child in coma, while having no motor response, can hear and understand the conversation going on around him. Such a child only appears to be in deep coma. Since the child may have this function, his parents talk to him throughout the day. They orient him to the day, the time, his location, the people on hand, and what stimulation he is receiving. This helps to keep the child tuned into the environment.

Lying in bed, totally immobile, provides little or no stimulation to the brain about sensation. At first the child does not have the tactile feedback to know that he has limbs. The result is that he does not move, basically because he is unaware that he has limbs with which to move. The child in coma needs to have the basic tactile sensation that allows him to know that he has arms, legs, hands and feet. Without sensation there will be no movement.

Mother and father use their understanding of frequency, intensity, and duration to create an effective program of tactile stimulation for their child. Hot and cold stimulation help the child to begin to feel his arms and legs for the first time. Parents make certain that the hot pack is hot enough and the cold pack is cold enough to provide a strong enough sensory message. It must never be so hot or so cold that it causes any injury to the child. Parents use their own sensation to gauge the correct temperature. The key is to provide stimulation that is intense enough to be effective without harming the child.

It is best to be able to reach all limbs and all parts of the body easily. The child is never bundled up in layers of clothing and blankets. Instead, he wears light, loose clothing that is easily removed to do the tactile stimulation during the day.

Parents use a hot pack all over the body and limbs, touching every inch of skin surface in a minute or two. This stimulation is followed by a minute of cold pack stimulation. This contrasting stimulation helps the child to differentiate the two sensations, just as he can see black and white more easily than shades of gray.

Along with hot and cold stimulation, non-abrasive pin pricking and scratching of the skin provide the strong stimulation needed to ensure that the sensory message arrives in the brain.

The Meaningful Stage

A child who has a light reflex and can distinguish light and dark and can follow a moving light is ready to distinguish bright colors. Parents show brightly colored objects, pictures, and articles of clothing to the child, one at a time, to develop visual ability. These sessions last only a few seconds, just long enough for the child to see the image but not long enough to tire him. It is best to provide many, many brief sessions throughout the day rather than a few long and tiring sessions.

Once the vital response to threatening sounds is consistent, a wider range of sounds is offered to develop the ability to understand meaningful sounds. At this point whistles, shouting, and ringing bells stimulate the auditory pathway. As the pathway improves, parents use more musical sounds.

Sounds that are common in the household, such as a knock at the door, footsteps approaching, and the phone ringing, are now part of the auditory program. Parents and other family members need to put expression and meaningful sound in their voice. This clarifies the auditory message.

As the child becomes increasingly sensitive to vital tactile stimulation, lighter forms of stimulation are needed, such as warm and cool sensation, soft and rough brushing, rubbing, massage, tickling, and caressing.

There are five pathways to the brain-visual, auditory, tactile, gustatory, and olfactory. The comatose child needs stimulation through all five pathways. Besides visual, auditory, and tactile stimulation, parents also provide regular gustatory and olfactory stimulation. The smell and taste of a lemon, vinegar, or some other strong foods help to arouse the child from coma. When these tastes and smells are combined with information that is also being provided via the visual, auditory, and tactile pathways, the child receives the same message by different pathways.

Summary

A child in coma is in a state of unconsciousness from which he has not yet been aroused. Armed with common household objects, a basic understanding of the development of the brain, and tremendous determination, parents can arouse their child from a profound coma to total consciousness.

This seemingly miraculous journey has been made many times by many children. Some of those children were comatose from birth. Others were well children who suffered severe trauma that resulted in coma.

These children and their superb parents have demonstrated over and over again that the potential of the human brain is truly wonderful.

By Janet Doman, Director
The Institutes for the Achievement of Human Potential
and Susan Aisen, Director
The Institutes for the Achievement of Intellectual Excellence