Disorders of consciousness - NHS

Vegetative state
A vegetative state is when a person is awake but is showing no signs of awareness.
A person in a vegetative state may:
open their eyes
wake up and fall asleep at regular intervals
have basic reflexes (such as blinking when they're startled by a loud noise or withdrawing their hand when it's squeezed hard)
They're also able to regulate their heartbeat and breathing without assistance.
But a person in a vegetative state doesn't show any meaningful responses, such as following an object with their eyes or responding to voices.
They also show no signs of experiencing emotions.
If a person is in a vegetative state for a long time, it may be considered to be:
a continuing vegetative state when it's been longer than 4 weeks
a permanent vegetative state when it's been more than 6 months if caused by a non-traumatic brain injury, or more than 12 months if caused by a traumatic brain injury
If a person is diagnosed as being in a permanent vegetative state, recovery is extremely unlikely but not impossible.
Minimally conscious state
A person who shows clear but minimal or inconsistent awareness is classified as being in a minimally conscious state.
They may have periods where they can communicate or respond to commands, such as moving a finger when asked.
A person may enter a minimally conscious state after being in a coma or vegetative state.
In some cases a minimally conscious state is a stage on the route to recovery, but in others it's permanent.
As with vegetative state, a continuing minimally conscious state means it's lasted longer than 4 weeks.
But it's more difficult to diagnose a permanent minimally conscious state because it depends on things like:
the type of brain injury
how severe the injury is
how responsive the person is
In most cases, a minimally conscious state isn't usually considered to be permanent until it's lasted for several months and there have been no signs of improvement.
A person thought to be in a permanent minimally conscious state usually has the same prognosis as a person in a vegetative state. The longer they remain in that state, the less chance they have for recovery.
Why they happen
Disorders of consciousness can occur if the parts of the brain involved with consciousness are damaged.
These types of brain injury can be divided into:
traumatic brain injury – the result of a severe head injury, such as an injury sustained during a car accident or a fall from a great height
non-traumatic brain injury – where the injury to the brain is caused by a health condition, such as a stroke
progressive brain damage – where the brain is gradually damaged over time (for example, because of Alzheimer's disease)
Making a diagnosis
A disorder of consciousness will only be confirmed after extensive testing to determine the person's level of wakefulness and awareness.
These examinations need to be carried out by someone experienced in disorders of consciousness, although the views of other healthcare professionals and family members should also be taken into consideration.
For some states of impaired consciousness, such as vegetative state and minimally conscious state, there are recommended criteria to help confirm a diagnosis.
Recovery
It's impossible to predict the chances of someone in a state of impaired consciousness improving.
It largely depends on:
the type of brain injury
how severe the injury is
the person's age
how long they have been in the state for
Some people improve gradually, whereas others stay in a state of impaired consciousness for years. Many people never recover consciousness.
There are only isolated cases of people recovering consciousness after several years.
The few people who do regain consciousness after this time often have severe disabilities caused by the damage to their brain.
Withdrawing nutritional support
If a person is in a permanent vegetative state for 12 months after a traumatic brain injury, or 6 months after a non-traumatic brain injury, then it may be recommended to withdraw their nutritional support.
This is because:
there's almost no chance of a recovery by this point
prolonging life would have no benefit for the person concerned
prolonging treatment could offer false hope and cause unnecessary emotional distress for the friends and family of the person concerned
The medical team will discuss the issue with family members.
If the family disagrees with the decision, then it will be referred to the courts.
If a decision is made to end nutritional support, a palliative care team, which specialises in providing care to the dying, will usually be involved in planning the withdrawal.
Once nutritional support is eventually withdrawn, the person will die within a few weeks
Locked-in syndrome
Locked-in syndrome has similar features to disorders of consciousness, but is considered and treated differently.
A person with locked-in syndrome is both conscious and aware, but completely paralysed and unable to speak.
They're usually able to move their eyes and are sometimes able to communicate by blinking.