How do people recover from a coma?

The speed of recovery from a coma depends on what caused it and the severity of damage to the brain. If the cause was a metabolic problem like diabetes that was treated with medication, a patient can come out of the coma relatively quickly. Many patients who overdose on drugs or alcohol also can recover once the substance leaves their systems. A massive brain trauma or a tumor can be more difficult to treat, and can lead to a much longer-lasting-or irreversible-coma.

Most comas don't last more than two to four weeks. Recovery is typically gradual, with patients gaining awareness over time. They may be awake and alert for just a few minutes the first day, but gradually stay awake for longer and longer periods. Research shows that a comatose patient's outcome relates closely to the Glasgow Coma Scale score. The less severe the score recorded within the first 24 hours of going into a coma, the more likely a patient will make a good recovery.

Some people emerge from a coma with no mental or physical disability, but most require at least some type of therapy to regain mental and physical skills. They may need to learn how to speak, walk or even eat again. Others never recover completely. They may regain some functions-such as breathing and digestion-and move into a vegetative state, but will never respond to stimuli.

Regarding the latter category of patients, the family may have to make some very difficult decisions. In cases where people do not recover quickly, relatives must decide whether to keep their loved one on a ventilator and feeding tube indefinitely, or to remove them and allow the person to die.

If the person in question has written an advanced medical directive known as a "living will," that decision is much easier, because family members can simply follow his or her wishes. When there's no living will, the family must carefully consult with doctors to determine the best course of action.