Another helpful way to treat spasticity and prevent contractures is to inhibit the stretch reflex.

The stretch reflex is a muscle contraction that occurs in response to stretching within the muscle. When a muscle lengthens, the muscle spindles are stretched and alpha motor neuron activity increases. This causes the stretched muscle fibers to contract.

This reflex normally protects the muscles from injury and tears, but it also makes them more difficult to stretch. To get around this, therapists recommend taking advantage of reciprocal inhibition. This occurs when the one muscle group activates and the brain inhibits the stretch reflex of the opposing muscle.

Therefore, to use this technique to stretch your spastic muscle, you must activate the opposite muscle. For example, if your calf muscles are tight, activate your shin muscles. Then, after a few seconds, you will relax that muscle and start stretching the spastic muscle.

This approach is effective but can be dangerous if not done correctly, so only try it under the supervision of your therapist.

7. Electrical Stimulation

Electrical stimulation involves placing electrodes over the skin where spastic muscles are located.  These electrodes emit electrical currents that mimic signals from the brain to stimulate the affected muscle and activate movement.

8. Surgery

Finally, in some cases, surgery may be needed to correct otherwise irreversible contracture deformities. Contractures not only shorten muscles but also can damage bones and ligaments.

Surgery can help lengthen muscles and repair some damage that has occurred. If the bones have become twisted by the contracture, the surgeon will most likely need to straighten them.

Some of these surgeries have long and painful recoveries, so it’s best to take early action to prevent the need for surgery.

Brain Injury Contractures: Key Points

Contractures after brain injury can occur for several reasons. The most common causes of contractures are physical inactivity and prolonged spasticity.

Preventing contractures will require regular stretching. This can help elongate the muscle fibers and prevent spasticity from developing into contractures or prevent contractures from getting worse.

Finally, stay as active as possible. The more you keep your muscles and joints moving, the more flexible they can become.

Every brain injury is unique and as a result, every individual will regain consciousness from a coma at a different rate. Generally, the more severe the brain damage, the longer it will take for the individual to recover.

Sometimes, a patient may suddenly lose consciousness after being fully alert. Other times, unconscious individuals may gradually regain consciousness. Due to the unpredictable nature of consciousness in the early stages of traumatic brain injury, it is nearly impossible to predict when a patient will awaken from a coma in the first 24 hours after a traumatic brain injury.

However, a coma rarely lasts over a month. Instead, individuals who remain unconscious for prolonged periods typically progress to a wakeful but unconscious state called post-coma unresponsiveness. In the next section, we will discuss post-coma unresponsiveness and additional states of consciousness that may occur after a coma.

What to Expect After Waking Up from Coma After Brain Injury

After an individual awakens from a coma, they may experience various states of consciousness. Below, we’ll address 3 common states of consciousness: post-coma unresponsiveness, minimally conscious state, and post-traumatic amnesia.

It’s important to note that a person’s progression between these post-coma stages is not always linear. Recovery can cease at any of these stages, and sometimes the person will skip directly from a coma to post-traumatic amnesia.

Post-Coma Unresponsiveness

If a person has eye movement but no other signs of consciousness, they are in a wakeful but unconscious state known as post-coma unresponsiveness.

An individual with post-coma unresponsiveness has regained a normal sleep/wake cycle and should be able to open and close their eyes, as well as react to loud noises. While these may appear to be signs of consciousness, they are actually the result of involuntary, autonomic responses.

Post-coma states can endure for months, even years, before the patient regains consciousness. It isn’t until individuals can demonstrate some purposeful behavior that they have transitioned to a minimally conscious state.

Minimally Conscious State

As the individual recovers, they may regain a sense of awareness of the world around them. This is referred to as a minimally conscious state.

Generally, a minimally conscious individual should be able to follow instructions. While there will be times when they cannot, the individual should be demonstrating some ability to act with intention.

When they can consistently respond to instructions and communicate, they have entered a state of post-traumatic amnesia.

Post-Traumatic Amnesia

Individuals with post-traumatic amnesia often struggle with memory, so they may not be able to recognize familiar faces and may appear confused or disoriented. However, individuals with post-traumatic amnesia should be responsive and able to demonstrate purposeful action.

Nearly every coma patient who reaches the state of post-traumatic amnesia will make a functional recovery. In fact, patients who transition from a coma to a minimally conscious state within 8 weeks are most likely to transition to post-traumatic amnesia and regain higher functions.

Now that you understand the various states of post-coma consciousness, the following section will cover how to measure the severity of a coma.

How to Measure the Severity of a Coma After Brain Injury

Doctors often refer to the Glasgow Coma Scale (GCS) to measure the severity of a coma after brain injury. The Glasgow Coma Scale is a simple test that gauges the degree of impaired consciousness an individual exhibits following a traumatic brain injury. This involves observing one’s ability to open and close their eyes, verbally communicate, and move.

Based on how functional an individual’s responses are, they will be assigned a score between 3-15 points. The higher the number, the more conscious the individual is, and the greater their likelihood of making a full recovery.

Up next, we’ll discuss some signs to keep an eye out for when your loved one has emerged from a coma.

What are the Signs of Recovery from a Coma?

Most individuals that recover from coma exhibit signs of preserved brain function, such as the presence of neurological reflexes.

Some neurological reflexes that a doctor may look for in coma patients include:

• Pupillary reactivity. The pupils should shrink in response to a light being shone in the eyes.
• Oculocephalic response. The eyes should turn to the right when the individual’s head is turned to the left, and vice versa.
• Gag reflex. The individual should gag or cough if a cotton swab or endotracheal tube is placed down their throat.

Generally, if the patient retains these reflexes, it is an excellent sign that they will recover. However, if these reflexes are not initially present, it does not mean recovery is impossible. There are instances where individuals who do not demonstrate these reflexes go on to make a functional recovery.

Coma After Brain Injury: Key Points

After a traumatic brain injury, individuals may fall into a deep state of unconsciousness called a coma. While it’s impossible to wake someone out of a coma, there is always hope that they may regain consciousness.

We hope this article helped you understand why a coma may occur after brain injury and how to identify signs of recovery.

If you like our content, you’ll love our ebook and newsletters! Get instant access to our TBI recovery tips ebook with 20 pages of helpful advice by signing up below.

You’ll also receive our emails that share survivor stories and more useful TBI recovery tips, which you can opt out of at any time. (We know you’ll love them, too.)

We will never sell your email address, and we never spam. That we promise.