Stedman’s Medical Dictionary-26th Edition (1995) defines a coma as “a state of profound unconsciousness from which one cannot be roused; may be due to the action of an ingested toxic substance or of one formed in the body, to trauma, or to disease.” Functionally, a person is in a coma when he or she is unable to respond purposefully to stimuli in the environment.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Adams, J. H., Graham, D. I., & Jennett, B. (2000). The neuropathology of the vegetative state after an acute brain insult. Brain, 123, 1327-1338.
American Congress of Rehabilitation Medicine (1995). Neurobehavioural criteria in recommendations for use of uniform nomenclature pertinent to patients with severe alterations in consciousness. Archives of Physical Medicine and Rehabilitation, 76, 205-209.
Anderson, V. A., Catroppa, C., Morse, S., Haritou, F., & Rosenfeld, J. (2000). Recovery of intellectual ability following traumatic brain injury in childhood: Impact of injury severity and age at injury. Pediatric Neurosurgery, 32, 282-290.
Attia, J., & Cook, D. J. (1998). Prognosis in anoxic and traumatic coma. Critical Care Clinics, 14, 497-511.
Ashwal, S. (2005). Recovery of consciousness and life expectancy of children in a vegetative state. Neuropsychological Rehabilitation, 15, 190-197.
Ashwal, S., Eyman, E. K. & Call, T. L. (1994). Life expectancy of children in a persistent vegetative state. Pediatric Neurology, 10, 27-33.
Aspen Consensus Conference (March 19- 23, 1996). Workgroup on the vegetative and minimally conscious states. Given at the Biomedical Institute, Apsen, Colorado.
Begali, V. (1987). Head Injury in children and adolescents: A resource and review for school and allied professionals (2 nd ed.). Brandon, VT: Clinical Psychology Publishing Company, Inc.
Boly, M., Faymonville, M. E., Peigneux, P., Lambermont, B., Damas, P., Del Fiore, G., et al. (2004). Auditory processing in severely brain injured patients: differences between the minimally conscious state and the persistent vegetative state. Archives of Neurology, 61, 233-238.
Boly, M., Faymonville, M. E., Peigneux, P., Lambermont, B., Damas, F., Luxen, A., et al. (2005). Cerebral processing of auditory and noxious stimuli in severely brain injured patients: Differences between VS and MCS. Neuropsychological Rehabilitation, 15, 283-239.
Booth, C., Boone, R. H., Tomlinson, G., & Detsky, A. S. (2004). Is this patient dead, vegetative, or severely neurologically impaired?: Assessing outcome for comatose survivors of cardiac arrest. The Journal of the American Medical Association, 291, 870-879.
Boyer, M. G. & Edwards, P. (1991). Outcome 1 to 3 years after severe traumatic brain injury in children and adolescents. Injury, 22, 315-320.
Brailowsky, S., Knight, R. T., & Efron, R. (1986). Phenytoin increases the severity of cortical hemiplegia in rats. Brain Research, 376, 71-77.
Casanova, E., Lazzari, R. E., Latta, S., & Mazzucchi, A. (2003). Locked-in syndrome: Improvement in the prognosis after an early intensive multi-disciplinary rehabilitation. Archives of Physical Medicine and Rehabilitation, 84, 862-867.
Chia, L.G. (1991). Locked-in syndrome with bilateral ventral midbrain infarcts. Neurology, 41, 445-456.
Cranford, R. (July 6, 1996). Misdiagnosing the persistent vegetative state. British Medical Journal, 313, 5-6.
Feeney, D. M., Gonzalez, A., & Law, W. A. (1982) Amphetamine, haloperidol, and experience interact to affect the rate of recovery after motor cortex injury. Science, 217, 855-857.
Fischer, C., & Luaté, J. (2005). Evoked potentials for the prediction of vegetative state in the acute stage of coma. Neuropsychological Rehabilitation, 15, 372-380.
Fischer, C., Morlet, D., Bouchet, P., Luaté, J., Jourdan, C., & Salord, F. (1999). Mismatch negativity and late auditory evoked potentials in comatose patients. Clinical Neuropsychology, 110, 1601-1610.
Fischer, C., Luaté, J. Némoz, C., Morlet, D., Kirkorian, G., & Mauguière, F. (2006). Improved prediction of awakening or nonawakening from severe anoxic coma using tree-based classification analysis. Critical Care Medicine, 34, 1520-1524.
Fisher, J., & Mathieson, C. (2001). The history of the Glasgow coma scale: Implications for practice. Critical Care Nursing Quarterly, 23 (4), 52-58.
Forsyth, R., & Jayamoni, B. (2003). Noradrenergic agonists for acute traumatic brain injury. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003984. DOI: 101002/1461858.CD003984.
Giacino, J.T. (1997). Disorders of consciousness: Differential diagnosis and neuropathologic features. Seminars in Neurology, 17, 105-111.
Giacino, J. T. (2005). The minimally conscious state: defining the borders of consciousness. Progress in Brain Research, 150, 381-395.
Giacino, J.T., Ashwal, S., Childs, N., Crawford, R., Jennet, B., Katz, D. I., et al. (February 2002). The minially conscious state: definition and diagnositc criteria. American Academy of Neurology, 58, 349-353.
Giacino, J. T., & Kalmar, K. (1997). The vegetative and minimally conscious state: A comparison of clinical features and functional outcome. Journal of Head Trauma Rehabilitation, 12 (4), 36-51.
Giacino, J. T., & Kalmer, K. (2005). Diagnostic and prognostic guidelines for the vegetative and minimally conscious states. Neuropsychological Rehabilitation, 15, 166-174.
Giacino, J., & Kasler, N. (1995). Outcome after severe traumatic brain injury: Coma, the vegetative state, and the minimally responsive state. Journal of Head Trauma Rehabilitation, 10, 40-56.
Giacino, J. T., & Trott, C. T. (2004). Rehabilitative management of patients with disorders of consciousness: grand rounds. Journal of Head Trauma Rehabilitation, 19, 254-265.
Giacino, J. T., & Whyte, J. (2003). Amantadine to improve neurorecovery in traumatic brain injury-associated diffuse axonal injury: A pilot double-blind randomized trial. Journal of Head Trauma Rehabilitation, 18, 4-5.
Giacino, J. T., & Whyte, J. (2005). The vegetative and minimally conscious states: current knowledge and remaining questions. The Journal of Head Trauma Rehabilitation, 20, 30-50.
Giacino, J. T., Kezmarsky, M. A., DeLuca, J, & Cicerone, K. D. (1991). Monitoring rate of recovery to predict outcome in minimally responsive patients. Archives of Physical Medicine and Rehabilitation, 72, 897-901.
Giacino, J. T., Ashwal, S. A., Childs, N., Cranford, R., Jennett, B., Katz, D. I., et al. (2002). The minimally conscious state: Definition and diagnostic criteria. Neurology, 58, 349-353.
Guérit, J. M. (2005). Neurophysiological patterns of vegetative and minimally conscious states. Neuropsychological Rehabilitation, 15, 357-371.
Hagen, C., Malakmus, C., & Durham, P. (1972). Levels of cognitive functioning. Downey, CA: Rancho Los Amigos Hospital.
Haig, A. J., & Ruess, J. M. (1990). Recovery from vegetative state of six months’ duration associated with Sinemet (levodopa/carbidopa). Archives of Physical Medicine and Rehabilitation, 71, 1081-1093.
Hansotia, P. L. (1985). Persistent vegetative state, Review and report of electrodiagnostic studies in eight cases. Archives of Neurology, 42, 673-682.
Jennett B, & Plum F. (1972). Persistent vegetative state after brain damage. RN, 35, 1-4.
Jennett, B., Adams, J. H., Murray, L. S., & Graham, D. I. (2001). Neuropathology in vegetative and severely disabled patients after head injury. Neurology, 56, 486-489.
Johnson, D. A., Roething-Johnston, K., & Richards, D. (1993). Biochemical and physiological parameters of recovery in acute severe head injury: responses to multisensory stimulation. Brain Injury, 7, 491-499.
Jordan, K. G. (1999). Nonconvulsive status epilepticus in acute brain injury. Journal of Clinical Neurophysiology, 16, 332-340. Abstract.
Kaelin, D. L., Cifu, D. X., & Matthies, B. (1996). Methylphenidate effect on attention deficit in the acutely brain-injured adult. Archives of Physical Medicine and Rehabilitation, 77, 6-9.
Kampfl, A., Schmutzhard, E., Franz, G., Pfausler, B., Haring, H. P., Ullmer, H., et al. (1998). Prediction of recovery from post-traumatic vegetative state with cerebral magnetic-resonance imaging. Lancet, 351, 1763-1767.
Kotchoubey, B. (2005). Apallic syndrome is not apallic: Is vegetative state vegetative? Neuropsychological Rehabilitation, 15, 333-356.
Laborde, A. & Whyte, J. (1997). Two-dimensional quantitative data analysis: assessing the functional utility of psychostimulants. Journal of Head Trauma Rehabilitation, 12, 90-92.
Lal, S., Merbitz, C. P., & Grip, J. C. (1988). Modification of function in head-injured patients with Sinemet. Brain Injury, 2, 225-233.
Laureys, S., Perin, F., Faymonville, M. E., Schnakers, C., Boly, M., Bartsch, V., et al. (2004). Cerebral processing in the minimally conscious state, Neurology, 63, 916-918.
Levy, D. E., Sidtis, J. J., Rottenberg, D. A., Jarden, D. O., Strother, S. C., Dhawan, V., et al. (1987). Differences in cerebral blood flow and glucose utilization in vegetative versus locked-in patients. Annals of Neurology, 22, 673-682. Abstract.
Lezak, M. D.(1986). Psychological implications of traumatic brain damage for the patient’s family. Rehabilitation Psychology, 3(4), 241-250.
Lombardi, F. Taricco, M., De Tanti, A., Telaro, E., & Liberati, A. (2002). Sensory stimulation of brain-injured individuals in coma or vegetative state: results of a Cochrane systematic review. Clinical Rehabilitation, 16, 464-472.
Mahalick, D. M., Carmel, P. W., Greenberg, J. P., Mologsky, W., Brown, J. A., Heary, R. F., et al. (1998). Psychopharmacologic treatment in acquired attention disorders in children with brain injury. Pediatric Neurosurgery, 29, 121-126.
Majerus, S., Gill-Thwaites, H., Andrews, K, & Laureys, S. (2005). Behavioral evaluation of consciousness in severe brain damage. In S. Laureys (Ed.). Progress in Brain Research, 150, 397-413.
Meythaler, J.M., Depalma, L., Devivo, M.J., Guin-Renfroe, S., & Novack, T.A. (2001). Sertraline to improve arousal and alertness in severe traumatic brain injury secondary to motor vehicle crashes. Brain Injury, 15, 321-331.
Meythaler, J. M., Brunner, R. C., Johnson, A., & Novack, T. A. (2002). Amantadine to improve neurorecovery in traumatic brain injury-associated diffuse axonal injury: a pilot double-blind randomized trial. Journal of Head Trauma Rehabilitation, 17, 300-313.
Mitchell, S., Bradley, V. A., Welch, J. L., & Britton, P. G. (1990). Coma arousal procedure: A therapeutic intervention in the treatment of head injury. Brain Injury, 4, 273-279.
Montes, J. M., Wong, J. H., Fayad, P.B., & Awad, I. A. (2000). Stereotactic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma: protocol and preliminary experience. Stroke, 31, 834-840. Abstract.
Multi-Society Task Force on PVS (1994). Medical aspects of the persistent vegetative state. New England Journal of Medicine, 330, 1499-1508.
Nickels, J. L, Schneider, W. N., Dobovy, M. L., & Wong, T. M. (1994). Clinical use of amantadine in brain injury rehabilitation. Brain Injury, 8, 709-718.
Owen, A. M., Coleman, M. R., Menon, D. K., Johnsrude, I. S., Rodd, J. M., Davis, M. H., et al. (2005). Residual auditory function in persistent vegetative state: A combined PET and fMRI study. Neuropsychological Rehabilitation, 15, 290-306.
Parvizi, J. & Damasio, A.R. (2003). Neuroanatomical correlates of brainstem coma. Brain, 126, 1524-1536.
Patterson, J. R., & Grabois, M. (1986). Locked-in syndrome: A review of 139 cases. Stroke, 17, 758-764.
Passler, M. A., & Riggs, R. V. (2001). Positive outcomes in traumatic brain injury-vegetative state: Patients treated with bromocriptine. Archives of Physical Medicine and Rehabilitation, 82, 311-315.
Perrin, F., Schnakers, C., Schabus, M., Degueldre, C., Goldman, S., Brédart, S., et al. (2006). Brain response to one’s own name in vegetative state, minimally conscious state and locked-in syndrome. Archives of Neurology, 63, 562-569.
Pickard, J. D. (2004). Part II: Functional imaging, electrophysiology and mechanical intervention. Neuropsychological Rehabilitation, 15, 272-275.
Pillai, S., Praharaj, S. S., Mohanty, A., & Kolluri, V. R. (2001). Prognostic factors in children with severe diffuse brain injuries: A study of 74 patients. Pediatric Neurosurgery, 34, 98-103.
Plenger, P. M., Dixon, C. E., Castillo, R. M., Frankowski, R. F., Yablon, S. A., & Levin, H. S. (1996). Subacute methylphenidate treatment for moderate to moderately severe traumatic brain injury: a preliminary double-blind placebo-controlled study. Archives of Physical Medicine and Rehabilitation, 77, 536-540.
Prassad, M. R., Ewing-Cobbs, L., Swank, P. R., & Kramer, L. (2002). Predictors of outcome following traumatic brain injury in young children. Pediatric Neurosurgery, 36, 64-74.
Raimondi, A. J., & Hirschauer, J. (1984). Head injury in the infant and toddler. Coma scoring and outcome scale. Child’s Brain, 11, 12-35.
Rappaport, M., Hall, K. M., Hopkins, K., Belleza, T., Cope, D. N. (March 1982). Disability rating scale for severe head trauma: Coma to community. Archives of Physical Medicine and Rehabilitation, 63(3), 118-123.
Rappaport, M., Doughtery, A. M., & Kelting, D. L. (July 1992). Evaluation of coma and vegetative states. Archives of Physical Medicine and Rehabilitation, 73, 628-634.
Reinhard, D., Whyte, J. & Sandel, M. (1996). Improved arousal and initiation following tricyclic antidepressant use in traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 77, 80-83.
Robinson, L. R., Micklesen, B. S., Tirschwell, M. D., & Lew, M. D. (2003). Predictive value of somatosensory evoked potentials for awakening from coma. Critical Care Medicine, 31, 960-967.
Rosenthal, M., Griffith, E. R., Bond, M. R., & Miller, J. D. (Eds.). (1983). Rehabilitation of the head injured adult. Philadelphia: F. A. Davis.
Schiff, N., Ribary, U., Moreno, D. R., Beattie, B., Kronberg, E., Blasberg, R., (2002). Residual cerebral activity and behavioural fragments can remain in the persistently vegetative brain. Brain, 125, 1210-1234.
Schiff, N. D., Rodriguez-Moreno, D., Kamal, A., Kim, K. H. S., Giacino, J. T., Plum, F., et al. (2005). fMRI reveals large-scale network activation in minimally conscious patients. Neurology, 64, 514-523.
Schallert, T., Hernandez, T. D., & Barth, T. D. (1986). Recovery of function after brain damage: Severe and chronic disruption by diazepam. Brain Research, 379, 104-111.
Schnakers, C., Majerus, S., & Laureys, S. (2005). Bispectral analysis of electroencephalogram signals during recovery from coma: Preliminary findings. Neuropsychological Rehabilitation, 15, 381-388.
Schneider, W. N., Drew-Cates, J., Wong, T. M., & Dombovy, M. L. (1999). Cognitive and behavioural efficacy of amantadine in acute traumatic brain injury: an initial double-blind placebo-controlled study. Brain Injury, 13, 863-872.
Schuaib, A., Mahmood, R. H., Wishart, T., Kanthan, R., Murabit, M. A., Ijaz, S., et al. (1995). Neuroprotective effects of lamotrigine in global ischemia in gerbils. A histological, in vivo microdialysis and behavioral study. Brain Research, 1995, 199-206.
Shewmon, D. A. (2000a). Coma prognosis in children. Part I: Definitional and methodological challenges. Journal of Clinical Neurophysiology, 17, 457-466.
Shewmon, D. A. (2000b). Coma prognosis in children. Part II: Clinical Application. Journal of Clinical Neurophysiology, 17, 467-472.
Shewmon, D. A., & DeGiorgio, C. M. (1989). Early prognosis in anoxic coma. In J. L. Bernat (Ed.), Ethical issues in neurological practice: Neurologic clinics (Vol. 7, pp. 823-843). Philadelphia, PA: W. B. Sanders.
Shiel, A., & Wilson, B. A. (2005). Can behaviors observed in the early states of recovery after traumatic brain injury predict poor outcome? Neuropsychological Rehabilitation, 15, 494-502.
Showalter, P. E., & Kimmel, D. (2000). Stimulating consciousness and cognition following severe brain injury: a new potential clinical use for lamotrigine. Brain Injury, 14, 997-1001.
Smith, E., & Delargy, M. (February 19, 2005). Locked-in syndrome. British Medical Journal, 330, 406-409.
Sterm, S. C. (1996). Classification of head injury. In R. K. Narayan, J. E. Wilberger, & J. T. Povlishock (Eds.), Neurotrauma (pp. 31-41). New York: McGraw-Hill.
Stevens, R. D., & Bhardwaj, M. D. (2006). Approach to comatose patient. Critical Care Medicine, 34, 31-41.
Strauss, D. J., Shavelle, R. M. & Ashwal, S. (1999). Life expectancy and median survival time in the permanent vegetative state. Pediatric Neurology, 21, 626-631.
Strauss, D. J., Ashwal, S., Day, S. M., & Shavelle, R. M. (2000). Life expectancy of children in vegetative and minimally conscious states. Pediatric Neurology, 23, 1-8.
Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness. A practical scale. Lancet, ii, 81-84.
Wade, D. T. (October 12, 1996). Misdiagnosing the persistent vegetative state: Persistent vegetative state should not be diagnosed until 12 months from onset of coma (letter). British Medical Journal. 313, 943-944.
Walker-Batson, D., Smith, P., Cutis, S., Unwin, H., & Greenlee, R. (1995). Amphetamine paired with physical therapy accelerates motor recovery after stroke-further evidence. Stroke, 26, 2254-2259.
WeeFIM System Clinical Guide: Version 5.01 (1998). University at Buffalo, Buffalo, NY.
Whyte, J., Vaccaro, M., Grieb-Neff, P., & Hart, T. (2002). Psychostimulant use in the rehabilitation of individuals with traumatic brain injury. Journal of Head Trauma Rehabilitation, 17, 284-299.
Whyte, J., Hart, T., Vaccaro, M., Grieb-Neff, P., Risser, A., Polansky, M., et al. (2004). Effects of Methylphenidate on attention deficits after traumatic brain injury: A multidimensional, randomized, controlled trial. American Journal of Physical Medicine & Rehabilitation, 83, 401-420.
Whyte, J., Katz, D, Long, D., DiPasquale, M. C., Polansky, M., Kalmar, K., et al. (2005). Predictors of outcome in prolonged posttraumatic disorders of consciousness and assessment of medication effects: A multicenter study. Archives of Physical Medicine and Rehabilitation, 86, 453-462.
Wijdicks, E. F. M., & Cranford, R. E. (August 2005). Clinical diagnosis of prolonged states of impaired consciousness in adults. Mayo Foundation for Medical Education and Research, 80(8), 1037-1046.
Wong, P. P., Monette, G., & Weiner, N. I. (2001). Mathematical models of cognitive recovery. Brain Injury, 15, 519-530.
Wood, R. L. (1991). Critical analysis of the concept of sensory stimulation for patients in vegetative states. Brain Injury, 5, 401-409.
Worzniak, M., Fetters, M., & Comfort, M. (1997). Methylphenidate in the treatment of coma. Journal of Family Practice, 44, 495-498.
Yamamoto, T. & Katayama, Y. (2005). Deep brain stimulation therapy for the vegetative state. Neuropsychological Rehabilitation, 15, 406-413.
Young, G. B. (2000). The EEG in Coma. Journal of Clinical Neurophysiology, 17, 473-485.
Zafonte, R. D, Watanabe, T. & Mann, N. R. (1998). Amantadine: a potential treatment for the minimally conscious state. Brain Injury, 12, 617-621.
Zandbergen, E. G., de Haan, R. J., Stoutenbeek, C. P., Koelman, J. H., & Hijdra, A. (1998). Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet, 352, 1808-1812.
Zandbergen, E. G., de Haan, R. J., Koelman, J. H., & Hijdra, A. (2000). Prediction of poor outcome in anoxic-ischemic coma. Journal of Clinical Neurophysiology, 17, 498-501.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Mayfield, J.W., Pedersen, L., Mcdonald, F. (2009). Neuropsychology and Coma Management. In: Reynolds, C.R., Fletcher-Janzen, E. (eds) Handbook of Clinical Child Neuropsychology. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-78867-8_30
Download citation
DOI: https://doi.org/10.1007/978-0-387-78867-8_30
Publisher Name: Springer, Boston, MA
Print ISBN: 978-0-387-70708-2
Online ISBN: 978-0-387-78867-8
eBook Packages: Behavioral ScienceBehavioral Science and Psychology (R0)