We often hear, read, or even use terms that we are not entirely sure what they mean. In common sense, we make arbitrary associations between a state and a term that does not always correctly describe that state. This situation usually occurs frequently with the vegetative state., Which is associated with the state of coma or the state of minimal consciousness. But in reality these three elements are different and we need to be clear about their differences.
In this article, we will know the most relevant aspects of the vegetative state, the possible causes and symptoms, as well as the treatments and care used for these cases.
What is the vegetative state?
It is determined that the person is in a vegetative state when the brain structures responsible for higher mental functions have ceased to functionBut the structures in the brain responsible for vital functions (sleep cycles, body temperature, breathing, and heart rate) are still functioning.
This means that the subject in the vegetative state will have vital signs and will appear to be awake, in the waking state, but really will not respond to any stimulation from the environment, nor be able to speak, in addition to not being aware of himself or others.
This circumstance represents one of the rarest and rarest brain pathologies to occur, but when it does occur, it is a permanent condition. There are treatments that have apparently given results in some patients, causing them to regain their brain function after a while. But it was not possible to determine whether these patients were really in a vegetative state or only had a minimal state of consciousness.
This state occurs when there is significant damage to the top of the brain, Making it impossible for the individual to have higher mental functions. However, the ascending and descending reticular systems (SARA and SIR) remain functional, addressing the waking and sleeping states of the subject.
Some of the specific causes that can cause a vegetative state include head trauma, cardiac or respiratory arrest that prevents oxygen from reaching the brain. Bleeding or brain infections can also trigger the vegetative state in the individual.
Although the brain is affected by its most important functions, he still has a capacity for action in certain areas of lifeSo it can sometimes seem that the person is consciously reacting to the environment. But they are in fact basic primary reflexes, which have a specific response to certain stimuli.
For example, patients in a vegetative state they can clench their fists when they touch the palm of their hand. That’s not to say they’re doing it on purpose, it’s more like babies’ palmar reflex.
The other symptoms of the vegetative state are as follows: they can open the eyes; they exhibit apparently normal sleeping behaviors; but which are not necessarily related to day and night, they are able to breathe, suck, chew, cough, choke, swallow and make sounds in the throat.
Although these behaviors may appear to be conscious, in reality they do not respond to any deliberate thought or intention on the part of the patient.
When the cause of the vegetative state has been head trauma and not a disease that decreases the flow of oxygen to the brain, minimal levels of EEG consciousness can be detected. For example, some patients may imagine their upper limbs moving, but not able to. As for physiological needs, they are completely involuntary in all cases.
For a correct diagnosis the patient must have undergone the corresponding medical evaluation, In addition to a nuclear magnetic resonance.
Apart from these evaluations, observation should be constant for a significant period of time, in order to prevent certain signs of consciousness from being overlooked. treatment
Since currently this state is not reversible, Care and treatment are preventive in nature, to prevent the subject’s physical situation from being affected.
What is done in these cases is to prevent immobilization issues and ensure that the nutrition is correct.
The physiotherapist and the nutritionist generally accompany the caregivers during the first days of treatment, indicating how the movements should be to help the patient and what the specific diet should be.
According to the laws of each country, there are measures on the suspension of the maintenance of life during the vegetative state. This issue should be discussed by hospital authorities in collaboration with relatives. In case the patient has left his wishes in writing, these should be taken into account when making the final decision.
- Canavero S. (editor) (2009), Handbook of Therapeutic Cortical Stimulation, New York: New Science.
- Owen, AM, Menon, DK, Johnsrude, IS, Bor, D. (2002), Detection of residual cognitive function in the persistent vegetative state, Neurocase 8 (5): 394-403.