Friends of Michael Schumacher are encouraged that the former Formula One star is emerging from his months-long coma, but experts and coma survivors note he likely faces a multi-year road to recovery.
"Comas aren't the way you see them on TV: one day you're in a coma and the next night you're sitting up chatting," said Barb Butler, a former Regina teacher who spent 27 days in a coma following a 1993 car crash.
"It's a gradual thing. You slowly come out of them."
On Friday, word came that the retired race car driver, who has been in a medically induced coma for three months following a skiing injury, was experiencing periods of consciousness.
This week, there were some reports suggesting the 45-year-old German racer is responding to voices and making eye contact.
The act of emerging from a comatose state is measured by how a patient responds on eye, motor skill and verbal tests based on a 15-point Glasgow Coma Scale, and can be a long process itself.
"I would begin opening my eyes, but not focusing," Butler recalls, about her own recovery. "People describe it as having doll eyes."
That graduated to an angry, focused look. "I just think I was confused," she says. She had a breathing tube in her mouth, which prevented her from speaking, so she was given a pad of paper to write on, but "I didn't really seem to have the urge to communicate."
Butler can't remember coming out of her coma and relies on details told to her by friends and family.
Emerging from the coma itself took time, but the rehabilitation process took even longer.
Butler spent several months at a rehabilitation hospital, followed by five years of frequent hospital visits.
'A chronic condition'
As for Schumacher, it's hard to know what his recovery will look like. Schumacher suffered a traumatic brain injury on Dec. 29 after a fall while skiing in the French Alps. But there are few public details about his condition.
The extent and area of brain damage will greatly determine his prognosis and rehabilitation, doctors say. All that is certain is that recovery won't be rapid.
Seven-time Formula One champion Michael Schumacher likely faces a years-long recovery when he fully emerges from a coma. (Clive Mason/Getty Images)
"It's been said that brain injury is a chronic condition," says Dr. Angela Colantonio, a senior scientist with the Toronto Rehabilitation Institute and head of the Brain Injury Association of Canada's research council. "It's pretty much with you the rest of your life."
For Butler, the long road to recovery involved relearning everything, including eating, reading, walking and even basic social skills.
"It was like being an alien on Earth," she says. "I didn't know any of the rules.
"At first when they were teaching me to walk, I didn't know why I couldn't walk. But the more you realize, 'I should be able to do this. I've been doing this for years. Why can't I do this now?' you get very frustrated."
Butler now serves as co-president of the Brain Injury Association of Canada and helps run a survivors' support group in Regina.
She still struggles with memory problems, which is typical for those with brain injuries. Another common issue is fatigue.
Doctors say symptoms, like seizures, can also appear later in life, though every case is unique.
"Some people have very severe brain injuries and have fantastic recovery," says Dr. Colantonio.
"And then there are cases where people don't even lose consciousness and have quite a lot of difficulty to the point that they cannot return to their old job and have very persistent symptoms."
Better treatment available
Not only can brain injuries themselves vary widely, but so, too, can the factors that help determine a patient's chances of recovery, such as that individual's fitness level, age, education and whether there has been a previous trauma to the brain.
Also influential is how much support a patient gets from family and friends through the long and arduous recovery, notes Dr. Colantonio.
Schumacher may also benefit from immense improvements in the understanding and treatment of severe brain injuries.
"It's a fascinating time," says Dr. Mark Bayley, a rehabilitation doctor at the Toronto Rehabilitation Institute who researches ways to improve cognition and physical recovery after brain injury and stroke.
"The imaging is getting better so we know what's going on in the brain, and the treatment that we have available to us is better."
At one time, experts believed the recovery of brain-injured patients plateaued at six months, but now it's thought that improvement can continue over years, said Dr. Colantonio.
The challenge after the early phase of recovery is to make sure the improvements do continue.
With positive signs that Schumacher's emerging from his coma, the team of experts around him will likely soon turn their attention from keeping him alive to planning a multi-year rehabilitation process.
"It's not just about saving a life, it's about [helping someone have] a life," notes Dr. Bayley. "And our challenge is to make that life meaningful."
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