Late-recovery from “permanent” vegetative state in the context of severe traumatic brain injury: A case report exploring objective and subjective aspects of recovery and rehabilitation

ABSTRACT

This article provides a detailed outline of the recovery of a young male patient during his emergence from a vegetative state (VS) 19 months after suffering a severe traumatic brain injury. Several similar cases have been documented, but these tend not to consider the subjective experience of the patient or family; our aim was therefore to provide a detailed account that emphasises our neuropsychological exploration of the impact of the injury on this person, and looks at the experience of his mother along the timeline from his accident to the end of a successful period in rehabilitation. Clinical details are presented including standardised and non-standard assessments, neuropsychological interventions, as well as reflections from the patient himself. Moreover, qualitative data from an interview with his mother is used to illustrate the emotional impact on family of such a vacillating diagnostic status and prognosis for the future. We conclude that late-emergence from VS is increasingly documented and further cases must be published to better understand this phenomenon. The present case illustrates the emotional impact this situation can have on a patient and his or her family, and gives an important insight into a patient’s view of his or her life and identity following such an event.

KEYWORDS:

• Disorders of consciousness
• vegetative state
• late emergence
• rehabilitation

Acknowledgements

The authors wish to thank Mr G and his mother for kindly allowing us to disseminate his story. We also wish to thank the multidisciplinary team at the Royal Hospital for Neuro-disability for allowing us to reproduce some of the work conducted with him, and the team at Queen Elizabeth Foundation in Banstead, Surrey, for contributing an update on his progress.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Mr G provided written consent for the authors to reproduce the information contained in this article.

2 In England, patients may receive short-term funding from a centralised public healthcare body (NHS England) for specialist neuro-rehabilitation services (i.e., Level 1 services) if their needs are highly complex, and cannot be met at more local specialist services (Level 2 services). Thus, only a small minority of people access Level 1 units. If there is a change in circumstances, for example, someone’s neurological status markedly changing, then a new block of funding may be agreed, as was the case with Mr G. This situation is rare.

3 In order to preserve anonymity, key personal information has been substituted with “---”.