They claim she's going to PT and learning to sit up. Yet they always have her lying flat on her back... Put her in a chair or stroller and let her experience the world from a different angle. What's the point in going on vacation if she'll be forced to stare at ceilings?
They used to claim no one would work with her. She had more ablitity to move her arms before but they stopped having her reach for things and she lost that tmovement.
Would any of the med kiwis be able to elaborate on the difference between a coma, vegetative state, minimally conscious state, and brain death?
The terms come up in this thread and when researching other similar past cases like Jahi and Teri Schiavo, and it seems a bit confusing to an average lay person. Are these different names for similar things, is one an umbrella for the other, is it a spectrum?
This is more written for the thead its from but heres what I posted about the differences in Luna's thead:
Glascgow Coma Scale with Modifications for Toddlers/Infants
"According to independent t-test, there is a statistically significant relationship between Glasgow
Coma Scale and
hydrocephalus (P=0.03)" Worse the hydrocephalus the lower the score the P means that there was a 99.97% this was NOT due to chance.
She shows reflexes also that should not exist at her age such as the Palmer grasp reflex which is what you see in very young infants that allows them to grasp your fingers if you touch the middle of their palm. At her age this is another clear indication of brain damage and usually means issues with the frontal lobe. She shows sunning, conjugate down gaze in the primary position, which is a sign of high intracranial pressure most commonly shown in patients with failed hydrocephalus shunts.
Due to lack of ability to close eyes it is hard to score her on that I don't believe we have ever seen her make meaningful eye contact.
Eye opening : 1
Motor Response : 3
Verbal Response : 2 (Anything videoed to show her agitated has been grunts and not normal crys for direct means)
Total : 6
Categorization:
Best Score : 15
Coma: No eye opening, no ability to follow commands, no word verbalizations ( 3 - 8 )
Unresponsive : 3 or below
Brain Injury Classification:
Minor Brain Injury----GCS score of 13 to 15
Moderate Brain Injury----GCS score of 9 to 12
Severe Brain Injury----GCS score of 3 to 8
Profound Brain Injury----GCS score of 3 or lower
Flowchart to Decide on Persistent Vegetative State (PVS) vs Minimally Conscious State (MCS)
It is quite obvious that the answer to "Is the Patient Conscious?" is a no which rules out MCS right off the bat. Next we chest for brainstem function and apnea, she obviously has brainstem function and nothing has been stated about apnea so we can rule out brain death. Now we look at sleep/wake cycles and if her eyes are open to stimulation or spontaneously. There is no way to know if her eyes open/close since her head is swollen to the point of effecting this, but we do know she has sleep cycles from posts her parents have made. Thus coma is ruled out and she is in a Persistent Vegetative State.
Figure 1. Technical Info on CMS vs PVS Figure 2. Outcomes for PVS
The definition of Traumatic vs Non-Traumatic brain injury is a simple one. Traumatic involves an external force such as a car wreck or shaken baby syndrome. Whereas Non-traumatic is any injury that is internal such as drowning, hypoxia, aneurysms, brain tumors, etc.
As for Luna, she has a non-traumatic brain injury that wherein her persistive vegative state has lasted for over 6 months. Removing her disorder itself form the equation she would be 97% likely to remain in the PVS after a year and 3% to be severely disabled if she went into a MCS.
On another note SBSK posted today shows you what happens when someone is severely brain injured as a child and survives into adulthood: