Brain Health Day | How did she wake up after becoming in a vegetative state?

Ms. Hu, 33, was unfortunately involved in a traffic accident in early April this year, sustaining a traumatic brain injury and losing consciousness immediately. More than twenty days after the incident, she was transferred to Nanjing Zijin Hospital. Upon admission, her CNPVSS score was only 2, indicating a severe coma and complete inability to perceive her surroundings. At the same time, she also exhibited increased muscle tone in all four limbs, spasticity in some extremities, and a high risk of pressure ulcers.

When will the patient regain consciousness, and how will they recover? These have become the primary concerns shared by the attending physician and the rehabilitation therapist.
Following discussion and analysis, the attending physician and the rehabilitation therapist developed a comprehensive treatment plan: awakening therapy, functional rehabilitation, and prevention of complications. By leveraging hyperbaric oxygen therapy and transcranial magnetic stimulation, combined with multisensory stimulation, they ensured optimal conditions for the patient’s awakening.

Is transcranial magnetic therapy, a relatively unfamiliar treatment, safe and effective?
1. Transcranial magnetic therapy uses high-intensity alternating magnetic fields that penetrate the skull to stimulate brain neurons for therapeutic purposes, and it is characterized by its painless physical nature.
2. With a development history spanning more than 30 years, its efficacy has been demonstrated by numerous scientific and clinical trials.
3. It is primarily used in the treatment of refractory brain disorders and has been widely applied across various fields, including psychiatry and neuropsychology as well as neurological rehabilitation.

What does “multisensory stimulation” encompass?
Multisensory stimulation primarily encompasses three types of stimuli: auditory, visual, and electrical.
1. Auditory stimulation: Utilize the voices of loved ones and close friends; play music that the patient previously enjoyed, thereby eliciting a neural response through subconscious auditory perception.
2. Optical stimulation: Stimulating comatose patients through visual contrast.
3. Electrode stimulation.

Following the implementation of the comprehensive arousal-promoting protocol, the patient began to gradually regain consciousness on July 21. In Ms. Hu’s mid‑course assessment, the CNPVSS score increased to 15 points. When others perform actions toward the patient, she is able to respond with simple, deliberate feedback. Meanwhile, lower‑extremity muscle tone has progressively decreased, and the risk of pressure ulcers shows a downward trend; in daily life, she can now use a walker to stand.

Although Ms. Hu has successfully regained consciousness, new challenges have emerged: what comes next after awakening? While her awareness is gradually returning, she remains unable to care for herself; her speech remains impaired, and she cannot speak; and her mood is highly labile, with frequent emotional outbursts. Accordingly, the attending physician and therapists, in light of her clinical progress, have initiated a new treatment plan: decannulation, limb‑function rehabilitation, removal of the nasogastric tube, and adjunctive emotional support to help stabilize her mood.

How does the new rehabilitation program differ from the previous one?
1. The new plan prioritizes functional rehabilitation while also striving to facilitate the early removal of the tracheostomy tube and nasogastric feeding tube.
2. Changes in rehabilitation training include balance exercises, with equipment assistance when necessary; transfer and sitting-up training; and activities to enhance daily living skills, such as brushing teeth and washing the face. To facilitate early removal of the nasogastric tube, swallowing training is provided, encompassing electrical stimulation, lip‑tongue exercises, the Mendelsohn maneuver, and oral feeding.
3. To facilitate early removal of the tracheostomy tube, respiratory training, cough-assistance exercises, and therapies aimed at controlling pulmonary infections were implemented.

Recently, Ms. Hu has made good progress in her rehabilitation, managing to spend 2–3 hours daily in a wheelchair, consuming an appropriate amount of soft‑textured food, tolerating a tracheostomy tube occlusion for up to 6 hours, and turning over independently while sleeping.

At the third “Zhejiang Donghua Neuroscience Talent Award” speech competition held on August 29, Qi Yuliang, head of the Rehabilitation Center at Nanjing Zijin Hospital, presented Ms. Hu’s case of awakening‑promoting rehabilitation and was awarded second prize. This recognition underscores the judges’ and peers’ endorsement of the hospital’s approach to awakening‑promoting rehabilitation.

Brain Health Day | How did she wake up after becoming in a vegetative state?

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