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    Progress for Man Who Spoke After 10-Year Coma

    Doctor Says Brain-Injured Firefighter Is Responsive but His Condition May Fluctuate

    States of Consciousness

    Ahmed says that before Herbert started talking, he was diagnosed as being in a persistent vegetative state. Ahmed says he'd heard that Herbert may have moved, understood more, and may have been more responsive -- which could indicate that he was actually in a minimally conscious state, not a coma -- but Ahmed says he himself never saw that happen.

    In a minimally conscious state, "there's inconsistent but definite behavioral evidence that the patient has an awareness [that] may be better or worse at some times," says Childs, who has worked for 18 years with patients with catastrophic brain injuries and disorders of consciousness.

    In a vegetative state, "there is no awareness of yourself or the environment," she explains.

    Childs says Terri Schiavo, who was recently at the center of a high-profile case regarding removal of her feeding tube, was in a persistent vegetative state.

    Asked what scientists know about what's going on in the brain in cases like Herbert's, Child says, "practically nothing."

    "Some of the basic science and basic questions about what happens with the neurophysiology of the brain as patients move through levels of consciousness are just beginning to be explored," she says. "We have very little science about the huge majority of patients, let alone what happens with this handful of patients who do the unusual."

    "I think it's true that the rare cases that have been reported have been younger. We do know [of] studies of traumatic brain injuries that as a whole, younger [patients] do better."

    Patients who reach minimal consciousness within the first few months do better than those who are vegetative," says Childs. But "nobody knows" what predictors or factors might explain cases like Herbert's, she says.

    'Slow Process'

    "Brain injury recovery is a very slow process," says Paulette Demato, program director of the Coma Recovery Association.

    "People may proceed to a certain level and then reach a plateau, and nothing else may happen for years after that," she tells WebMD.

    Herbert's case "kind of gives hope to all the families out there who are waiting for that miracle. These things do happen," says Demato.

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