There may be a restored method for the person in comatose.

I have been working as a teacher for special-needs children for more than 30 years. I met a student who was in comatose. I worked with the student at the school, and also I have been going through the process of the recovery of my friend Toshiya Miyata a.k.a. Miyapu’s who had suffered brainstem hemorrhage. Because of those experiences, I began to believe that there must be some rehab methods which family members and friends who are not in the medical field such as myself can support.
Not as a medical expert, but as an educator, and almost as a family member who commute every day to help rehabilitation, I have been using some methods which are based on what I learned from the children at the school. I gathered the information of how to think and communicate as well as rehabilitation methods which I believe worked the best on the student in comatose and Miyapu.

The most important thing to know.

The thing that I consider the most important is no matter how serious the impairment may look, everyone has feelings. When they don’t respond at all, you may think that they don’t know what is going on. But my students always teach me that is far from the truth.
One time, I was in charge of a child whose brain function was completely shut down except for her basic needs to stay alive. According to the CT scan, she could not see, hear nor know anything.
Every day, all I could do was hug her, talk to her, sway her, sing songs to her, pick her up and put her on my lap.
However, eventually she started moving her limbs when she heard my footsteps. She also started showing her smile when I tickled her on her face while singing the Japanese folk song “Ippon bashi kocho kocho”. Finally she began to smile right before the tickling part was coming.
Supposedly she could not see, hear or feel anything, but she looked forward to being tickled by me and when she was actually tickled her expression of joy proved to me that her consciousness was there.
Yuri-chan had an accident while taking a bath and the CT scan showed nothing but blank in her brain, and at first she gave no reaction to any stimulation. But after a while, she began responding with her eyelids. When I first saw her after a long period, she was in the wheel chair and staring at her mother. When I thought of her mother’s great love and the power of recovery in her brain, I couldn’t help but crying.
By meeting some other children who were also in comas, I strongly believed that the most important thing for those people who are in relationships with them is to know that they need to believe no matter how unconscious they looked, they knew, heard and saw everything.

The brain has a tremendous amount of potential.

Another important thing is that you must believe that the brain has a tremendous amount of potential.
Some children showed immediate change, while other children advanced after various efforts. What was actually happening in their brain at the time?
Since I am not a medical expert, I don’t know exactly what’s happening in their brain but I believe that the brain cells have power to restore what human being were born with by compensating each other and recovering.

In the bible, there is a phrase [Ask. And it shall be given   to you. Seek. And ye shall find. Knock. And it shall be opened unto you.] I think even though the brain's axis cylinder was damaged by the hemorrhage, it might be able to grow even 1/10000 of micron at a time by stimulating over and over. The restoration period won’t show any change until it is connected. If you give up on it there, the damaged axis cylinder will never grow back. However, if you continue working on without giving  up, I believe it will be restored and healed completely. I always keep this belief in my mind when I work with the children and Miyapu.

Through my experience, I came to believe that there is a way for people in comatose to recover . Although I am not in the medical field, there is a method from the educational and welfare field, that I felt passion to spread to as many people as possible. There is no better feeling than witnessing the first symptom of the recovery. I always cry when I see their family members shed the tears of joy.

The wish for helping them from a non-medical field has been growing bigger inside of me.
I’d like to share a particular exercise I have been doing. Before I start, I would like address that the situation of each child and patient varies. One might have some other disease such as osteoporosis or heart disease on top of the brain damage. In some cases, what I have done may not be applied. Please understand the condition of the patients carefully, and consult the doctors of the hospital before you try.

Work on every sense

Work on the heart ...Keep talking and encouraging them
The thing which children who are in the special-needs school taught me is everyone has feeling, no matter how serious the condition may look. Even if the person does not respond at all, it doesn’t mean they don’t have any feeling. They simply cannot respond to you. I believe everyone has the same feeling.

・I talk to them near their face.
・I never talk negatively.

Keep telling them “It is all right” or “We will do this together” and I keep encouraging them.
In case of children, I often hold them by placing my hands on their back and sway them while I am talking to them. One doctor told me that such action like swaying and hugging stimulates the brainstem a great deal.

Work on the sense of hearing
I believe that music as well as voice stimulates their brain to increase function. However, I don’t think it’s a good idea to leave the TV or music on all day long. Especially, I don’t think it’s good to surround them with multi layers of sound. I believe it’s important to turn off all the other noise when you talk to them.

Ordinary people can distinct between the words from the person and words from the radio or TV. However, as I noticed in the case of both Miyapu and the children I dealt with, I could sense that they couldn’t tell the difference the sounds and it seemed that they were hearing them as undistinguishable noise.

Work on the sense of smelling
I believe that it is good to introduce good aroma in the environment. Even people who have a tracheotomy, they can still smell it. Mrs. Momoko Suzuki, mother of Miss Junko, who was described in Prof. Murakami's comment, always put aroma near her daughter's pillow. I also always place aroma near Miyapu's pillow.

Work on the mouth and lips
I heard that the mouth is directly connected with trigeminal nerve because of the mouths proximity to the brain. That is why the nerve transmitter reaches the brain easily when the mouth is stimulated. During the class with children and as well as with Miyapu, I often stimulate both inside and outside of their mouths and their cheeks with the back of both regular and an electric toothbrush. When they brush their teeth it is easy to keep saliva in the mouth, sometimes it becomes a terrible incident if it goes into their lungs. So while I stimulate their mouth with a toothbrush, I ask someone to remove saliva from their mouth with the vacuum equipment. It is a little hard to use a saliva remover with a toothbrush sometimes, but you can also use other things like teeth cleaning tissue or Kururiena, which cleans out sputum from in the mouth.
Since some impaired children can’t close their mouth, inside of the mouth tends to dry out. In some cases, the mucus forms a lump and sometimes the bacteria in the mucus causes odor. In those cases, they can develop pneumonia if the infected saliva goes into the wrong pipe .
But if you are patient enough to keep working , you may experience a miracle such as what happened to one of the children I dealt with who had been in comatose. The child opened its eyes after cleaning the mouth with gel over and over.
I know the importance of stimulating the mouth. I would like you to go and take a look the web page of oral care.
It is also effective to give their cheek and lips a tweak as well as massaging their face.

Sitting down
If you have them bedridden all the time, they will start having the symptom called “disuse syndrome”. I think it not only produces a variety of diseases, but also it makes the brain function very sluggish.
From the experience with the children, I realized that to raise them from the lying position for even ten to twenty minutes per day could improve their state of consciousness greatly. By placing the brain in a higher place than the lying position, I think the gravity affects the brain function.

So I decided to get Miyapu up on the bed.
As I consulted with the nurses and doctors, I let Miyapu sit at the side of the bed so that he could throw his legs out. After he became able to hold his head up, I let him stand at least once a day by using the function of the bed of moving up and down. When you do it by yourself, you have to be cautious with safety. I would recommend you to do it cautiously after you learn and practice sitting them up by looking information from the web site “Caring method” .
Another thing you should take extra care is the bedsores. When they sit down, it naturally put pressure on their hipbone. If they are diabetic, you need to be more careful since it could cause them poor blood circulation by sitting. Even if they do not have any illness or disease, they should have a time limit. I used music as a time limit for the children and Miyapu as I encourage them to sit up until the music was over. I think that it is very hard for them to sit in the beginning. Then gradually, I increased it to 2 songs and 3 songs. Music can give them the idea about how long they have to sit and make it easy for them to stick to the practice.

Also we have to pay attention to the level of oxygen. It is important to watch their facial expression and consider that saliva could go into the lungs while sitting down.

Although there are a number of risks to concern, I won’t discontinue but keep working on as consulting with the doctors and the family members of them.

Moving the arms and legs
If arms and legs don’t move without the command from the brain, it might be useful to send a signal in the opposite direction; from limbs to the brain. In the case of Miyapu, he tries to signal his brain to move his hands and legs by making a motion of his arms and legs a hundred times a day. Since he began to make a motion with his right hand and right leg by himself, I asked him to move by himself while I assist him.
However, there’s an important fact to know. When the limbs are not being moved for a long time, sometimes it has contracture, and also the bones could be fragile after lying down so long. So, you should never overdo it. In that case, I try to flex their hands, legs and body until it can't go on, and then give pressure for about 10seconds with my hands, then release. Then I press them for 10seconds over again. Although it requires patience, it can help the joints’ flexibility in some of these cases.  However, some bones could be too fragile to do this exercise, so please be cautious.
Miyapu uses a low-frequency vibration equipment, too. The device is to exercise the muscles. He purchased a household device. But sometimes it gives him pain and discomfort, so I think when you use this device, you better watch the process during exercise. When I work with children, I often discussed with their parents and doctors how to exercise them while watching their state of being.

Work on the skin
I often wipe their faces and bodies with the towel after I have soaked it in warm water and squeezed it out. I also soak their hands and feet in the warm water. The skin all over the body tends to get dried after being bedridden so long. Therefore, I believe it is important to massage their body parts such as their fingers using massage lotion.

Work on the nails
If you don't use your hands and feet, the edges of the nails become round and thick. Perhaps, when you walk and use fingers, the pressure keeps the nails flat. It is very hard to tediously put continuous pressure onto their finger and toe nails to prevent them from deforming. On the other hand, finger and toe nails have an assortment of sensory nerves. So I apply pressure to every finger and toe nail a few times a day.

Have them brush their teeth like you do it by yourself
They can't brush their teeth, wipe nor shave their faces because they can’t move their limbs. But I let them hold a brush, towel, and shaver by themselves. Of course, it is easier if a caregiver or their family does that for them, but their brain may remember what they used to do in their daily life. When Miyapu was shaved by someone, I couldn't tell if his memory had come back, but when he was supported to hold his hand as if he was shaving by himself, he stretched below his nose and lift his chin as he used to do.

To sit on the wheelchair and go outside
It stimulates them to get out of their hospital rooms and go outside. You must have a wheel chair to do it.

I believe riding on the wheelchair not only changes their posture but also brings a huge effect.
Years ago, I had an opportunity to be with a child whose brain didn’t show any activity in the CT view regardless of any stimulus, however when the child was taken outside, there was activity in the brain wave especially when it breezed.

I use my car for daily use but it is made for welfare usage and the passenger seat comes out. I believe that taking them for driving and shopping definitely stimulate their brain.

To keep the record
Some people may improve immediately while others may take a few years. Also, the change may be too subtle to notice until one day you just realize it was happening all those times. You might feel discouraged to continue the effort if you don’t see any change. I would recommend you to keep a journal so that you can look back and see what has become possible compared to the year before.
You will be encouraged by recognizing that there is a change. Today’s technology enables you to record a short movie with your cell phone. I also have been taking lots of movies of Miyapu’s improvement.

Do the rehabilitation with joy

Whether you can see their change or not, it is very important that you praise them constantly. Everyone likes being praised but feels disappointed when denied. Every day, I always look for lots of fun things and at the end of the day, I search for all the great things that happened. I think this is the secret of success for their motivation. You can always find something good. Even if it looked like no change has happened, you can find something positive such as, “It’s good we are alive”, “It was good to see each other again”, “It’s good your fever is not as high as yesterday” and so on. You can appreciate the recovery. Finding something good is very important for me. A lot of unexpected events can happen in our daily lives. Of course, Miyapu is not an exception. He has had an operation to remove the bladder calculus. Another time, he suffered a disease which his flesh turned into a bone.

No matter what happens, it is crucial to me to remember that every experience is paving a path to a better day, waiting for us in the future.

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