Bringing coma patients back to life: Germany's Kliniken Schmieder sets the world standard (and we've successfully copied some of their techniques in our home care routine)

By Sherry Webb Phipps 

Overview of Kliniken Schmieder

Kliniken Schmieder, founded in 1950 by Prof. Dr. Friedrich Schmieder, is a leading network of neurological rehabilitation clinics in Germany, known for its innovative and comprehensive approaches to treating neurological disorders, including disorders of consciousness (DoC) such as coma, unresponsive wakefulness syndrome (UWS), and minimally conscious state (MCS). With six cohesive clinics, including key facilities in Allensbach and Heidelberg, the family-run institution treats over 14,000 patients annually from around the world. Their motto, “Never give up!” reflects a commitment to restoring patients’ quality of life through evidence-based, individualized care, supported by a multidisciplinary team of neurologists, therapists, nurses, and researchers. The clinics emphasize cutting-edge technology and research, with their own research institute and collaborations with university hospitals and international experts like the Coma Science Group led by Prof. Steven Laureys.

Methods for Treating Disorders of Consciousness

Kliniken Schmieder’s Brain Stimulation Center (BSC) at Allensbach specializes in innovative treatments for DoC, employing both non-invasive and invasive techniques to promote recovery of consciousness:

• Non-Invasive Brain Stimulation: Transcranial Direct Current Stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS) are used to enhance neural activity by electrically or magnetically stimulating nerve cells, targeting brain regions critical for arousal and awareness, such as the prefrontal cortex or thalamus. These methods aim to improve neural plasticity and reconnect disrupted neural networks.
• Invasive Brain Stimulation: Deep Brain Stimulation (DBS) involves surgically implanting electrodes in areas like the ventral tegmental area to deliver electrical impulses, enhancing connectivity in the brain’s arousal networks. This is typically used for severe cases unresponsive to other treatments.
• Pharmacological Interventions: Medications like amantadine (a dopaminergic agent to enhance arousal), zolpidem (a sedative with paradoxical awakening effects in some patients), and other stimulants (e.g., methylphenidate) are used to target neurotransmitter systems, tailored to individual patient needs.
• Multidisciplinary Rehabilitation: Coma stimulation programs include sensory stimulation (auditory, visual, tactile), physical therapy to prevent contractures, occupational therapy for functional tasks, and speech therapy to support communication in patients transitioning to MCS. Robotic-assisted therapy and virtual reality enhance sensory and motor recovery.
• Advanced Diagnostics: Tools like functional MRI (fMRI), electroencephalography (EEG), and the Coma Recovery Scale-Revised (CRS-R) detect covert consciousness (cognitive motor dissociation, CMD) and monitor recovery progress. These help identify patients with recovery potential and guide treatment.
• Sleep-Wake Cycle Management: The Centre for Sleep Medicine, led by Dr. Manuel Eglau, uses light therapy, behavioral interventions, and medications (e.g., melatonin) to regulate sleep patterns, as preserved sleep architecture (e.g., sleep spindles, REM sleep) correlates with better outcomes.
• Dysphagia Treatment: Pharyngeal stimulation is used to improve swallowing, reducing complications like aspiration pneumonia.

These methods are integrated into a biopsychosocial approach, involving families to support recovery and emotional well-being.

Outcomes and Impact on Patients

While specific case studies of individual patients awakened from DoC at Kliniken Schmieder are not publicly detailed in available sources, the clinics’ comprehensive approach has contributed to their global recognition as Centers of Excellence in neurorehabilitation. Their focus on early intervention—starting rehabilitation as soon as possible after brain injury—has been shown to improve prognosis, reduce hospital stays, and enhance motor, cognitive, and functional recovery. The use of advanced diagnostics like fMRI and EEG allows identification of patients with CMD (15–20% of DoC cases), who have a higher likelihood of recovery due to preserved cognitive function. Treatments like amantadine have accelerated recovery in clinical trials, and techniques like tDCS and TMS have shown promise in promoting earlier awakening and reducing disability. The clinics’ holistic care, including family involvement and innovative therapies, supports patients in regaining independence in daily activities, such as communication, mobility, and self-care. However, outcomes vary based on factors like the cause of DoC (e.g., traumatic vs. hypoxic brain injury), patient age, and time since injury.

Kliniken Schmieder’s pioneering work in neurological rehabilitation, particularly through its Brain Stimulation Center, positions it as a leader in treating disorders of consciousness. By combining advanced brain stimulation, pharmacological interventions, multidisciplinary rehabilitation, and precise diagnostics, the clinics offer hope to patients with severe brain injuries. Their success is reflected in their ability to treat complex cases and their international reputation, making their methods a model for home care adaptations, such as sensory stimulation and sleep management, in settings like the US.

For more information, visit Kliniken Schmieder’s official website.