Binary Communication

All of us have questions that he would like to ask to a person in a coma. Is the person in agony? Does the person want  a treatment to continue or to be aborted? Should we continue life-support? What does he experience right now? How does he feel? Would he like to wake from coma? What is his opinion, or what are his feelings about life, about a possible life's ending, or about the physical care he is receiving? And there are many more questions like that. The method described below provides a guideline about how questions can be asked to a comatose person, and how answers may be obtained.

Communication is a two-way road, like ask and reply. In its most simple form, one human being can ask a simple question to another human being, just aiming for a confirming “yes” or a denying “no” reply. When communicating with someone comatose, a start can be made using questions that need only a defined reaction meaning “yes”. In a next phase, striving is developing a method of “binary” communication, in which we search for a way for the comatose person to express a “yes” or “no” at free choice to a question being asked.


 Sounds and movements are the most effective way for a comatose person to respond to questions. Keep in mind that reactions may be delayed due to the seriousness of the brain-injury, or of course as a result of medication, and above all that the level in which a person in a coma is available for communication often varies with a stronger level of absence. When no response occurs, take a break or continue the next day, closely looking for possible changes.

Instructions for a binary communication set-up:

Notice and pace breathing

Sit next to the comatose person and adapt to his breathing rhythm. Tell the person you are there, then press the wrist on the inhalation;

Notice a repetitive signal

The possibility to set-up a binary communication-system is determined by detecting a repeating signal. For instance, you might notice a person lifting an eyebrow repetitiously, moving his mouth, bending a finger, making a noise, moving his head, closing the eyes, squeezing your hand, or any other way of a subtle signal;

Establish contact using the signal

Try to establish a communication with a signal that's as clear as possible and mark this as a signal, by saying: "I notice you move your eyebrow, you can use that eyebrow to communicate."

Hand touch

In addition, place your hand lightly in the area where the signal originates to give the person more access to that particular signal. Wait for a reaction. The next time the person uses that signal, respond enthusiastically, encourage to repeat, praise him and suggest using that particular signal to communicate. Ask the person if he agrees and ask him to give the signal for a “yes”. Touch the place when the signal is given again, because by doing this, you might amplify the signal. When the signal is then given, a communication has been set-up. Do know, that there might not immediately be a reaction, so you might have to repeat the process later on. It can be very hard for a comatose person to control a movement, and to use it as a communication-signal. He might need some more time for it. Just try it again later;

Setting up a yes- and-no  communication

Once you have established a signal for communication, a binary communication can be started. Say to the person that this signal will be used to communicate. Tell him, that when you ask a question, giving the particular sign will mean <yes>, and not giving a sign at all means <no>. Ask the person if he understood, and if so, to repeat using the signal:
"From now on, you move your eyebrow to say <yes>, if you understand, move your eyebrow". When this really happens, the signal is established.
Another possibility can be that the person gives another signal, for example squeezing your hand. This might mean he wants this to be the signal. Ask him again in the same way if that is what he wants, and propose using that 'squeezing the hand' as a <yes> signal.
A lot of people move their eyes. Therefore, the muscles around the eyes are perfectly suited to be used as a communication-signal. To do this, touch one of the muscles above the eyelids, saying: "You can use this muscle to say <yes> if you want to. We will call this muscle-movement a <yes>, and doing nothing counts as a <no>. If you agree, say yes by moving that muscle now".
Respond with enthusiasm when the signal is given, and let him know you've seen and noticed it;

Ask questions about the altered state

After you establish a signal of communication, tell the person that in a moment you will ask some questions. Give him time first to prepare inwardly. Then, by speaking slow and clear, you start asking questions that can be answered with a simple <yes> or <no>, like: "Are you in pain?". Notice any responses. When the assembled signal is given, this means <yes>. For the time being, no reaction means no>.  Remember that responses may be a bit delayed because of medication or physical impairment. You'll want to ask a lot, and you'll have all opportunity for this. Maybe you'd mostly like to ask about persons or events from a recent past, but more important is connecting to the person's current state of mind, by asking about how his experiences are at the moment. So ask questions related to the person’s current altered state, such as:

"Are you happy with where you are now?"

“Are you having a good trip down there?”

"Are you in pain?"

"Do you want to come back?"

"Do you want to remain in this state?"

"Do you want to go on living?"

If you are unsure about the answers to these questions, you can wait a few days, and then just ask them again.

Notice and establish a second signal

When binary communication is on track after a while, and a clear signal is used for <yes>, it's time to start looking for another signal to replace the silence used for a <no> answer, because giving an assembled signal is more explicit than giving no sign at all. Do this the same way as you did establish the first signal. Establishing the second signal for the answer <no> makes communicating a lot easier and a lot more effective.

Congratulations! You have now established a binary communication with another human being, who is likely to be very happy with this, in probable desperate need of your support and attention.