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Table 16.43 Multimodal Sensory Stimulation for Recovery of Consciousness Post ABI

by | Dec 13, 2018

Table 16.43 Multimodal Sensory Stimulation for Recovery of Consciousness Post ABI

 

Author/Year/ Country/ Study Design/N Methods Outcomes
Moattari et al.

(2016)

Iran

RCT

PEDro=8

N=60

 Population: TBI; Mean Age=37 yr; Gender: Male=50, Female=10; Mean GCS=6.

Intervention: Participants in a coma were randomized to receive standard care (control, n=20) or a sensory stimulation program (treatment) from a qualified nurse (n=20) or a family member (n=20). The program involved awakening (5 min), auditory (10 min), visual (10 min), tactile (5 min), and olfactory (10 sec) stimulation 2x/ day for 7 days. Outcomes were assessed daily over 7 days.

Outcome Measure: Glasgow Coma Scale (GCS), Rancho Los Amigos Scale (RLAS), Western Neurosensory Stimulation Profile (WNSSP).
  1. Mean GCS scores were significantly higher in the family group than in the nurse and control groups at 6 days (8.85 versus 7.15 versus 6.60, p=0.035) and 7 days (9.20 versus 7.15 versus 6.70, p=0.001).
  2. Mean RLAS scores were significantly higher in the family group than in the nurse and control groups at 5 days (2.60 versus 2.15 versus 2.10, p=0.006), 6 days (2.95 versus 2.15 versus 2.15, p=0.001), and 7 days (3.10 versus 2.15 versus 2.15, p=0.001).
  3. Mean WNSSP scores were significantly higher in the family group than in the nurse and control groups at 4 days (17.55 versus 11.05 versus 11.15, p=0.03), 5 days (28.15 versus 15.45 versus 14.75, p=0.003), 6 days (44.75 versus 17.65 versus 14.45, p=0.001), and 7 days (50.35 versus 18.4 versus 14.55, p=0.001).
  4. The family group showed significant improvements on GCS (p=0.001), RLAS (p<0.01), and WNSSP (p=0.001) in separate comparisons to the nurse group and controls.
  5. The nurse group showed significant improvements on WNSSP (p=0.002), but not GCS (p=0.98) or RLAS (p=0.38)  when compared to controls but not on
Tavangar et al.

(2015)

Iran

RCT

PEDro=7

N=40

 Population: ABI; Mean Age=36 yr; Mean GCS=6.

Intervention: Participants in a coma were randomized to receive standard care (control, n=20) or auditory stimulation (treatment, n=20). Stimulation involved listening to 5-1 5 min voice recordings of a family member 2 x/day for 10 days.

Outcome Measure: Glasgow Coma Scale (GCS).
  1. Mean GCS significantly improved in both groups after 10 days (p=0.0001).
  2. Mean GCS at 10 days was significantly higher in the treatment group than in controls (10.25 versus 7.75, p=0.0001).
Gorji et al.

(2014)

Iran

RCT

PEDro=5

N=13

 Population: TBI; GCS Range≤8.

Intervention: Patients were randomly assigned to receive standard care (control) or listen to a 10-minvoice recording of a “loved one”2x/ day for 2 wk (treatment).

Outcome Measure: Coma Duration.
  1. Coma duration (time to GCS=15) was significantly shorter in the treatment group compared to controls (p<0001).
Megha et al.

(2013)

India

RCT

PEDro=6

N=30

 Population: TBI; Treatment Group 1 (TG1, n=10): Mean Age=35 yr; Mean Time Post Injury=7.8 days; Mean GCS=3.4. Treatment Group 2 (TG2, n=10): Mean Age=40.9 yr; Mean Time Post Injury=7.8 days; Mean GCS=3.5. Control Group (CG, n=10): Mean Age=43.2 yr; Mean Time Post Injury=7.5 days; Mean GCS=3.4.

Intervention: Participants in a coma were randomly assigned to receive conventional physiotherapy (CG) or multimodal stimulation for 2 wk. Stimulation was delivered in 20 min sessions 5x/ days (TG1) or 50 min sessions 2x/ days (TG2). Outcomes were assessed before and after treatment.

Outcome Measure: Glasgow Coma Scale (GCS), Western Neuro Sensory Stimulation Profile (WNSSP).
  1. GCS significantly improved in TG1 (z=2.821, p=0.005), TG2 (z=2.848, p=0.004), and CG (z=2.724, p=0.006) after treatment.
  2. WNSSP significantly improved in TG1 (z=2.809, p=0.005), TG2 (z=2.807, p=0.005), and CG (z=2.812, p=0.005) after treatment.
  3. After treatment, there were significant overall differences between groups in GCS (χ2=9.516, p=0.009) and WNSSP (χ2=17.136, p<0.001).
  4. GCS after treatment was significantly higher in TG1 (U=14, p=0.005) than in CG. GCS was higher in TG2 than CG (U=19, p=0.019) and in TG1 than TG2 (U=42.5, p=0.579), but these differences were not significant.
  5. WNSSP after treatment was significantly higher in TG1 than TG2 (U=14.5, p=0.005) and CG (U=6, p<0.001), and in TG2 than CG (U=11, p=0.002).
Abbasi et al.

(2009)

Iran

RCT

PEDro=7

N=50

 Population: ABI; Treatment Group (n=25): Mean Age=30.4 yr; Gender: Male=22, Female=3; Mean GCS=7.0. Control Group (n=25): Mean Age=30.4 yr; Gender: Male=21, Female=4; Mean GCS=6.9.
Intervention: Participants were randomized to receive either a regular family visiting program (treatment) or routine care (control).  Family visits were 15 min for 6 days and were structured to include affective, auditory, and tactile stimulation. Outcomes were assessed at baseline and 30min after each visit.
Outcome Measure: Glasgow Coma Scale (GCS).
  1. The treatment group showed significant increases in GCS scores on each day during the study period (p<0.05).
  2. After 6 days, GCS scores in the treatment group were significantly higher than in the control group (8.8 versus 6.8, p=0.0001)
Park et al.

(2016)
Korea & USA
Pre-Post Test
N=9

 Population: TBI; Mean Age=29.7 yr; Gender: Male=9, Female=0; Mean GCS=5.88; Mean SSAM=3.44.

Intervention: Comatose patients underwent both direct, and non-direct auditory stimulation in random order (15 min each, 1 hr between treatments).

Outcome Measure: Glasgow Coma Scale (GCS), Sensory Stimulation Assessment Measure (SSAM).
  1. GCS and SSAM scores were significantly increased above baseline after exposure to direct and non-direct auditory stimulation (both p=0.008).
  2. Compared to non-direct auditory stimulation, SSAM scores improved significantly more after direct stimulation (p=0.021).
Cheng et al.

(2013)

China

Cohort

N=86

 Population: TBI=53, Non-TBI=33; Mean Age=46 yr; Gender: Male=67, Female=19; Median Time Post Injury=5 mo.

Intervention: Participants in a vegetative state (VERSUS, n=47) or minimally conscious (MCS, n=37) received auditory stimulation with a bell, their own name, or both.

Outcome Measure: Coma Recovery Scale-Revised (CRS-R).
  1. Overall, more patients responded to their own name compared to the bell (p<0.001).
  2. MCS patients localized more often to their own name compared to the bell (p<0.001); this was not significant in the VERSUS group (p>0.05).
  1. Overall, CRS-R scored were higher when patients were able to localize to both their own name and the bell.
Di Stefano et al. (2012)

Italy

Case Series

N=12

 Population: TBI; Mean Age=30.75 yr; Gender: Male=7, Female=5; Mean Time Post Injury=5.75 mo.

Intervention: Participants in a vegetative state (VERSUS, n=6) or minimally conscious state (MCS, n=6) received sensory stimulation based on biographically meaningful objects. The order of phases were: Hygienic Care (H1), Cognitive Stimulation (CS1), Enriched Stimulation (ES), Cognitive Stimulation (CS2), and Hygienic Care (H2).

Outcome Measure: Wessex Head Injury Matrix (WHIM) – Number of Behaviours (NB) and Best Behaviours (BB).
  1. NB was statistically greater in the ES phase (p<0.01).
  2. There was no significant difference in NB between H1 and H2 (p>0.05) or CS1 and CS2 (p>0.05).
  3. There was no significant difference in NB between VERSUS patients and MCS patients (p>0.05).
  4. The BB was observed in the ES phase for all 12 patients.
Urbenjaphol et al. (2009)

Thailand

PCT

N=40

 Population: TBI; Mean Age=34 yr; Gender: Male=28, Female=12; Mean Time Post Injury=7 days; Mean GCS=5.

Intervention: Participants received standard care (control, n=20) or a multimodal sensory stimulation program (treatment, n=20). The program involved tactile, gustatory, olfactory, auditory, and visual stimulation. Each modality was stimulated for 30m in/day at 2 hr intervals over 14 days.

Outcome Measure: Glasgow Coma Scale (GCS), Sensory Modality Assessment & Rehabilitation Technique (SMART).
  1. Mean GCS scores were significantly higher in the treatment group than in controls at 14 days (10.45 versus 5.9, p<0.05).
  2. Mean SMART scores were significantly higher in the treatment group than in controls at 14 days (14.76 versus 8.72, p<0.05).
Wilson et al.

(1996)

UK

Pre-Post

N=24

 Population: TBI; Mean Age=29 yr; Mean Time Post Injury=16 mo.
Intervention: Participants received multimodal and unimodal stimulation.  Familiar personal items were also used with both stimulations. Stimulation was administered 2x/ day in 3 wk blocks until they were no longer in a vegetative state or were discharged.
Outcome Measure: Behaviour.
  1. Frequency with which eyes were observed opened increased significantly following multimodal (p<0.001) and multimodal familiar (p<0.05) stimulation; no significant changes were seen following unimodal stimulation.
  2. Significant increases in the frequency of spontaneous movements with eyes opened following multimodal (p<0.005), unimodal (p<0.05) and multimodal familiar stimulation (p<0.05).
  3. There was a significant decrease in the frequency of eyes shut with no body movement following both multimodal (p<0.005) and multimodal familiar stimulation (p<0.05).
  4. There was a significant reduction in reflexive movements with eyes shut following multimodal stimulation (p<0.025).
Wood et al.

(1992)

USA

PCT

N=8

 Population: ABI; Mean Age=23.3 yr; Mean Time Post Injury=56.5 days; Mean GCS=9.5.

Intervention: Participants received intensive regulated sensory stimulation (treatment, n=4) or standard unregulated stimulation (control, n=4). Treatment involved sensory stimulation with low ambient noises, regular rest intervals free from stimulation, and appropriate inter-stimulus intervals during therapy.
Outcome Measure: Glasgow Coma Scale (GCS), Rancho Los Amigos Scale (RLAS), Length of Stay (LOS).
  1. Mean LOS was shorter in the treatment group than the control group (88.7 days versus 125.7 days).
  2. The treatment group made greater progress on GCS and RLAS scores than the control group.
  3. All patients in the treatment group progressed into an acute rehab setting compared with only one of the control patients.
  4. No statistical comparisons were reported.
Hall et al.

(1992)

Canada

PCT

N=6

 Population: TBI; Mean Age=37.5yr; Gender: Male=5, Female=1; Mean Time Post Injury=15.8d; Mean GCS=4.8.
Intervention: Participants were alternated every week between either specific directed stimulation (SDS), or non-directed stimulation (NDS), each for 30 min/day, for the duration of the treatment period. SDS involved multisensory input based on level of response, while NDS did not.
Outcome Measure: Glasgow Coma Scale (GCS), Rancho Los Amigos Scale (RLAS), Western Neuro Sensory Stimulation Profile (WNSSP), Sensory Stimulation Assessment Measure (SSAM).
  1. General improvement on the GCS and RLAS was seen over the course of the treatment for both conditions.
  2. General improvement on the WNSSP was seen over the course of the treatment for both conditions, with improvement from 20% to 80%.
  3. Subjects obtained higher SSAM scores for eye movements during the SDS condition than during the NDS condition.
Mitchell et al.

(1990)

UK

PCT

N=24

 Population: ABI; Mean Age=23yr; Gender: Male=20, Female=4; Mean Time Post Injury=8d; Mean GCS=5.

Intervention: Participants received a multisensory stimulation program (treatment, n=12) or standard care (control, n=12). The program involved vigorous stimulation of auditory, tactile, olfactory, gustatory, visual, kinesthetic, proprioceptive, and vestibular modalities in a cyclical manner for 1hr, 1-2x/d over 4 days.
Outcome Measure:  Glasgow Coma Scale (GCS), Coma Duration.
  1. Mean GCS increased more rapidly in the treatment group.
  2. Mean coma duration for the treatment group was significantly shorter than for controls (22d versus 27d, p<0.05).
Kater (1989)

USA

PCT

N=30

 Population: ABI; Mean Age=28yr; Gender: Male=18, Female=12; Time Post Injury<6 mo.
Intervention: Participants received controlled structured sensory stimulation (treatment, n=15) or standard care (control, n=15). Treatment involved visual, auditory, olfactory, gustatory, tactile, and kinesthetic stimulation for 45min, 2x/d,  6d/wk for 1-3 mo.
Outcome Measure: Rancho Los Amigos Scale (RLAS).
  1. Patients in the treatment group had a significantly improved mean RLAS score compared with controls (6.33 versus 4.40, p<0.05); RLAS was inversely correlated with initial GCS.
  2. Subjects with moderate and deep coma (GCS=3-10) benefitted more from treatment, while subjects with light coma severity (GCS=11-14) showed little difference from the controls.
  3. Subjects from enriched environments showed significant improvement compared with subjects from non-enriched environments (t=2.20, p<0.05).

PEDro=Physiotherapy Evidence Database rating scale score (Moseley et al., 2002).