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Table 16.37 Sensory Stimulation for Recovery of Consciousness Post ABI

by | Dec 12, 2018

Table 16.37 Sensory Stimulation for Recovery of Consciousness Post ABI

 
Author/Year/ Country/ Study Design/N Methods Outcomes
Johnson et al. (1993) UK RCT PEDro=3 N=14 Population: ABI; Treatment Group (TG, n=7): Mean Age=27.7 yr; Time Post Injury<48 hr; Mean GCS=4.8. Control Group (CG, n=7): Mean Age=31.4 yr; Time Post Injury<48 hr; Mean GCS=4.8. Intervention: Participants were randomized to receive sensory stimulation (TG) or no stimulation (CG). Treatment involved stimulation of the five senses (olfactory, visual, auditory, gustatory, and tactile) for 20 min/ day during ICU stay. Outcome Measure: Physiological parameters (heart rate, skin conductance), Biochemical parameters (Methoxy-4-Hydroxyphenylglycol (MHPG), Acetylcholinesterase (ACHE), Catecholamine, Serotonin).
  1. MHPG levels were significantly higher in the TG than CG post treatment (F=8.54, p<0.006).
  2. No significant group differences post treatment were seen in heart rate (F=0.70, p<0.499) or skin conductance (F=2.51, p<0.092), nor for levels of catecholamine, serotonin, or ACHE.
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.
Davis & Gimenez (2003) USA PCT N=12 Population: TBI; Treatment Group (n=9): Mean Age=30 yr; Mean Time Post Injury=9 days; Mean GCS=5.5. Control Group (n=3): Mean Age=30 yr; Mean Time Post Injury=6 days; Mean GCS=6. Intervention: Participants received either a structured auditory sensory stimulation program (treatment) or no stimulation (control). Stimulation included:  orientation and commands; bells, blocks and claps; music; familiar voices; and television or radio. Participants received stimulation 5-8x/d for 5-15min each up to 7d days. Outcome Measure: Glasgow Coma Scale (GCS), Disability Rating Scale (DRS), Ranchos Los Amigos Scale (RLAS), Sensory Stimulation Assessment Measure (SSAM).
  1. Mean change in GCS score was not significantly different between groups (p=0.278). However, GCS were lower in the treatment group and increased over time, while they were higher in the control group and decreased over time.
  2. Mean change in DRS score was significantly greater in the treatment group than the control group (2.7 versus 0.3, p=0.0005).
  3. Mean change in SSAM score was significantly greater in the treatment group than the control group (11 versus 0.3, p=0.015).
  4. Mean change in RLAS score was 1.2 in the treatment group, while there was no change in the control group.
Gruner & Terhaag (2000) Germany Pre-Post N=16 Population: ABI; Mean Age=43.6 yr; Mean Time Post Injury=28 days; Mean GCS=6.5. Intervention: Participants received multimodal early onset stimulation (MEOS) for 1 hr, 2x/day for 10 days (1-30 days). MEOS involved acoustic, tactile, olfactory, gustatory, and kinesthetic stimulation. Outcome Measure: Physiological parameters (cardiovascular and respiratory).
  1. Changes in heart and respiratory frequencies were noted; the most significant changes were found following tactile and acoustic stimulation.
  2. No statistical comparisons were reported.
Pierce et al. (1990) USA Case Control N=31 Population: ABI; Mean Age=24 yr; Gender: Male=21, Female=10; GCS Range<6. Intervention: Participants received vigorous multisensory stimulation (auditory, vestibular, visual and cutaneous) provided by close family for up to 8 hr/day and 7 days/wk, continuing until conventional rehabilitation. The control group was composed of a historical group of consecutive patients in prolonged coma (n=135). Outcomes were assessed 10-12 mo post injury. Outcome Measure: Coma Duration, Glasgow Outcome Scale (GOS).
  1. The number patients who emerged from the coma did not differ significantly between groups.
  2. No significant improvements were noted between groups in GOS scores (p>0.25).
  3. No significant differences were found in reasonable recovery rate between treatment and control groups (42% versus 31%, p>0.025).
PEDro=Physiotherapy Evidence Database rating scale score (Moseley et al., 2002).