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). |
- 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).
- 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).
- 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).
- 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.
- 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
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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). |
- Mean GCS significantly improved in both groups after 10 days (p=0.0001).
- Mean GCS at 10 days was significantly higher in the treatment group than in controls (10.25 versus 7.75, p=0.0001).
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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. |
- Coma duration (time to GCS=15) was significantly shorter in the treatment group compared to controls (p<0001).
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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). |
- 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.
- 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.
- 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).
- 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.
- 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).
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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). |
- The treatment group showed significant increases in GCS scores on each day during the study period (p<0.05).
- 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)
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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). |
- GCS and SSAM scores were significantly increased above baseline after exposure to direct and non-direct auditory stimulation (both p=0.008).
- Compared to non-direct auditory stimulation, SSAM scores improved significantly more after direct stimulation (p=0.021).
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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). |
- Overall, more patients responded to their own name compared to the bell (p<0.001).
- 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).
- Overall, CRS-R scored were higher when patients were able to localize to both their own name and the bell.
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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). |
- NB was statistically greater in the ES phase (p<0.01).
- There was no significant difference in NB between H1 and H2 (p>0.05) or CS1 and CS2 (p>0.05).
- There was no significant difference in NB between VERSUS patients and MCS patients (p>0.05).
- The BB was observed in the ES phase for all 12 patients.
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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). |
- Mean GCS scores were significantly higher in the treatment group than in controls at 14 days (10.45 versus 5.9, p<0.05).
- Mean SMART scores were significantly higher in the treatment group than in controls at 14 days (14.76 versus 8.72, p<0.05).
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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. |
- 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.
- 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).
- 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).
- There was a significant reduction in reflexive movements with eyes shut following multimodal stimulation (p<0.025).
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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). |
- Mean LOS was shorter in the treatment group than the control group (88.7 days versus 125.7 days).
- The treatment group made greater progress on GCS and RLAS scores than the control group.
- All patients in the treatment group progressed into an acute rehab setting compared with only one of the control patients.
- No statistical comparisons were reported.
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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). |
- General improvement on the GCS and RLAS was seen over the course of the treatment for both conditions.
- General improvement on the WNSSP was seen over the course of the treatment for both conditions, with improvement from 20% to 80%.
- Subjects obtained higher SSAM scores for eye movements during the SDS condition than during the NDS condition.
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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. |
- Mean GCS increased more rapidly in the treatment group.
- Mean coma duration for the treatment group was significantly shorter than for controls (22d versus 27d, p<0.05).
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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). |
- 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.
- 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.
- Subjects from enriched environments showed significant improvement compared with subjects from non-enriched environments (t=2.20, p<0.05).
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