Sensory stimulation for brain injured individuals in coma or vegetative state

Lombardi, Francesco; Taricco, Mariangela; Tanti, Antonio De; Telaro, Elena; Liberati, Alessandro

doi:10.1002/14651858.cd001427

Cited by 50 publications

(44 citation statements)

References 36 publications

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“…Other treatments A wide range of other treatments, including structured sensory stimulation, 163 repetitive TMS, 164 hyperbaric oxygen, 165 and various dopaminergic and GABAergic medications, 166 have been administered to patients with DOCs, but the evidence is insufficient to formulate r ecommendations regarding their use in clinical practice.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

Disorders of consciousness after acquired brain injury: the state of the science

et al. 2014

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| The concept of consciousness continues to defy definition and elude the grasp of philosophical and scientific efforts to formulate a testable construct that maps to human experience. Severe acquired brain injury results in the dissolution of consciousness, providing a natural model from which key insights about consciousness may be drawn. In the clinical setting, neurologists and neurorehabilitation specialists are called on to discern the level of consciousness in patients who are unable to communicate through word or gesture, and to project outcomes and recommend approaches to treatment. Standards of care are not available to guide clinical decision-making for this population, often leading to inconsistent, inaccurate and inappropriate care. In this Review, we describe the state of the science with regard to clinical management of patients with prolonged disorders of consciousness. We review consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures. We conclude with a provocative discussion of bioethical and medicolegal issues that are unique to this population and have a profound impact on care, as well as raising questions of broad societal interest.

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Section: Pharmacological Interventionsmentioning

confidence: 99%

Disorders of consciousness after acquired brain injury: the state of the science

et al. 2014

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“…It is well known, however, that vigilance and awareness fluctuate in such patients, resulting in variable behaviors and cognitive performances. [2][3][4] At present, there is no standard description of the different vigilance states in VS/UWS and MCS patients.…”

Section: Introductionmentioning

confidence: 99%

Sleep in the Unresponsive Wakefulness Syndrome and Minimally Conscious State

Cologan

Drouot

Parapatics

et al. 2013

Journal of Neurotrauma

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The goal of our study was to investigate different aspects of sleep, namely the sleep-wake cycle and sleep stages, in the vegetative state/unresponsive wakefulness syndrome (VS/UWS), and minimally conscious state (MCS). A 24-h polysomnography was performed in 20 patients who were in a UWS (n = 10) or in a MCS (n = 10) because of brain injury. The data were first tested for the presence of a sleep-wake cycle, and the observed sleep patterns were compared with standard scoring criteria. Sleep spindles, slow wave sleep, and rapid eye movement sleep were quantified and their clinical value was investigated. According to our results, an electrophysiological sleep-wake cycle was identified in five MCS and three VS/UWS patients. Sleep stages did not always match the standard scoring criteria, which therefore needed to be adapted. Sleep spindles were present more in patients who clinically improved within 6 months. Slow wave sleep was present in eight MCS and three VS/UWS patients but never in the ischemic etiology. Rapid eye movement sleep, and therefore dreaming that is a form of consciousness, was present in all MCS and three VS/UWS patients. In conclusion, the presence of alternating periods of eyes-open/eyes-closed cycles does not necessarily imply preserved electrophysiological sleep architecture in the UWS and MCS, contrary to previous definition. The investigation of sleep is a little studied yet simple and informative way to evaluate the integrity of residual brain function in patients with disorders of consciousness with possible clinical diagnostic and prognostic implications.

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“…Cumulative findings from these studies indicate that the evidence is insufficient to firmly conclude that these interventions improve neurologic outcome. 30 However, 1 study was done specifically to investigate the effects of familiar voices (ie, family members) versus unfamiliar voices on ICP values. 31 That study showed no significant change in ICP associated with verbal stimuli and no difference between the effects of familiar and unfamiliar voices on patients' ICP values, indicating that this intervention is safe and can be performed by family and ICU staff.…”

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confidence: 99%

Effects of Nursing Interventions on Intracranial Pressure

Olson

McNett

Lewis

et al. 2013

American Journal of Critical Care

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Background Intracranial pressure is a frequent target for goaldirected therapy to prevent secondary brain injury. In critical care settings, nurses deliver many interventions to patients having intracranial pressure monitored, yet few data documenting the immediate effect of these interventions on intracranial pressure are available. Objective To examine the relationship between intracranial pressure and specific nursing interventions observed during routine care. Methods Secondary analysis of prospectively collected observational data. Results During 3118 minutes of observation, 11 specific nursing interventions were observed for 28 nurse-patient dyads from 16 hospitals. Family members talking in the room, administering sedatives, and repositioning the patient were associated with a significantly lower intracranial pressure. However, intracranial pressure was sometimes higher, lower, or unchanged after each intervention observed. Conclusion Response of intracranial pressure to nursing interventions is inconsistent. Most interventions were associated with inconsistent changes in intracranial pressure at 1 or 5 minutes after the intervention.

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Sensory stimulation for brain injured individuals in coma or vegetative state

Cited by 50 publications

References 36 publications

Disorders of consciousness after acquired brain injury: the state of the science

Disorders of consciousness after acquired brain injury: the state of the science

Sleep in the Unresponsive Wakefulness Syndrome and Minimally Conscious State

Effects of Nursing Interventions on Intracranial Pressure

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