Sensory stimulation programme to improve recovery in comatose patients

Abstract

The purpose of this study was to examine whether positive changes in consciousness level after applying a sensory stimulation programme exceed natural recovery. A single experimental group interrupted time series design was used. Subjects were brain-injured patients who were hospitalized at a university hospital in South Korea. The sensory stimulation programme was composed of auditory, visual, olfactory, gustatory, tactile and physical stimulation. Levels of consciousness were evaluated using the Glasgow Coma Scale. The intervention was carried out twice, first for 4 weeks, then a recession period was allowed for 4 weeks, and immediately after this the second intervention was implemented for 4 weeks. Results showed significant alterations in consciousness levels 2 weeks after starting intervention 1. This effect increased gradually and was maintained for 3-4 weeks. However, consciousness levels began to decrease 2 weeks after terminating intervention 1 and this decrement continued until starting intervention 2. The pattern of improvement of intervention 1 could be represented as a gradual onset and temporary duration model. At the beginning of intervention 2, consciousness levels were maintained at a low level. However, they began to increase again after 2 weeks and this increment continued even after terminating intervention 2. Therefore, the effect of intervention 2 could be represented as a gradual onset and permanent duration model. These results suggest that an intervention programme should be applied for more than 1 month to achieve a permanent effect on consciousness levels and that at least 2 weeks are required for any significant effect.

Nursing Interventions: Effects of Coma Arousal Technique on the Clinical Outcomes of Unconscious Patients

“…Unconsciousness has long been recognized as a research priority in critical care, unfortunately, many of the studies in this area suffer from design weaknesses, such as non-standardized practices, so definitive recommendations for clinical practice are difficult to make (3,5) . In addition, recent developments in the field of functional neuroimaging have resulted in dramatic evidence that unconscious patients can hear and seemingly retain some cognitive ability (11) .…”

“…Coma is a pathological state related to severe and prolonged dysfunction of vigilance. Vegetative stage suggests a preservation of autonomic functions (e.g., cardio-vascular, respiratory and thermoregulation functions) and reemergence of the sleep-wake cycle (i.e., periods of spontaneous eyes opening) (5) . Behaviorally, there is no response to verbal order and, although moaning may occur, there is no intelligible speech.…”

“…Some patients may remain in a vegetative state for years or even decades. The outcome from coma and vegetative state depends on the cause, location, severity and extent of neurological damage (5) . The longer the patient remains in coma more they suffer from a long term cognitive, behavioral and emotional impairment which prevents them from pursuing active and responsible lives after brain injury.…”

Rehabilitation interventions for vegetative and minimally conscious patients

“…However, 56% of these remained severely impaired. Furthermore, Oh and Seo (2003) also demonstrated significant alterations in conscious levels after two weeks of sensory stimulation, composed of auditory, visual, olfactory, gustatory, tactile and physical stimulation twice a day, five days a week for four weeks. However, these results were based on only seven subjects within three months of injury where spontaneous recovery may occur.…”

“…Rehabilitation in this environment is aimed at improving patients motor and functional recovery while preventing or treating complications (Cope & Hall, 1982;Mazaux, De-S-Ze, Joseph, & Barat, 2001). Early rehabilitation has been associated with better outcomes in severely brain injured patients (Mackay, Bernstein, & Chapman, 1992;Oh & Seo, 2003). Patients in the vegetative and minimally conscious state are frequently denied early rehabilitation.…”