Interventions Facilitating Recovery of Consciousness Following Traumatic Brain Injury: A Systematic Review
OTJR: Occupation, Participation and Health
Weaver, J. A., Watters, K., et al. (2023).
OTJR: Occupation, Participation and Health, 43(2), 322-336.
This systematic review explores the effectiveness of interventions that aim to improve the arousal and awareness of people with disorders of consciousness secondary to severe traumatic brain injury (TBI). This article summary only includes treatments within the scope of speech-language pathology (SLP).
American Occupational Therapy Association
June 1, 2013 to October 31, 2020
Published, peer-reviewed studies excluding case series, case reports, expert opinion documents, qualitative studies, and systematic reviews
27 (14 within SLP scope)
<div>Findings demonstrated that multimodal sensory stimulation (MSS) improved arousal and awareness in adults with disorders of consciousness secondary to severe TBI (Level 1B and Level 2B Evidence; Moderate Certainty of Evidence). Specific findings included: </div>
<ul>
<li><span style="color: #333333;">MSS significantly improved outcomes when used in the context of intensive care units (ICUs) or acute care trauma units (6 studies;</span><span style="color: #333333;"> </span><span style="color: #333333;">Level 1B and Level 2B Evidence).</span><span style="color: #333333;"> </span></li>
<li><span style="color: #333333;">MSS programs that used stimuli salient and meaningful to the patient significantly improved arousal and awareness (5 studies; </span><span style="color: #333333;"><span style="color: #333333;">Level 1B and Level 2B Evidence</span></span><span style="color: #333333;">). Of these, one study reported improvements for patients in a minimally conscious state, but not for patients in a vegetative state (Level 2B Evidence).</span></li>
<li><span style="color: #333333;">MSS programs delivered by families significantly improved arousal and awareness (</span><span style="color: #333333;">4 studies; Level 1B and Level 2B Evidence). </span></li>
</ul>
<div>Limitations to these findings include heterogeneity across studies, lack of long-term follow-up, potential for publication bias, and a moderate risk of bias for two of eight studies. Additional high-quality research is indicated.</div>
<div>Unimodal auditory sensory stimulation improved awareness and arousal for people with disorders of consciousness secondary to severe TBI (Level 1B and Level 2B Evidence; Low to Moderate Certainty of Evidence). Specific findings included:</div>
<ul>
<li><span style="color: #333333;">The use of familiar voices telling structured, familiar stories demonstrated statistically significant improvements in awareness and arousal (3 studies; Level 1B and Level 2B Evidence; Moderate Certainty of Evidence). </span></li>
<li><span style="color: #333333;">Following the use of familiar voices telling unstructured content, patients demonstrated significant improvements in awareness and arousal when compared to non-direct auditory stimulation such as television output or music (1 study; Level 2B Evidence; Low Certainty of Evidence).</span></li>
<li><span style="color: #333333;">For patients in the ICU, the use of family-selected familiar music via headphones for 10 minutes daily for 1 week improved Glasgow Coma Scale (GCS) scores when compared to silence (1 study; Level 1B Evidence; Low Certainty of Evidence).</span></li>
<li><span style="color: #333333;">For patients in the ICU, personalized verbal orientation information delivered via headphones for 10 minutes, 3 times daily for 10 days improved GCS scores (1 study; Level 2B Evidence; Low Certainty of Evidence).</span></li>
</ul>
<div>Limitations to these findings include heterogeneity between studies, lack of long-term follow-up, potential for publication bias, and a limited number of included studies. Future high-quality research should investigate unimodal interventions for other sensory domains (e.g., olfactory, gustatory, visual).</div>
