Effectiveness of Sensory Stimulation to Improve Arousal and Alertness of People in a Coma or Persistent Vegetative State After Traumatic Brain Injury: A Systematic Review
American Journal of Occupational Therapy
Padilla, R., & Domina, A. (2016).
American Journal of Occupational Therapy, 70(3), 7003180030.
<div>This systematic review investigates the effects of sensory stimulation interventions on arousal and alertness in adults in a coma or persistent vegetative state secondary to traumatic brain injury (TBI). This article summary only contains findings from interventions within speech-language pathology scope of practice.</div>
Not stated
From 2008 to 2013, with additional findings from one 2003 study
<div>Published, peer-reviewed studies</div>
9
<div>Unimodal auditory stimulation demonstrated mixed results in improving arousal and alertness in people in <span style="color: #333333;">a coma or persistent vegetative state secondary to TBI</span>. Specific findings included: </div>
<ul>
<li><span style="color: #333333;">One systematic review reported that the evidence on auditory stimulation was conflicting; however, this review did not reliably identify how many and which senses were stimulated within each included study (Level I Evidence). </span></li>
<li><span style="color: #333333;">One study demonstrated that use of a patient's own name was more likely to elicit responses than neutral sounds (e.g., bell ringing); however, unilateral auditory stimulation did not improve Glasgow Coma Scale (GCS) scores. Within this study, individuals in a vegetative state were more likely to respond than those in a coma (</span><span style="color: rgb(51, 51, 51);">Level III Evidence</span><span style="color: #333333;">).</span><span style="color: #333333;"> </span></li>
</ul>
<div>Limitations to these findings include an overall lack of available research, lack of long-term follow-up, and heterogeneity between included studies. Additional high-quality research is warranted.</div>
<div>Frequent repetition of multimodal stimulation in the initial stages of recovery increased the level of consciousness of adults in a coma or persistent vegetative state secondary to TBI. This was especially true if the stimulation was salient and meaningful to the patient (9 studies; Level I to Level III Evidence). Additional findings included:</div>
<ul>
<li><span style="color: #333333;">Statistically significant changes appeared between 6 and 14 days of treatment, with dosages of 3–5 daily sessions lasting between 7 and 20 minutes (9 studies; Level I to Level III Evidence). </span></li>
<li><span style="color: #333333;">Multimodal sensory stimulation was more effective in increasing consciousness in patients that were minimally conscious compared to those in a coma or vegetative state. Within these studies, combinations of familiar tactile, olfactory, and gustatory stimulations generally yielded positive results (4 studies; Level III Evidence). </span></li>
<li><span style="color: #333333;">Active responses decreased between treatment sessions during times when ordinary medical care was provided (1 study, Level III Evidence). </span></li>
<li><span style="color: #333333;">Repetitive stimulation over a longer period provided more sustained results (6 studies; Level I to Level III Evidence). </span></li>
<li><span style="color: #333333;">Behavioral response to multimodal stimulation depended on both the complexity of stimuli and the intensity of treatment (2 studies; Level III Evidence). </span></li>
</ul>
<div><span style="color: #333333;">Limitations to these findings include a lack of long-term follow-up and heterogeneity between included studies. Additional high-quality research is warranted.</span></div>
