Music, Occupational, Physical, and Speech Therapy Interventions for Patients in Disorders of Consciousness: An Umbrella Review
NeuroRehabilitation
Murtaugh, B., Morrissey, A. M., et al. (2024).
NeuroRehabilitation, 54(1), 109-127.
This umbrella review of systematic reviews investigates the effects of various interventions for people with disorders of consciousness. While the review includes treatments provided by other professions (i.e., music, occupational, and physical therapists), this article summary only contains treatments within the scope of speech-language pathologists. Specific details about the included articles are available elsewhere in the Evidence Maps. See the Associated Article(s) section below for the citations.
Not stated
This umbrella systematic review contains a number of reviews, only some of which are related to SLP practice. Of particular relevance to the article’s conclusions are the following reviews:<br />
<ul>
<li>Klingshirn, H., Grill, E., et al. (2015). Quality of Evidence of Rehabilitation Interventions in Long-Term Care for People With Severe Disorders of Consciousness After Brain Injury: A Systematic Review. <em>Journal of Rehabilitation Medicine, 47</em>(7), 577-585. https://doi.org/10.2340/16501977-1983</li>
<li>Lancioni, G. E., Bosco, A., et al. (2010). An Overview of Intervention Options for Promoting Adaptive Behavior of Persons with Acquired Brain Injury and Minimally Conscious State. <em>Research in Developmental Disabilities, 31</em>(6), 1121-1134. </li>
<li>Li, J., Cheng, Q., et al. (2020). Sensory Stimulation to Improve Arousal in Comatose Patients after Traumatic Brain Injury: A Systematic Review of the Literature. <em>Neurological Sciences, 41</em>(9), 2367-2376. https://doi.org/10.1007/s10072-020-04410-9</li>
<li>Lombardi, F. F., Taricco, M., et al. (2002). Sensory Stimulation for Brain Injured Individuals in Coma or Vegetative State. <em>Cochrane Database of Systematic Reviews, 2</em>, CD001427. https://doi.org/14651858.CD001427</li>
<li>Padilla, R., & Domina, A. (2016). 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. <em>American Journal of Occupational Therapy, 70</em>(3), 7003180030. https://doi.org/10.5014/ajot.2016.021022</li>
<li>Weaver, J. A., Watters, K., et al. (2023). Interventions Facilitating Recovery of Consciousness Following Traumatic Brain Injury: A Systematic Review. <em>OTJR: Occupation, Participation and Health, 43</em>(2), 322-336. https://doi.org/10.1177/15394492221117779</li>
</ul>
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From database inception to March 31, 2023
Systematic reviews with and without meta-analyses
15 (9 with in-scope treatments)
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<div>Sensory stimulation showed a positive trend towards towards improving responsiveness in individuals with disorders of consciousness. Additionally, sensory stimulation was associated with limited adverse events. Family involvement appeared to elicit more purposeful behavioral responses from patients. As such, the authors recommended the use of a standardized sensory stimulation protocol that can be delivered partially or fully by the family.</div>
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<div>Of note, the majority of research focused on auditory and tactile stimulation, with limited investigation of gustatory, olfactory and visual stimulation. Future research should explore a wide range of stimulation modalities and use outcome measures that have proven validity, reliability and sensitivity.</div>
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<div>Assistive technology, including micro-switches and voice output communication devices, had mixed effects for improving responsiveness in individuals with disorders of consciousness. </div>
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<ul>
<li>One review reported that repetitive practice using assistive technologies allowed these patients to engage with and control their environment (e.g., turning televisions and radios on or off, using call buttons for staff/care partners). </li>
<li>A group of nine studies within this review demonstrated mixed findings, with varying treatment responses both between and within studies. </li>
</ul>
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<div>Additional high-quality research with larger sample sizes is needed.</div>
