Sensory stimulation of brain-injured individuals in coma or vegetative state: results of a Cochrane systematic review
Abstract
Objectives: To assess the effectiveness of sensory stimulation programmes in patients in coma or vegetative state.
Design: Systematic review of randomized control trials (RCT) and nonrandomized controlled clinical trials (CCT) comparing any type of stimulation programmes with standard rehabilitation in patients in coma or vegetative state. The Injuries Group specialized register, the Cochrane Controlled trial register, EMBASE, MEDLINE, CINAHL, PSYCHLIT from 1966 to January 2002 were searched without language restriction. Reference lists of articles were scanned and experts in the area contacted to ”nd other relevant studies. Abstracts and papers found were initially screened by one reviewer. Three reviewers independently identi”ed relevant studies, extracted data and assessed study quality, resolving disagreement by consensus.
Outcome measures: Duration of unconsciousness (including coma and vegetative state) de”ned as the time between trauma and objective recovery of the ability to respond to verbal commands; level of consciousness, as measured by the Glasgow Coma Scale (GCS); level of cognitive functioning (LCF); functional outcomes, as measured by Glasgow Outcome Scale (GOS) or by Disability Rating Scale; negative effects (e.g. increased intracranial pressure).
Results: Three studies (one RCT and two CCTs) with 68 traumatic brain-injured patients in total, most of whom were road accident victims, met the inclusion criteria. The overall methodological quality was poor and studies differed widely in terms of study design and conduct. Moreover, due to the diversity in reporting of outcome measures, a quantitative metanalysis was not possible. None of the three studies provided useful and valid results on outcomes of clinical relevance for coma patients.
Get full access to this article
View all access and purchase options for this article.
References
Levin HS, Saydjari C, Eisenberg HM et al. Vegetative state after closed head injury: a traumatic coma data bank report. Arch Neurol 1991; 48: 580–585.
The Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (second of two parts). N Engl J Med 1994; 330: 1572–1579.
Sazbon L, Zagreba F, Ronen J, Solzi P, Costeff H. Course and outcome of patients in vegetative state of nontraumatic aetiology. J Neurol, Neurosurg Psychiatry 1993; 56: 407–409.
Le Winn EB, Dimancescu MD. Environmental deprivation and enrichment in coma. Lancet 1978; 2: 156–157.
Wood RL. Critical analysis of the concept of sensory stimulation for patients in vegetative states. Brain Injury 1991; 4: 401–410.
Zasler ND, Kreutzer JS, Taylor D. Coma stimulation and coma recovery a critical review. NeuroRehabilitation 1991; 1: 33–34.
Andrews K. International working party on the management of the vegetative state: summary report. Brain Injury 1996; 11: 797–806.
Giacino JT, Zasler ND, Katz DI, Kelly JP, Rosemburg JH, Filley CM. Development of practice guidelines for assessment and management of the vegetative and minimally conscious states. J Head Trauma Rehabil 1997; 12: 79–89.
Mitchell S, Bradley VA, Welch JL, Britton PG. Coma arousal procedure: a therapeutic intervention in the treatment of head injury. Brain Injury 1990; 4: 273–279.
Wilson SL, Powell GE, Elliot K, Thwaites H. Sensory stimulation in prolonged coma: four single case studies. Brain Injury 1991; 5: 393–400.
Doman G, Wilkinson R, Dimancescu MD, Pelligra R. The effect of intense multisensory stimulation on coma arousal and recovery. Neuropsychol Rehabil 1993; 3: 203–212.
Wood R, Winkowski TB, Miller JL, Tierney L, Goldman L. Evaluating sensory regulation as a method to improve awareness in patients with altered states of consciousness: a pilot study. Brain Injury 1992; 6: 411–418.
American Congress of Rehabilitation Medicine. Neurobehavioural Criteria in Recommendations for use of uniform nomenclature pertinent to patients with severe alterations in consciousness. Arch Phys Med Rehabil 1995; 76: 205–209.
Teasdale G and Jennet B. Assessment of coma and impaired consciousness: a practical scale. Lancet 1974; 2: 81–84.
Hagen C, Malkmus D, Durham P. Levels of cognitive functioning. Rehabilitation of the head injured adult. Comprehensive physical management. Professional Staff Association of Rancho Los Amigos Hospital, CA, 1979.
Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1: 480–484.
Rappaport M, Hall KM, Hopkins HK, Belleza T, Cope DN. Disability rating scale for severe head trauma: coma to community. Arch Phys Med Rehabil 1982; 63: 118–123.
Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995; 273: 408–412.
Mackay LE, Bernstein BA, Chapman PE, Morgan AS, Milazzo LS. Early intervention in severe head injury: long-term bene”ts of a formalized programme. Arch Phys Med Rehabil 1992; 73: 635–641.
Wood RL, Winkowski T, Miller J. Sensory regulation as a method to promote recovery in patients with altered states of consciousness. Neuropsychol Rehabil 1993; 3: 177–190.
Boyle MEM, Greer RD. Operant procedures and the comatose patient. J Appl Behav Anal 1983; 16: 3–12.
De Young S, Grass RB. Coma recovery programme. Rehabil Nurs 1987; 12: 121–124.
Hall MEM, MacDonald S, Young GC. The effectiveness of directed multisensory stimulation versus nondirected stimulation in comatose CHI patients: pilot study of a single subject design. Brain Injury 1992; 6: 435–445.
Johnson MJ, Omery A, Nikas D. Effects of conversation on intracranial pressure in comatose patients. Heart Lung 1989; 18: 56–63.
Pierce JP, Lyle DM, Quine S, Evans NJ, Morris J, Fearnside MR. The effectiveness of coma arousal intervention. Brain Injury 1990; 4: 191–197.
Rader MA, Alston JB, Ellis DW. Sensory stimulation of severely brain-injured patients. Brain Injury 1989; 3: 141–147.
Rosadini G, Sannita WG. Inter and intra-hemispheric topographic analyses of quantitative EEG in patients in coma. Res Commun Psychol, Psychiatry Behav 1982; 7: 97–107.
Schinner KM, Chisolm AH, Grap MJ, Siva P, Hallinan M, LaVoice-Hawkins AM. Effects of auditory stimuli on intracranial pressure and cerebral perfusion pressure in traumatic brain injury. J Neurosci Nurs 1995; 27: 348–354.
Sisson R. Effects of auditory stimuli on comatose patients with head injury. Heart Lung 1990; 19: 373–378.
Weber PL. Sensorimotor therapy: its effect on electroencephalograms of acute comatose patients. Arch Phys Med Rehabil 1984; 65: 457–462.
Wilson SL, Powell GE, Elliot K, Thwaites H. Evaluation of sensory stimulation as a treatment for prolonged coma – Seven single experimental case studies. Neuropsychol Rehabil 1993; 3: 191–201.
Wilson SL, Brock D, Powell GE, Thwaites H, Elliot K. Constructing arousal pro”les for vegetative state patients – a preliminary report. Brain Injury 1996; 10: 105–113.
Wilson SL, Powell GE, Brock D, Thwaites H. Behavioural differences between patients who emerged from vegetative state and those who did not. Brain Injury 1996; 10: 509–516.
Guina FD, Cosic T, Kracun L, Dimic Z. Sensorimotor stimulation of comatose patients. Acta Med Croatica 1997; 51: 101–103.
Jones R, Hux K, Morton-Anderson A, Knepper L. Auditory stimulation effect on a comatose survivor of traumatic brain injury. Arch Phys Med Rehabil 1994; 75: 164–171.
Johnson DA, Roething-Johnston K, Richards D. Biochemical and physiological parameters of recovery in acute severe head injury: responses to multisensory stimulation. Brain Injury 1993; 7: 491–499.
Kater KM. Response of head-injured patients to sensory stimulation. Western J Nurs Res 1989; 11: 20–33.
Mitchell S, Bradley VA, Welch JL, Britton PG. Coma arousal procedure: a therapeutic intervention in the treatment of head injury. Brain Injury 1990; 4: 273–279.
Cooper JB, Jane JA, Alves WM, Cooper EB. Right median nerve electrical stimulation to hasten awakening from coma. Brain Injury 1999; 13: 261–267.
Whyte J. Toward a methodology for rehabilitation research. Am J Phys Med Rehabil 1994; 6: 428–435.
Grosswasser Z., Sazbon L. Outcome in 134 patients with prolonged post-traumatic unawareness. J Neurosurg 1990; 72: 81–84.
Cite article
Cite article
Cite article
OR
Download to reference manager
If you have citation software installed, you can download article citation data to the citation manager of your choice
Information, rights and permissions
Information
Published In
Article first published: August 2002
Issue published: August 2002
PubMed: 12194617
Authors
Metrics and citations
Metrics
Article usage*
Total views and downloads: 693
*Article usage tracking started in December 2016
Altmetric
See the impact this article is making through the number of times it’s been read, and the Altmetric Score.
Learn more about the Altmetric Scores
Articles citing this one
Receive email alerts when this article is cited
Web of Science: 75 view articles Opens in new tab
Crossref: 96
- The effects of non-invasive brain stimulation on disorder of conscious...
- Rehabilitation Care of the Child with an Acute Severe Traumatic Brain ...
- Effect of high‐frequency repetitive transcranial magnetic stimulation ...
- Factors associated with improvement in impaired consciousness during t...
- Music as Sensory Stimulation and Therapeutic Intervention
- Śpiączka i jej społeczne konsekwencje. Przegląd wątków poruszanych w d...
- Responses to stimuli in the ‘snoezelen’ room in unresponsive wakefulne...
- Bedside patient engagement monitor for rehabilitation in disorders of ...
- Neurorehabilitation for people with disorders of consciousness: an int...
- FDT bei speziellen neurologischen Erkrankungen
- Toward a coherent structuration of disorders of consciousness expertis...
- Therapies to Restore Consciousness in Patients with Severe Brain Injur...
- Effects of sensory stimulation on level of consciousness in comatose p...
- Restoration of arm and hand functions via noninvasive cervical cord ne...
- Effect of Rehabilitation Treatments on Disability in Persons With Diso...
- Mental activity of the children during the early stage of rehabilitati...
- Neurosensory stimulation outdoors enhances cognition recovery in cogni...
- Uso de bromocriptina en pacientes con alteración de conciencia secunda...
- A study into the feasibility of using HRV variables to guide treatment...
- Traumatic brain injury and frontal lobe plasticity
- Disorders of Consciousness
- Evidence-based position paper on Physical and Rehabilitation Medicine ...
- Disorders of Consciousness in China
- Sensory Stimulation Program
- Minimally Conscious State
- Vegetative State (Persistent)
- FDT bei speziellen neurologischen Erkrankungen
- Assessment and Intervention with Patients with Severe Disorders of Con...
- Effects of preference and sensory modality on behavioural reaction in ...
- Minimally Conscious State
- Vegetative State (Persistent)
- Physiotherapie in der Intensivmedizin
- Sensory Stimulation and Music Therapy Programs for Treating Disorders ...
- The Medical Practice Impact of Functional Neuroimaging Studies in Pati...
- Neurofeedback in Three Patients in the State of Unresponsive Wakefulne...
- Music in Research and Rehabilitation of Disorders of Consciousness: Ps...
- Disorders of consciousness
- LOCFAS–Assessed Evolution of Cognitive and Behavioral Functioning in a...
- Placebo-Controlled Trial of Familiar Auditory Sensory Training for Acu...
- Clinical management of the minimally conscious state
- Technology-aided programs for post-coma patients emerged from or in a ...
- Rieducazione del paziente traumatizzato cranioencefalico
- Rehabilitación del paciente con traumatismo craneoencefálico
- Effets bénéfiques de la musique préférée sur les capacités cognitives ...
- Microswitch-aided programs with contingent stimulation versus general ...
- Music in disorders of consciousness
- Vegetative and autonomic dysfunctions
- Electrical modulation of neuronal networks in brain-injured patients w...
- Kinésithérapie chez le patient présentant une altération de l’état de ...
- Effect of High-Frequency Repetitive Transcranial Magnetic Stimulation ...
- Neuroimaging of patients with disorders of consciousness: from bench t...
- Rehabilitation of patients with head injuries
- Music therapy with disorders of consciousness and neuroscience: the ne...
- Effect of frequency of multimodal coma stimulation on the consciousnes...
- The vegetative and minimally conscious states: a review of the literat...
- Disorders of consciousness: responding to requests for novel diagnosti...
- Sensory Stimulation Program
- Pharmacological Treatments
- I postumi della grave cerebrolesione: stato vegetativo e stato di mini...
- Robotic gait training in patients with impaired consciousness due to s...
- Minimally Conscious State
- Vegetative State (Persistent)
- Les programmes de stimulations sensorielles
- Physiotherapie in der Intensivmedizin
- An overview of intervention options for promoting adaptive behavior of...
- Observations on the Ethical and Social Aspects of Disorders of Conscio...
- Acute management of acquired brain injury Part III: An evidence-based ...
- Neurologische Frührehabilitation
- Neuromodulation on cervical spinal cord combined with hyperbaric oxyge...
- Ethical Issues in the Treatment of Severe Brain Injury
- Chronic Consciousness Disorders
- Brain Injury Rehabilitation of Children and Youth: Neurodevelopmental ...
- Neuropsychology and Coma Management
- Two persons with severe post-coma motor impairment and minimally consc...
- Technology-based intervention options for post-coma persons with minim...
- Dorsal Column Stimulation in Persistent Vegetative State
- Comparison of orthostatic reactions of patients still unconscious with...
- Is there anybody in there? Detecting awareness in disorders of conscio...
- Washing and Assessing: Multiple Diagnosis and Hidden Talents
- Promoting Engagement, Requests and Choice by a Man with Post-Coma Perv...
- Learning in Post-coma Persons with Profound Multiple Disabilities: Two...
- Cognitive-behavioural stimulation protocol for severely brain-damaged ...
- Brain perfusion and VEP reactivity in occipital and parietal areas are...
- Guidelines for Quality Management of Apallic Syndrome / Vegetative Sta...
- Acquired brain injury: acute management
- Evidenzbasierte neuropsychologische Therapie in der neurologischen Frü...
- A learning setup for a post-coma adolescent with profound multiple dis...
- Effect of sleep-wake rhythm on consciousness disturbance in cerebrovas...
- Neurorehabilitation issues in states of disordered consciousness follo...
- Chronic disorders of consciousness
- Consciousness, Coma, and Caring for the Brain-injured Patient
- Clinical Diagnosis of Prolonged States of Impaired Consciousness in Ad...
- Assessing level of consciousness and cognitive changes from vegetative...
- Le nursing et l’accompagnement dans le cinéma
- Grundlagen und Empirie der Neuropsychologischen Therapie: Neuropsychot...
- Management of Disorders of Consciousness in Neurorehabilitation
Figures and tables
Figures & Media
Tables
View Options
Get access
Access options
If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:
loading institutional access options
Alternatively, view purchase options below:
Purchase 24 hour online access to view and download content.
Access journal content via a DeepDyve subscription or find out more about this option.
