Sensory stimulation of brain-injured individuals in coma or vegetative state: results of a Cochrane systematic review

Lombardi, Francesco; Taricco, Mariangela; Tanti, Antonio De; Telaro, Elena; Liberati, Alessandro

doi:10.1191/0269215502cr519oa

Cited by 108 publications

(49 citation statements)

References 33 publications

(52 reference statements)

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“…Despite widespread offlabel use, evidence regarding the effectiveness of neuropharmacology is inconclusive [7][8][9][10]. Evidence of improved functioning given behavioral interventions, such as sensory stimulation, is also inconclusive [11]. The paucity of evidence has been due, in part, to the lack of reliable and valid methods that detect and track neurobehavioral functioning in unconscious persons over time.…”

Section: Introductionmentioning

confidence: 99%

“…Standard rehabilitation practice includes the development of individualized rehabilitation plans, and behavioral assessments are conducted to establish goals and to monitor progress [1]. Despite the lack of scientific evidence, sensory stimulation has been used as the standard rehabilitation intervention to achieve these goals during coma recovery [11].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A measure of neurobehavioral functioning after coma. Part II: Clinical and scientific implementation

Pape¹,

Senno²,

Guernon³

et al. 2005

JRRD

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Abstract-This longitudinal validation study is Part II of a twopart series. Part I focuses on the methods used to construct the neurobehavioral measure derived from the Disorders of Consciousness Scale (DOCS) as well as the evidence of reliability and validity. Part II illustrates, through a series of selected case reports, the clinical use of repeated DOCS measures to enhance and complement medical rehabilitation management. The use of repeated DOCS measures in scientific investigations of mechanisms of injury is also described. Participants included patients at rehabilitation hospitals who were 18 years of age and older and unconscious after severe brain injury. Medical decision making regarding short-term effects of pharmacological intervention was augmented and improved through the examination of individual neurobehavioral recovery patterns. We identified medications to treat secondary medical complications and successfully determined effective dosage, presumably improving prognosis for recovery. We facilitated and enhanced development and refinement of individualized rehabilitation programs. Two investigations of treatment effectiveness during coma recovery and examination of the relationship between behavioral changes and neural adaptation are also described. By systematically tracking and mapping individual patterns of neurobehavioral recovery, we show that medical and rehabilitation management after coma can be enhanced. In addition, we also show that by examining the relationship between the DOCS neurobehavioral measure with mechanistic indicators of neurological recovery such as functional magnetic resonance imaging, scientific investigations of treatment and rehabilitation effectiveness can be enhanced.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A measure of neurobehavioral functioning after coma. Part II: Clinical and scientific implementation

Pape¹,

Senno²,

Guernon³

et al. 2005

JRRD

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show abstract

“…Specific stimulation therapies have been attempted but rarely induce awareness 3 . While reports of a few individual patients or small uncontrolled series of treated patients claim improvement in awareness, a meta-analysis of studies of physical and environmental stimulation, deep-brain electrical stimulation, and pharmacological stimulation of VS patients showed no unequivocal effect of any therapy on improving awareness 66 .…”

Section: Evolving Neuroscience Understanding Of Diagnoses and Prognosmentioning

confidence: 90%

Observations on the Ethical and Social Aspects of Disorders of Consciousness

Racine

Rodrigue

Bernat

et al. 2010

Can. j. neurol. sci.

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Disorders of consciousness such as coma, the vegetative state (VS), and the minimally conscious state (MCS) are neurological syndromes that disturb awareness or both wakefulness and awareness. Medical advances and neurotechnology have increased the probability of survival for patients suffering from severe neurological injury. Although coma rarely persists more than a few weeks, some patients remain in a VS or a MCS for years. The care of chronically unconscious patients raises vexing medical, ethical, and social questions concerning diagnosis, prognosis, communication with family members, and decision making, including the withdrawal of life support. Our goals here are to update the principal controversies surrounding disorders of consciousness and to discuss how scientific developments and social factors have lead to changes in the ethical landscape of these disorders. ABSTRACT:The care of chronically unconscious patients raises vexing medical, ethical, and social questions concerning diagnosis, prognosis, communication with family members, and decision making, including the withdrawal of life support. We provide updates on major controversies surrounding disorders of consciousness. Issues such as withdrawal of artificial nutrition and hydration -which had been considered "settled" by many in the medical, legal and ethical communities -have resurfaced under the pressure of social groups and religious authorities. Some assumptions about the level of awareness and the prognosis of vegetative state and minimal conscious patients are questioned by advances in clinical care because of insights produced by neuroscience research techniques, particularly functional neuroimaging. Both the clinical and neuroscience dimensions of disorders of consciousness raise complex issues such as resource allocation and high levels of diagnostic inaccuracies (at least, for the vegetative state). We conclude by highlighting areas needing further research and collaboration.RÉSUMÉ: Observations sur les aspects éthiques et sociaux des troubles de la conscience. La prise en charge de patients inconscients chronique soulève des questions médicales, éthiques et sociales qui sont éprouvantes en ce qui concerne le diagnostic, le pronostic, la communication avec les membres de la famille et les décisions à prendre, dont le retrait des mesures de maintien en vie. Nous faisons une mise à jour des grandes controverses concernant les troubles de la conscience. Les controverses telles le retrait de la nutrition artificielle et de l'hydratation -qui étaient considérées comme résolues par plusieurs membres des communautés médicale, légale et éthique -ont refait surface sous la pression de groupes sociaux et d'autorités religieuses. Certaines notions au sujet du niveau de conscience et du pronostic de l'état végétatif et les patients minimalement conscients, qui étaient tenues pour acquises, sont remises en question à cause des progrès dans les soins cliniques découlant des techniques de recherche en neurosciences, particulièrement de l'imagerie fonc...

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“…In its more elaborate forms, this approach involves specific daily sessions with the presentation of intensive multisensory stimulation, a physically and verbally guided manipulation of relevant daily objects or exposure to emotional and autobiographical stories (e.g., Di Stefano et al 2012;Pape et al 2015). The most basic forms of stimulation are considered unlikely to have a significant impact on the patients' levels of attention and direct involvement with the context or their long-term recovery prospects (Abbate et al 2014;Lancioni et al 2014b;Lombardi et al 2002). The intensive/elaborate and emotionally charged forms of stimulation are considered more likely to have positive effects on the patients' behavior and recovery process (Di Stefano et al 2012;Lotze et al 2011;Pape et al 2015).…”

Section: Intervention Proceduresmentioning

confidence: 99%

Assessment and Intervention with Patients with Severe Disorders of Consciousness

Lancioni

Bosco

O’Reilly

et al. 2017

Adv Neurodev Disord

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Sensory stimulation of brain-injured individuals in coma or vegetative state: results of a Cochrane systematic review

Abstract: This systematic review indicates that there is no reliable evidence to support the effectiveness of multisensory stimulation programmes in patients in coma or the vegetative state.

Cited by 108 publications

References 33 publications

A measure of neurobehavioral functioning after coma. Part II: Clinical and scientific implementation

A measure of neurobehavioral functioning after coma. Part II: Clinical and scientific implementation

Observations on the Ethical and Social Aspects of Disorders of Consciousness

Assessment and Intervention with Patients with Severe Disorders of Consciousness

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