Effectiveness of “Coma Stimulation Technique” on Conscious Level and Brain Functioning among Comatose Patients with Traumatic Brain Injury
Varma A Sindhubhai, Sukhpal Kaur, Pravin Salunke, Sandhya Ghai
Keywords :
Brain functioning, Coma stimulation technique, Consciousness, Glasgow coma scale, Traumatic brain injury
Citation Information :
Sindhubhai VA, Kaur S, Salunke P, Ghai S. Effectiveness of “Coma Stimulation Technique” on Conscious Level and Brain Functioning among Comatose Patients with Traumatic Brain Injury. J Postgrad Med Edu Res 2023; 57 (1):3-7.
Objective: To assess the effectiveness of the coma stimulation technique (CST) on consciousness and brain functioning among comatose traumatic brain injury (TBI) patients.
Materials and methods: The study was conducted amongst admitted patients in neurosurgical units of a tertiary care center in North India. A single group was exposed to the intervention of CST, and its effectiveness was observed on the Glasgow Coma Scale (GCS) and Coma Recovery Scale (CRS). A total of 156 TBI patients were assessed for eligibility. The patients above 18 years with GCS between three and eight and patients with stable vital signs were included in the study. Patients having a past history of head injury, cardiac arrest lasting >4 minutes, and history of brain stem injury was excluded. Finally, 40 patients were analyzed. The intervention constituted CST, which involved promoting awakening, maintaining arousal, and enhancing the rehabilitative potential of comatose patients by stimulating all five senses, that is, visual, olfactory, gustatory, tactile, auditory, and kinesthetic. CST was administered once a day from day 1 to day 14 or till the discharge of the patients. Postintervention GCS and CRS scores were assessed on days 3rd, 7th, 10th, and 14th/at the time of discharge. The main outcome measures were the GCS and CRS scores.
Statistical analysis: Continuous variables are presented as the median and interquartile range (IQR). McNemar and Wilcoxon's tests were used to analyze the effectiveness of CST on GCS and CRS scores.
Results: Median GCS score of the patients was six at the baseline. After the intervention, it was 10 on day 14th/at the time of discharge. Before the intervention, the median CRS score was five. It increased to 14 on day 14th/at the time of discharge. There was a statistically significant improvement in GCS and CRS scores after the intervention, as per McNemar's test (p < 0.001) and Wilcoxon's test (p < 0.001).
Conclusion: Early intervention with CST may help in the improvement of the level of consciousness and brain functioning of the comatose patient with TBI.
Lombardi F, Taricco M, De Tanti A, et al. Sensory stimulation for brain injured individuals in coma or vegetative state. Cochrane Database Syst Rev 2002;2002(2):CD001427. DOI: 10.1002/14651858
Mandeep, Kumar P, Souza C. Effectiveness of early intervention of coma arousal therapy in traumatic brain injury patients. Int J Head Neck Surg 2012;3(3):137–142. DOI: 10.5005/jp-journals-10001-1114
Walsh R. Sensory environments, brain damage, and drugs: a review of interactions and mediating mechanisms. Int J Neurosci 1981;14(3-4):129–137. DOI: 10.3109/00207458108985825
Mandeep, Chitkara N, Goel S, et al. Traumatic head injury: early intervention by coma arousal therapy. Indian J Neurotrauma 2013;10(1):13–18. DOI: 10.1016/j.ijnt.2013.05.004
Urbenjaphol P, Jitpanya C, Khaoropthum S. Effects of the sensory stimulation program on recovery in unconscious patients with traumatic brain injury. J Neuro Sci Nurs 2009;41(3):E10–E16. DOI: 10.1097/JNN.0b013e3181a23e94
Hall ME, MacDonald S, Young GC. The effectiveness of directed multisensory stimulation versus non-directed stimulation in comatose CHI patients: pilot study of a single subject design. Brain Inj 1992;6(5):435–445. DOI: 10.3109/02699059209008139
Karma D, Rawat AK. Effect of stimulation in coma. Indian Pediatr 2006;43(10):856–860.
Wood RL, Winkowski TB, Miller JL, et al. Evaluating sensory regulation as a method to improve awareness in patients with altered states of consciousness: a pilot study. Brain Inj 1992;6(5):411–418. DOI: 10.3109/02699059209008137
Pape TLB, Rosenow JM, Steiner M, et al. Placebo-controlled trial of familiar auditory sensory training for acute severe traumatic brain injury: a preliminary report. Neurorehabil Neural Repair 2015;29:537–547. DOI: 10.1177/1545968314554626
Gerber CS. Understanding and managing coma stimulation: are we doing everything we can? Crit Care Nurs Q 2005;28(2):94–108. DOI: 10.1097/00002727-200504000-00002
Coronado VG, Basavaraju SV, McGuire LC, et al. Surveillance for Traumatic. Brain Injury–Related Deaths – United States, 1997–2007 [Internet]. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6005a1.htm
CDC | Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths | Traumatic Brain Injury | Injury Center [Internet]. Available from: http://www.cdc.gov/traumaticbraininjury/data/rates.html
Kumar V, Singh A, Tewari MK, et al. Home care of discharged postoperative neurosurgery patients: are the caregivers responsible? Asian J Nur Edu Res 2015;5(3):344–350. DOI: 10.5958/2349-2996.2015.00071.3
Sharma A, Kaur S, Tewari MK, et al. Extent of the burden of caregiving on family members of neurosurgical inpatients in a tertiary care hospital in North India. J Neurosci Nurs 2014; 46(1):E3–E9. DOI: 10.1097/JNN.0000000000000030
Kumar V, Singh A, Tewari MK, et al. Caregivers’ perspective on home-based care of operated neurosurgery patients discharged from PGIMER, Chandigarh, India. Indian J Palliat Care 2015;21(2):253–254. DOI: 10.4103/0973-1075.156513
Mitchell S, Bradley VA, Welch JL, et al. Coma arousal procedure: a therapeutic intervention in the treatment of head injury. Brain Inj 1990;4(3):273–279. DOI: 10.3109/02699059009026177
Oh H, Seo W. Sensory stimulation programme to improve recovery in comatose patients. J Clin Nurs 2003;12(3):394–404. DOI: 10.1046/j.1365-2702.2003.00750.x