Coma

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Question Received:

1. I am looking for information about Coma Stimulation and outcome measures for same, can you help?

Response:

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I am looking for information about Coma Stimulation and outcome measures for same, can you help?

2nd April 2024

Many brain-injury rehabilitation programmes include sensory stimulation as part of the treatment for severely brain-injured patients. The stimulation can be provided by members of the health team and by family members. Although the merits or otherwise of this treatment are still being evaluated (Davis and White, 1995), there is evidence that sensory stimulation has been beneficial for some patients (Mitchell et al, 1990; Ansell, 1991; Wilson et al, 1991; Wood et al, 1992; Wilson, Powell, Brock, and Thwaites, 1996a). The use of a variety of stimuli, particularly those with a particular significance for the patient, was found to be more effective than a single stimulus (Wilson, Powell, Brock, and Thwaites, 1996b). It has been recommended that coma stimulation should commence during the early stages of recovery in intensive care rather than being delayed until the rehabilitation setting (Helwick, 1994; Sosnowski and Ustik, 1994). Wood (1991) provided a conceptual model of coma arousal and sensory stimulation with the aim of developing a more scientific approach in its use.

Several outcome measures of coma stimulation have been developed:

• The Sensory Stimulation Assessment Measure (SSAM) was developed to measure responsiveness in patients who are unable to communicate or follow verbal instructions (Rader and Ellis, 1994). The responses of patient are quantified on three behavioural scales: Eye Opening, Motor, and Vocalization, each scale being subdivided into six points

• The Western Neuro Sensory Stimulation Profile (WNSSP) was developed to assess cognitive function in head-injured adults receiving sensory stimulation (Ansell and Keenan, 1989). The WNSSP consists of 32 items which assess the patient’s state of arousal and attention, expressive communication, and response to auditory, visual, tactile, and olfactory stimulation

• The European Head Injury Evaluation Chart (EHIEC) can be used to assess head-injured patients from the initial insult to several years following injury (Cudmore and Pentland, 1996)

• Arousal Profiles Arousal Profiles assess changes in eye opening and spontaneous movements as a result of sensory stimulation treatment (Wilson, Brock, Powell, Thwaites, and Elliott, 1996).

References

• Ansell, B.J. (1991) Slow-to-recover brain-injured patients: rationale for treatment. Journal of Speech and Hearing Research, 34(5), 1017-1022 (Oct).

• Ansell, B.J., and Keenan, J.E. (1989) The Western Neuro Sensory Stimulation Profile: a tool for assessing slow-to-recover head-injured patients. Archives of Physical and Medical Rehabilitation, 70(2), 104-108 (Feb).

• Cudmore, S., and Pentland, B. (1996) Early experience of the utility of the European Head Injury Evaluation Chart. Brain Injury, 10(7), 517-529 (Jul).

• Davis, A.E., and White, J.J. (1995) Innovative sensory input for the comatose brain-injured patient. Critical Care Nursing Clinics North America, 7(2), 351-361 (Jun).

• Helwick, L.D. (1994) Stimulation programs for coma patients. Critical Care Nurse, 14(4), 47-52 (Aug).

• Mitchell, S., Bradley, V.A., Welch, J.L., and Britton, P.G. (1990) Coma arousal procedure: a therapeutic intervention in the treatment of head injury. Brain Injury, 4(3), 273-279 (Jul-Sep).

• Rader, M.A., and Ellis, D.W. (1994) The Sensory Stimulation Assessment Measure (SSAM): a tool for early evaluation of severely brain-injured patients. Brain Injury, 8(4), 309-321 (May-Jun).

• Sosnowski, C., and Ustik, M. (1994) Early intervention: coma stimulation in the intensive care unit. Journal of Neuroscience Nursing, 26(6), 336-341 (Dec).

• Wilson, S.L., Powell, G.E., Elliott, K., and Thwaites, H. (1991) Sensory stimulation in prolonged coma: four single case studies. Brain Injury, 5(4), 393-400 (Oct-Dec).

• Wilson, S.L., Powell, G.E., Brock, D., and Thwaites, H. (1996a) Behavioural differences between patients who emerged from vegetative state and those who did not. Brain Injury, 10(7), 509-516 (Jul).

• Wilson, S.L., Powell, G.E., Brock, D., and Thwaites, H. (1996b) Vegetative state and responses to sensory stimulation: an analysis of 24 cases. Brain Injury, 10(11), 807-818 (Nov).

• Wilson, S.L., Brock, D., Powell, G.E., Thwaites, H., and Elliott, K. (1996) Constructing arousal profiles for vegetative state patients–a preliminary report. Brain Injury, 10(2), 105-113 (Feb).

• Wood, R.L. (1991) Critical analysis of the concept of sensory stimulation for patients in vegetative states. Brain Injury, 5(4), 401-409 (Oct-Dec).

• Wood, R.L., Winkowski, T.B., Miller, J.L., Tierney, L., and Goldman, L. (1992) Evaluating sensory regulation as a method to improve awareness in patients with altered states of consciousness: a pilot study. Brain Injury, 6(5), 411-418 (Sep-Oct).

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