Coma stimulation

Introduction[edit | edit source]

Coma stimulation is also termed Sensory Stimulation or Basal Stimulation. Petra Potmesilova et al defined it as "a rehabilitation concept that works on the pedagogical-treatment principle and allows support for the perception, communication, and physical abilities of a person with any disability, regardless of its type and severity."[1]

It is a collaborative approach that refers to the application of a specific structured stimulus to comatose patients for a particular period thereby improving their level of consciousness and recovery.[2][3]Coma-stimulation therapies have been administered to patients with decreased levels of consciousness or loss of memory for decades in rehabilitation settings [4] to prevent sensory deprivation and promote recovery[5]. They may be administered through any sensory modality, with tactile and auditory stimuli being the most common. The rationale for this class is that sensory stimulation may enhance neural processing, support neuroplasticity, and thus promote reemergence of consciousness.[4]Sensory stimulation differs significantly in terms of duration, type of application, or mode of stimulation. The goal of this technique is the activation of the brain, improving the patient’s responsiveness, improving the transmission of the stimulus and fostering the overall recovery, and reducing the duration of recovery.[2]

The stimuli can be:






and gustatory[8].

Mode of stimulation[edit | edit source]

Sensory stimulation can be unimodal or multimodal, however, research suggests that sensory modalities are more effective when in concert with each other.[9]

Unimodal: Refers to the application of only one stimulus at a time.

Multimodal: Refers to the application of more than one stimulus at a given point in time. Multimodal mode of stimulation has proven to be more effective in improving the level of consciousness when compared to unimodal.[9]

Theoretical Framework[edit | edit source]

1. Sensory Deprivation Theory Comatose patients experience sensory deprivation as the ability to respond to stimuli- internal or external is altered. This alteration further leads to an increase in the threshold of activation of the reticular activating system. As coma stimulation is a controlled stimulation it is assumed to meet the higher threshold of these reticular neurons thereby increasing the cortical activity and improving responsiveness.

2. Neural Plasticity; Neural plasticity is the ability of the nervous system to change continually by increasing dendritic branching and the number of dendrites. Damage to the nervous system catalyzes this increase in synaptogenesis. The application of stimulus during the period of neural regrowth is assumed to maximize the effect of plasticity. Therefore it is ideal to start coma stimulation as soon as the patient is medically stable and when the patient is closest to his time of injury.[8]

Method of application[edit | edit source]

Ideal position: 30° propped up position.

Visual- Administered by using a flashlight, bright-colored objects, a mirror, and pictures of various shapes and sizes. The patient is encouraged to track these objects.[7]

Auditory- Uses taped voice recordings of family and friends, favorite music, or sounds from nature[5]

Olfactory- Uses perfume, spices, or the aroma of food items.

Gustatory- Spices, popsicles. Swabs of appropriate items can be touched on the patient’s tongue to stimulate the taste sensation.

Tactile- Administered by rubbing different textures like satin, silk, fur, smooth metal, sandpaper, or cool or warm items over the patient's body surfaces.[6]

Proprioception- Passive range of motion for all joints.

Duration of stimulation[edit | edit source]

Varies from 20 minutes to 3 hours per day. Can be repeated twice a day.

References[edit | edit source]

  1. Potmesilova P, Potmesil M, Mareckova J. Basal Stimulation as Developmental Support in At-Risk Newborns: A Literature Review. Children. 2023 Feb 16;10(2):389.
  2. 2.0 2.1 Hellweg S. Effectiveness of physiotherapy and occupational therapy after traumatic brain injury in the intensive care unit. Critical care research and practice. 2012 Oct;2012.
  3. Faozi E, Fadlilah S, Dwiyanto Y, Retnaningsih LN, Krisnanto PD. Effects of a Multimodal Sensory Stimulation Intervention on Glasgow Coma Scale Scores in Stroke Patients with Unconsciousness. Korean Journal of Adult Nursing. 2021 Dec 1;33(6):649-56.
  4. 4.0 4.1 Edlow BL, Sanz LR, Polizzotto L, Pouratian N, Rolston JD, Snider SB, Thibaut A, Stevens RD, Gosseries O. Therapies to restore consciousness in patients with severe brain injuries: a gap analysis and future directions. Neurocritical care. 2021 Jul;35:68-85.
  5. 5.0 5.1 5.2 Zuo J, Tao Y, Liu M, Feng L, Yang Y, Liao L. The effect of family-centered sensory and affective stimulation on comatose patients with traumatic brain injury: a systematic review and meta-analysis. International Journal of Nursing Studies. 2021 Mar 1;115:103846.
  6. 6.0 6.1 6.2 Li J, Cheng Q, Liu FK, Huang Z, Feng SS. Sensory stimulation to improve arousal in comatose patients after traumatic brain injury: a systematic review of the literature. Neurological Sciences. 2020 Sep;41:2367-76.
  7. 7.0 7.1 Cheng L, Cortese D, Monti MM, Wang F, Riganello F, Arcuri F, Di H, Schnakers C. Do sensory stimulation programs have an impact on consciousness recovery?. Frontiers in neurology. 2018 Oct 2;9:826.
  8. 8.0 8.1 Bos S. Coma stimulation. Worldviews on Evidence‐based Nursing presents the archives of Online Journal of Knowledge Synthesis for Nursing. 1997 Feb;4(1):1-6.
  9. 9.0 9.1 Norwood MF, Lakhani A, Watling DP, Marsh CH, Zeeman H. Efficacy of Multimodal Sensory Therapy in Adult Acquired Brain Injury: A Systematic Review. Neuropsychology Review. 2022 Sep 2:1-21.