AROUSAL THERAPY COMA STIMULATION ICU.pptx

Coma stimulation is a treatment in which a health care professional or a patient's family member systematically applies stimulation to one or more of the patient's five senses, for the purpose of increasing patient responsiveness. The rationale is that exposure to frequent and various sensory stimulation will facilitate both dendritic growth and improve synaptic connectivity in those with damaged nervous systems (Ansell, 1991; Kater, 1989). This review was conducted to determine whether research supports the incorporation of a coma stimulation program into routine nursing care. Included studies were of stimulation programs in inpatient settings, analyzing both multimodal and unimodal sensory stimulation. Implications for nursing practice are given, including specific prescriptives for implementing a coma stimulation program and areas for further research.
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.
theory:
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.

1. Dr. Yukta Suresh Telrandhe [email protected] II-MPT, Department of Neuro-Physiotherapy, Maharashtra Institute Of Physiotherapy, Latur Maharashtra, India – 413 531. AROUSAL THERAPY

2. CONTENTS Introduction Mode of stimulation Theoretical frame work Method of application References 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 3

3. INTRODUCTION sensory stimulation or basal stimulation. Coma stimulation/coma arousal therapy. Helped many patients recover from traumatic brain injuries sooner. Coma stimulation therapies have been administered to patients with decreased levels of consciousness or loss of memory for decades in rehabilitation settings to prevent sensory deprivation and promote recovery. 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 4

4. 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. 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. 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 5

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. 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 fostering the overall recovery, and reducing the duration of recovery. 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 6

6. What are good signs someone is coming out of coma? Localized response: There are appropriate movements by the patient in response to sound, touch or sight. Following simple commands: Opening and closing eyes, sticking the tongue out, or gripping and releasing hands when asked are examples. 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 7

7. TRACTILE AUDITORY VISUAL PROPRIOCEPTIVE OLFACTORY GUSTATORY 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 8

8. Mode of stimulation Sensory stimulation can be unimodal or multimodal 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. 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 9

9. THEORETICAL FRAMEWORK SENSORY DEPRIVATION THEORY NEURAL PLASTICITY 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 10

10. 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 higher threshold of these reticular neurons thereby increasing the cortical activity and improving responsiveness. 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 11

11. NEURAL PLASTICITY It is the ability of the nervous system to change continually by increasing dendritic branching and the number of dendrites. Damage to the nervous system catalysis 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 on soon as the patient is medically stable and when the patient is closest to his time of injury. 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 12

12. METHOD OF APPLICATION Ideal position: 30* propped up position. Visual- Administered by using a flashlight, bright–coloured objects, a mirror and pictures of various shapes and sizes. The patient is encouraged to track these object. Auditory: Uses taped voice recordings, music or sounds from nature or family members voices. 10-05-2024 AROUSAL THERAPY Dr. Yukta T. [email protected] 13

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14. Olfactory: Uses perfume, spices or the aroma of food items. Gustatory: Spices, swabs of appropriate items can be touched on the patients tongue to stimulate the taste sensation. tractile: Administered by rubbing different textures like satin, silk, fur, smooth metal, sandpaper or cool or warm items over the patient’s body surfaces. Proprioception: Passive range of motion for all joints. 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 15

15. Duration of stimulation Varies from 20 min to 3 hours per day. Can be repeated twice a day. 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 16

16. SENSORY STIMULATION Verbal orientation Music Bells Clapping Tunning fork Photographs Pen light Familiar objects Flash cards Vinegar Spices Perfume Potpourri Orange peel Lemon peel Mouthwash swabs Lemon juice Sweet or salty solutions Holding Rubbing lotion Heat/cold Cotton ball Rough surfaces Familiar object Turning Range of motion 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 17

17. RESPONSES TO STIMULATION Startle reaction Visual tracking Toward sound Follows commands Eye blink Visual tracking Grimacing Tearing Head turning Grimacing Spitting swallowing Localization Withdrawal posturing Assisted ROM Follows commands 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 18

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19. Effectiveness of Early Intervention of Coma Arousal Therapy in Traumatic Head Injury Patients: Mandeep, Pravin Kumar (2012) Thirty comatose patients with traumatic head injury were systematically randomly selected. Both the experimental group and control group had 15 patients each. Patients in the experimental group were given coma arousal therapy while those in the control group did not receive any coma arousal therapy. Glasgow coma scale (GCS) and coma recovery scale (CRS) were assessed before and after 1 and 2 weeks of protocol. The rationale is that coma arousal therapy of sufficient frequency, intensity and duration arise the brain by improving neuronal organization, stimulating the reticular activating system and increasing the level of cognitive function. Maximum reorganization of the brain occurred within the first few weeks after brain injury. The rationale is that exposure to frequent and various sensory stimulations facilitates both dendritic growth and improves synaptic connectivity in those with damaged nervous system. 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 20

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21. Effectiveness of Coma Stimulation Program in Traumatic Brain Injury: Anjali Sharma (2024) The study was conducted on 15 TBI patients. To all the subjects one session of a coma stimulation program with two sessions of conventional physiotherapy was given for 4 weeks. Glasgow coma scale was used as the outcome. The total duration of the study was 1 year. Individual subject management was done for a period of 4 weeks with treatment time of 30-45 minutes for conventional treatment in two sets along with another session of 50 min for multisensory stimulation therapy for 6 days a week. Results from this study suggest that providing a repetitive coma stimulation program for 4 weeks can enhance consciousness recovery in traumatic brain-injured patients. Significant improvement in response to coma stimulation program as measured by Glasgow coma scale. 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 22

22. REFERENCES 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. 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. 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. 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. 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 23

23. 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 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. 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. 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. 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. 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 24

24. THANK YOU….. 10-05-2024 AROUSAL THERAPY Dr.Yukta T. [email protected] 25