In reviewing abstracts and articles related to Sensory Stimulation, conclusions of this being a controversial and moot topic are formed. Zasler pointed out that there are different theories that strive to rationalize sensory stimulation. Among these theories are possible facilitation of neural recovery following brain injury, promotion of the activation of primitive brain centres, maintenance and improvement of tonic arousal pathways, and limitation of the type and extent of afferent input to the central nervous system.
He also mentioned that arguments will be formed as to whether or not there is little to no rationale for sensory stimulation in a person who was truly comatose or vegetative (2009) Of the articles mentioned above, three of the studies showed significant statistical findings in relation to the effectivity of sensory stimulation on comatose patients. Karma and Rawat’s study showed improvement after two weeks of stimulation therapy of 77% of the patients in the treatment group.
The control group, on the other hand, showed the same GCS scores showing no statistically significant improvement on level of consciousness. (Karma and Rawat 2006 as cited in Regence 2008) Urbenjahol, Jutpanya, Khaoropthum’s study showed significant statistical findings in the mean Glasgow Coma Scare scores after starting with the stimulation program in the experimental group making them conclude that the program can enhance brain recovery in traumatic brain-injured patients. (2009)
A significant difference in level of consciousness was observed in the intervention group at the first day and after fourteen days of administering sensory stimulation for Bassampour, Zakerimoghadam, Faghihzaded and Goudarzi study. They likewise concluded that auditory stimulations with familiar voice were an effective way in increasing a comatose patient’s level of consciousness. (2007) Six of the journals claimed marked or significant improvement in a patient’s level of consciousness, although the results failed to mention statistical result or evidence.
Oh and Seo’s experiment results showed significant alterations in consciousness two weeks after starting intervention. This experiment dealt with having four consecutive weeks of the intervention programme, halting it after that for the duration of four weeks, and resuming the treatment for another four weeks. After the first phase of the therapy, they started with the four-week gap for cessation of treatment. Two weeks after terminating the treatment, the patients’ consciousness again began to decrease.
Such result prompted them to recommend that an intervention programme should happen for more than a month for its effectivity. Aside from this, they also inferred that at least two weeks should be allowed for significant changes to take effect. (2003) In the diary kept by Su-Chen and Mei-Yung that chronicled their experience in the treatment of their patient where they applied sensory stimulation, they saw a dramatic change in the client’s level of consciousness. From a six in the Glasgow Coma Scale, the patient’s improved state is now an 11.
(2009) Gruner’s study is different from the others as his wasn’t Glasgow Coma Scale-driven. His measure was heart and respiratory frequencies of patients in his sample group. Collectively, it was called as vegetative parameters. Given the difference in measuring tool, he was still able to identify significant changes in the patients’ vegetative parameters. This result made him recommend that stimulation treatment should always be driven by the needs of individual patients rather than having a fixed pattern of administration. (2009)
Mitchell, Bradley, Welch and Britton likewise found that the total duration of the coma was significantly shorter in the experimental group. (1990) While Doman, Wilkinson, Dimanescu and Pelligra’s study focused on prognosis of acute coma against chronic coma, their results also showed that in both conditions, stimulation markedly influenced the outcome of patients’ prognosis. (1993) Morarty’s initial experiment showed that standardized stimulation of the five senses helped in a patient’s early emerge from a vegetative state. (2005)
Two of the articles showed insignificant findings as to the effect of stimulation in comatose patients. Lombardi, Taricco, De Tanti, Telaro and Liberati found that there was no strong evidence in determining sensory stimulation’s benefits in patients with coma. (2002) Ansell and Keenan’s study did not reveal an actual set of data that will prove or disprove the effectivity of sensory stimulation as their study focused more on a way to measure patients’ reaction to stimulus, and not the improvement from one state to another. Because of this, the data points were too broad to confirm and demonstrate improvement.
It doesn’t, however, change the fact that the improvement and effectivity wasn’t documented in this study. (1990) Sometimes, showing marked improvement in actual measuring tool doesn’t mean that there is significant statistical data to back it up. Such is the case of Davis and Gimenez. While the Glasgow Coma Scale scores changed from pre-assessment to post-assessment showed marked improvement, statistical analysis showed that there is still no significance in the data points to conclude that sensory stimulation does have an effect on comatose patients.
(2003) Recommendations as a researcher: Closer inspection of the articles led to the conclusion that sensory stimulation is something that should be done as part of nursing care for patients in vegetative state. As mentioned above, sensory stimulation doesn’t deal mostly with the rigorous and intensive procedures. Sensory stimulation can be as simple as turning the television on, or the radio on to keep the patients aware of their surroundings. It is hapless, however, that medical policies that encourages sensory stimulation have yet to be approved.
Five medical policies were viewed and all of them considered sensory stimulation as “investigational,” “not medically necessary,” “experimental,” or “unproven. ” Blue cross of Idaho’s recent review of literature in April 2007 showed that there is still insufficient evidence to evaluate the efficacy of the treatment. This made the policy statement unchanged. (2007) Regence’s investigation updated in April 2008 likewise revealed lack of demonstration of the effectiveness of sensory stimulation as treatment for comatose patients.
Lack of updates for additional studies also contributed to their decision to render the existing policy unchanged. (2008) LifeWise Health Plan of Washington’s last updated last June 2009 showed no studies that would make them re-assess the policy to include sensory stimulation as part of care plan for comatose patients. Before this, an older review of literature yielded the same result as above. There is insufficient evidence to evaluate the effectiveness of the treatment. (2009) CareAllies’ last review of the policy in December 2008 gave the conclusion that effective treatment interventions for patients in a coma are lacking.
While studies of sensory stimulation have been made over the course of years, they still found insufficient evidence in literature to have their policies changed. (2008) Empire Blue Cross and Blue Shield’s policy review in June 2006 led to the conclusion of not having enough medical literature to prove that efforts of sensory stimulation to hasten the coma patient to wake up and/or affect the quality of life post-coma. They further insisted that further rehabilitation treatment using standard nursing interventions is an alternative to sensory stimulation.
(2006) Overall, the lack of evidence to prove the effectivity of sensory stimulation hasn’t been firmly established to change minds of the people who create medical policies. This still should not discourage nurses to be creative in trying to improve a patient’s way of living. As mentioned above, sensory stimulation can range from complex to simple ones. Perhaps the more complex regimen should be further studied in order for it to be implemented, but the simple ones should be basic enough to be part of any nurse’s care plan.
Conversely, no policy should have to be written in order for simple stimulation to be implemented. As Baker wrote, “The basis of coma arousal therapy lies in the frequency, intensity and duration of environmental stimuli that the patient receives,” and “Coma arousal therapy should commence as soon as possible after the development of coma and may start in the intensive care unit providing the person’s medical condition is stable. ” (2000) Because of this, there is a need to have this programme, if not a part of a medical policy, at least a part of daily nursing care plan.