Why then, did they choose to test the efficacy of this program? Health care givers believe that the brain probably has restorative powers that have yet to be appreciated. (Lasden 1982 cited in DeYoung 2000) Those who believe in the effectiveness of intense multi-sensory stimulation think that doing so will stimulate the reticular system of the brain that is responsible for arousal and wakefulness. (Snyder 1983 cited in DeYoung 2000) Through sensory stimulation then, DeYoung wrote, the hope is to awaken and train portions of the brain that was previously unused. (2000)
DeYoung further wrote about the International Coma Recovery Institute (ICRI) as being one of the advocates of Sensory Stimulation Program. She wrote, “For almost all patients accepted into this program, the prognosis is “hopeless” in terms of any recovery from coma; families have previously been told that the patient will never improve. The coma recovery team does not believe that most cases are hopeless. The ICRI program is based on the belief that in most cases the patient can be aroused and elevated to a higher level of functioning (LeWinn and Dimancescu, 1978 cited in DeYoung 2000).
The ICRI has been in existence since 1977 and has treated more than 250 patients. Ninety-two percent of those patients have aroused from coma, 35 percent have become functionally independent, and 57 percent have improved in physical and mental abilities. In only 4 percent of the cases has there been no change in condition. These statistics are even more impressive considering that the average program patient has already been in coma for six months by the time of admission. One patient was accepted who had been in coma for four years. ” (2000)
She likewise said that in ICRI, the multi-sensory and physical stimulation plan is carried out by day four of the patient’s stay in the hospital. Depending on the level of consciousness and sensory-motor function, the plan is tailored to fit the needs of the patient. Once the initial assessment is completed, a program plan is created. The reactivity to the stimulation of the senses and the motor function of the extremities are recorded on a 6-point scale. If a patient scores low on the scale, then a more intensive stimulation will be required.
On the other hand, if a patient scores closer to a 6, then the program will not be as intense. (2000) A sample multi-sensory program that was published by DeYoung for patients who score low on the scale is as follows: For Visual stimulation: bright light is used to be turned on and off for a second for the duration on 10 seconds. This is done every hour for 11 hours all the while evaluating papillary reaction, initiation of eye blink or movement of head. For Auditory stimulation: simple, loud sound is created, like clapping of two pieces of metal or wood next to the left ear, and then to the right ear.
This is done three times every hour for 11 hours. To measure effectivity, the patient should initiate blink or the head should turn briskly upon auditory stimulation or startle reflex. For Olfactory stimulation: ammonia is used and placed for 5 seconds under each nostril. This is done every hour for 11 hours. The intended reactions are tearing, facial flush, breath-holding or withdrawal from stimulus. For Gustatory stimulation: a drop of Tabasco sauce is placed on the tongue once every hour for 11 hours. The expected reactions are diaphoresis, facial flush, spitting and swallowing.
For Tactile stimulation (light touch): a feather or sponge is trailed down the limbs, one side first followed by the other. This is done every hour for 11 hours, continuously until the patient can give verbal response. For Pressure stimulation: increased pressure is placed against the muscles, first to one side, then to the other. This is done every hour for 11 hours. As with in tactile stimulation, the exercise is continued until the patient can give verbal response. For Pain stimulation: pressure is applied to TMJ, trapezius muscle and/or fingernail beds for up to 5 seconds.
This is done every hour for 11 hours. Patients are expected to withdraw from the stimulus. For Range of motion: alternating movements of arms and legs are done 15 times every hour for 11 hours. Aside from this, range of motion exercises are applied to all joints in approximately 150 ranges of each joint per day. For both activities, the method of evaluation is the degree of range patient participation. (2000) The six-point scale used to base the intensity of the program is as follows: For Visual response: 1. Pupil dilated with no response to light 2. Pupils constrict appropriately to light
3. Eyes track moving object 4. Perceives color and light 5. Recognizes written/pictorial images For Olfactory response: 1. No reaction to ammonia spirits 2. Nose twitching, tearing, flushing of face with ammonia 3. Turning of head away from stimulus For Gustatory response: 1. No swallow/gag/cough reflex 2. Poor swallow reflex; saliva drools 3. Inability to open mouth 4. Tongue moves food efficiently for swallow 5. Patient eating semi-solids 6. Patient drinking fluids For Auditory response: 1. No reaction to loud stimulus 2. Patient startles appropriately to loud stimulus
3. Turns head to voice 4. Follows commands For Tactile response: 1. No response to deep pain 2. Withdrawal to painful stimulus 3. No response to light touch, pressure, vibration 4. Piloerection to cold stimulus 5. Withdrawal to cold stimulus For Range of Motion response: 1. Flaccidity 2. No voluntary movement 3. Spasticity of joints 4. Moves joint/limb to command 5. Assists with exercise A score of 1 is considered to be the lowest level of response and 6 is considered to be the highest level of response for each of the qualifiers mentioned. (2000)
Baker also suggested other activities that can be used as an example of sensory stimulation. First, the pupils of the eyes must be constricted, after which, with the eyes remaining open, flash cards can be used to stimulate patients visually. Clear contrast must be used so that it would be more distinguished. Startle reflex can also be used as a form of auditory stimulation. This can be achieved by creating loud noise that would startle the patient. Tactile stimulation can be achieved by deep pressure massages, pinching, slapping, and use of a vibrator, loofah sponge and brushes.
(Hunter 1986 as cited in Baker 2000) To achieve gustatory stimulation, substances with strong flavor can be used to achieve facial grimacing, which is one of the shows that the sense is still working. Same thing can be used in trying to stimulate the olfactory sense. One can use oils and different kinds of perfumes, and the objective is to achieve facial grimacing. (2000) Giacino mentioned that environmental enrichment strategies as form of sensory stimulation, albeit unstructured, can also be done.
In environmental enrichment, the patient is exposed to any naturally-occurring stimuli to try to increase brain activation and then, behavioral responses. Simple things such as TV or radio broadcasts, family pictures or audiotapes can be used. (2009) On the other hand, Empire Blue Cross Blue Shield policy states the intensity of the program varies from one or two cycles of stimulation daily that takes about an hour each to hourly stimulation cycles that lasts anytime between 15-20 minutes for 12-14 hours a day, 6 days a week.