Research Reports - Effectiveness of direct and non-direct auditory stimulation on coma arousal after traumatic brain injury

 Int J Nurs Pract. 2016 May 30. doi: 10.1111/ijn.12448. [Epub ahead of print]

Park S(1), Davis AE(2).

The aim of this study was to evaluate the effect of direct and non-direct
auditory stimulation on arousal in coma patients with severe traumatic brain
injury and to compare the effects of direct vs. non-direct auditory stimulation.
A crossover intervention study design was used. Nine participants who were
comatose after a severe traumatic brain injury underwent direct and non-direct
auditory stimulation. Direct auditory stimulation requires a higher level of
interpersonal interaction between the patient and stimuli such as voices of
family members, orientation by a nurse or family member and familiar music. In
contrast, non-direct auditory stimuli were characterized as more general, less
familiar, less interactive, indirect and not lively such as general music and TV
sounds. Participants received both direct and non-direct auditory stimulation in
randomized order for 15 minutes. Recovery of consciousness was measured with the
Glasgow Coma Scale (GCS) and Sensory Stimulation Assessment Measure (SSAM). The
Friedman test with post hoc analysis by Wilcoxon's signed-rank test comparisons
was used for data analysis. Patients who received both direct and non-direct
auditory stimulation exhibited significantly increased GCS (p = 0.008) and SSAM
scores (p = 0.008) over baseline. The improvement in SSAM scores after direct
auditory stimulation was significantly greater than that after non-direct
auditory stimulation (p = 0.021), but there was no statistically significant
difference in GCS scores (p = 0.139). Auditory stimulation, in particular direct
auditory stimulation, might be useful for improving the recovery of consciousness
and increasing the arousal of comatose patients. The SSAM is more useful for
detecting subtle changes from stimulation intervention than the GCS. 

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