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. 2018 Oct 2;9:826.
doi: 10.3389/fneur.2018.00826. eCollection 2018.

Do Sensory Stimulation Programs Have an Impact on Consciousness Recovery?

Free PMC article

Do Sensory Stimulation Programs Have an Impact on Consciousness Recovery?

Lijuan Cheng et al. Front Neurol. .
Free PMC article


Objectives: Considering sensory stimulation programs (SSP) as a treatment for disorders of consciousness is still debated today. Previous studies investigating its efficacy were affected by various biases among which small sample size and spontaneous recovery. In this study, treatment-related changes were assessed using time-series design in patients with disorders of consciousness (i.e., vegetative state-VS and minimally conscious state-MCS). Methods: A withdrawal design (ABAB) was used. During B phases, patients underwent a SSP (3 days a week, including auditory, visual, tactile, olfactory, and gustatory stimulation). The program was not applied during A phases. To assess behavioral changes, the Coma Recovery Scale-Revised (CRS-R) was administered by an independent rater on a weekly basis, across all phases. Each phase lasted 4 weeks. In a subset of patients, resting state functional magnetic resonance imaging (fMRI) data were collected at the end of each phase. Results: Twenty nine patients (48 ± 19 years old; 15 traumatic; 21 > a year post-injury; 11 VS and 18 MCS) were included in our study. Higher CRS-R total scores (medium effect size) as well as higher arousal and oromotor subscores were observed in the B phases (treatment) as compared to A phases (no treatment), in the MCS group but not in the VS group. In the three patients who underwent fMRI analyses, a modulation of metabolic activity related to treatment was observed in middle frontal gyrus, superior temporal gyrus as well as ventro-anterior thalamic nucleus. Conclusion: Our results suggest that SSP may not be sufficient to restore consciousness. SSP might nevertheless lead to improved behavioral responsiveness in MCS patients. Our results show higher CRS-R total scores when treatment is applied, and more exactly, increased arousal and oromotor functions.

Keywords: brain injuries; consciousness; minimally conscious state; persistent vegetative state; sensory stimulation.


Figure 1
Figure 1
Changes in CRS-R total scores. This figure illustrates the mean (bars = 95% confidence intervals) of the CRS-R total scores on treatment (dark gray) vs. off treatment (light gray) for both vegetative (VS) and minimally conscious (MCS) groups (A) but also within each group, separately (B). Asterisks indicate significant results (p < 0.05).
Figure 2
Figure 2
Brain areas with treatment-related metabolic changes. The left side of (A) illustrates, at the group level, areas with treatment-related metabolic changes which include the right middle frontal gyrus, the right superior temporal gyrus as well as the bilateral ventro-anterior thalamic nucleus (L = left, R = right) (p < 0.005 voxel-wise uncorrected). On the right side of (A), z-scores for each activated area are also reported at each phase (ABAB) for patients MCS 7, MCS 8, and VS 11. (B) Shows the CRS-R total scores on the last week of each phase (ABAB) for patients MCS 7, MCS 8, and VS 11.

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