Structured Abstract
Brain Injury Structured Abstract - BI #15
The coma-arousal procedure may reduce the duration of coma and increase patients' responsiveness
CITATION: Mitchell, S., Bradley, V. A., Welch, J. L., & Britton, P. G. (1990). Coma arousal procedures: A therapeutic intervention in the treatment of head injury. Brain Injury, 4(3), 273-279.
LEVEL OF EVIDENCE: IIB3c
This cohort design study, sample size ranged below 20 in each condition (n = 12 and n = 12) with low internal validity and low external validity provided a IIB level of evidence.
RESEARCH OBJECTIVE/QUESTION
To examine the effects of coma arousal procedures vs. no procedure on level of consciousness in persons with traumatic brain injury.
DESIGN
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RCT |
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Single Case |
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Case Control |
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X |
Cohort |
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Before-After |
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Cross-Sectional |
This study is occasionally referred to as a prospective design. A cohort design involves a group of people who have been exposed to a certain situation (not an identical situation necessarily) and the results that follow. This group of people is compared to a control that has not been exposed to the situation. This is different from an RCT study because a group of exposed people is formed primarily, and a group of non-exposed people is found to match the experimental group as well as possible. The experimental group received the coma arousal procedures while the matched control group did not.
SAMPLING PROCEDURE
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Random |
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Consecutive |
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X |
Controlled |
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Convenience |
Individuals for the study were selected according to criteria that had been pre-selected for that certain study. This sampling procedure is not necessarily composed of volunteers but people who fit the criteria. The pairs of subjects were closely equated in terms of age, sex, type and location of head injury, surgical intervention, and Glasgow Coma Scale Score.
SAMPLE
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N = 24 |
M age = 22.54 |
Male = 20 |
Ethnicity = NR |
Female = 4 |
NR = Not reported
Participants were closely equated in terms of age, sex, type, and location of head injury. An experimental group of 12 severely head injured clients received a coma arousal program while a matched control did not. Age range 17-40 years old. Mean duration of coma - stimulation group 22 days, control group 26.9 days, < 8 Glasgow Coma Scale
PARTICIPANT CHARACTERISTICS
Severe traumatic brain injury
MEDICAL DIAGNOSIS/CLINICAL DISORDER
Traumatic Brain Injury, Coma
OT TREATMENT DIAGNOSIS
Physical substrates: Cognitive substrate
OUTCOMES
Eye response
Body movement
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Measures |
Reliability |
Validity |
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1. Mean duration of coma |
NR |
NR |
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2. Glasgow Coma Scale Mean weekly scores |
NR |
NR |
NR = Not Reported
Outcome - OT terminology
Performance Component
1. Cognitive component level of arousal
2. Motor control
Outcome - ICIDH-2 terminology
Body structure
INTERVENTION
1. Coma Arousal Procedure (CAP)
2. Control group received no arousal procedure
Description
Sensory stimulation treatment using stimuli
- Auditory stimulation
- Tactile stimulation
- Olfactory stimulation
- Taste stimulation
- Visual stimulation
- Kinesthetic proprioceptive & Vestibular
No arousal procedure
Who delivered
Relatives of patients trained in protocol
Setting
High dependency unit hospital, United Kingdom, Newcastle General Hospital
Frequency
1-2 Times a day for 1 hour each cycle
Duration
4 cycles - 4 days
RESULTS
- Total duration for the coma arousal procedure group was shortened
- Mean weekly Glasgow Coma Scale scores were larger
- Compare t (11 d · f) = 2.38 P < 0.05
- Represented graphically in figure
CONCLUSIONS
Biases
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Attention |
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Masking/blinding |
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Drop outs |
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Contamination |
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Co-intervention |
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The coma arousal procedure intervention significantly reduced total coma duration and coma lightened more rapidly.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice - Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Beatriz C. Abreu, PhD, OTR, FAOTA, and colleagues. For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
