Multisensorial Stimulation in Comatose Patients: a literature survey

DOI: 10.15343/0104-7809.200832.1.8

Abstract

A coma is a situation of extreme degradation of the level of consciousness where the individual remains with closed eyes, with no perception of the
external world, incapable of communicating, answering to commands and having elaborated behaviors. The level of consciousness, that is, the alert state that keeps
us awaken, depends on Ascendant Reticular Activating System, which is located at the core of the brainstem between the myelencephalon and the mesencephalon.
Coma may be generated by several etiologies, causing damages in ARAS’s cortical activation. With the intention of facilitating the recovery from coma, programs
of multisensorial stimulation (MS) were created aiming to stimulate ARAS and thus to assist in the recovery of the level of conscience of comatose patients. In view
of this, the objective of this work was to analyze what the literature shows about the influence of multisensorial stimulation on the level of consciousness of coma
patients. We did a literature survey in the electronic databases Medline, Cochrane, Scielo and Lilacs and in Pubmed and Highwire search sites. Articles selected cover
the period 1983- 2007. Keywords used were: coma, sensorial stimulation, perception and rehabilitation. We included clinical assays focusing in MS for comatose
patients, and excluded articles that had studied other forms of treatment in comatose patients that did not aimed at increasing the level of consciousness. Twenty
scientific articles were analyzed that presented controversial results regarding the type of stimulation, time of duration of the therapy and results reached after the
application of the multisensorial stimulation program in comatose patients. Although clinical indications pointed to improvements in the level of consciousness
with the use of multisensorial stimulation, there is no scientific evidence of its effectiveness. No randomized clinical assay was located that really established the
improvement of the level of consciousness in comatose patients submitted to a multisensorial stimulation program. It is thus necessary to design studies with a
better methodological adequacy, as well as the follow-up of a broader number of patients.