Sensory Stimulation Protocol for the Complex Acute CVA Patient: A Case Report

Research Objectives: Understand the implications of a low-level sensory stimulation protocol for patients with disorders of consciousness

Discuss the importance of multidisciplinary participation in a sensory stimulation protocol for patients with disorders of consciousness

Discuss the utilization of the JFK-CRS assessment to monitor changes in consciousness in patients presenting as minimally conscious or vegetative state

Design: Case Study over 5 month hospital stay

Setting: Large comprehensive stroke center

Participants: 45-year-old woman in a vegetative state who had suffered both a severe CVA and TBI

Interventions: An evidence-based, low level multimodal sensory stimulation protocol for a three-week trial period; the patient presented with little to no response to external stimuli. Her score did improve during the trial period, but she remained in a vegetative state. Physical and occupational therapy continued after the trial and encouraged upright sitting tolerance and provided sensory stimulation. The patient was more alert and was following simple commands; a ventriculoperitoneal shunt was then placed.

Main Outcome Measures: JFK coma scale
AM-PAC

Results: JKF-CRS scores improved from 3 to 14, emerging out of her vegetative state. She tolerated sitting in a chair for over three hours and had begun tolerating partial standing activities via a tilt table. Improvement in cognitive and communication function was demonstrated via improved attention to task for up to 10 minutes, 75-90% accuracy with one step commands, and yes/no responses via head nods/squeezing/left foot plantar flexing to target. Fluctuations did occur based on fatigue, positioning, and use of live interpreter versus iPad translator.

Conclusions: Multidisciplinary staff education regarding the importance of sensory stimulation protocols could aid in regular administration of these protocols for patients in a vegetative state and/or ICU setting. Therapy services are often underutilized in ICU settings due to lack of provider understanding of services to be rendered, as well as lack of therapist understanding of interventions to utilize. Thus, sensory stimulation utilization can be of significant value for patients, providers, and therapy colleagues. Earlier implementation in our patient’s recovery can improve outcomes and prevent further complications.

Author(s) Disclosures: none