title: Effectiveness of Sensory Stimulation to Improve Arousal and Alertness of People in a Coma or Persistent Vegetative State After Traumatic Brain Injury: A Systematic Review.
abstract: OBJECTIVE
  This systematic review evaluates the effectiveness of sensory stimulation to improve arousal and alertness of people in a coma or persistent vegetative state after traumatic brain injury (TBI).
  
  
  METHODS
  Databases searched included Medline, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews. The search was limited to outcomes studies published in English in peer-reviewed journals between 2008 and 2013.
  
  
  RESULTS
  Included studies provide strong evidence that multimodal sensory stimulation improves arousal and enhances clinical outcomes for people in a coma or persistent vegetative state after TBI. Moderate evidence was also provided for auditory stimulation, limited evidence was provided for complex stimuli, and insufficient evidence was provided for median nerve stimulation.
  
  
  CONCLUSIONS
  Interventions should be tailored to client tolerance and premorbid preferences. Bimodal or multimodal stimulation should begin early, be frequent, and be sustained until more complex activity is possible.
authors.affiliation: René Padilla, PhD, OT/L, FAOTA, LMHP, is Executive Director of Global Engagement and Associate Professor of Occupational Therapy, Creighton University, Omaha, NE; rpadilla@creighton.edu.
authors.forename: René
authors.initials: R
authors.lastname: Padilla
authors.affiliation: Anna Domina, OTD, OTR/L, is Assistant Professor of Occupational Therapy and Academic Clinical Education Coordinator, Creighton University, Omaha, NE.
authors.forename: Anna
authors.initials: A
authors.lastname: Domina
mesh_terms: D000161:Acoustic Stimulation / Q000379:methods; D001143:Arousal / Q000502:physiology*; D001930:Brain Injuries / Q000150:complications / Q000628:therapy; D003128:Coma / Q000209:etiology / Q000628:therapy; D061345:Early Medical Intervention / Q000379:methods; D006801:Humans; D017063:Outcome Assessment, Health Care; D018458:Persistent Vegetative State / Q000209:etiology / Q000628:therapy; D010812:Physical Stimulation / Q000379:methods*; D012677:Sensation