Abstract
Background. Sensory stimulation is often provided to persons incurring severe traumatic brain injury (TBI), but therapeutic effects are unclear. Objective. This preliminary study investigated neurobehavioral and neurophysiological effects related to sensory stimulation on global neurobehavioral functioning, arousal, and awareness. Methods. A double-blind randomized placebo-controlled trial where 15 participants in states of disordered consciousness (DOC), an average of 70 days after TBI, were provided either the Familiar Auditory Sensory Training (FAST) or Placebo of silence. Global neurobehavioral functioning was measured with the Disorders of Consciousness Scale (DOCS). Arousal and awareness were measured with the Coma-Near-Coma (CNC) scale. Neurophysiological effect was measured using functional magnetic resonance imaging (fMRI). Results. FAST (n = 8) and Placebo (n = 7) groups each showed neurobehavioral improvement. Mean DOCS change (FAST = 13.5, SD = 8.2; Placebo = 18.9, SD = 15.6) was not different, but FAST patients had significantly (P =.049; 95% confidence interval [CI] = -1.51, -.005) more CNC gains (FAST = 1.01, SD = 0.60; Placebo = 0.25, SD = 0.70). Mixed-effects models confirm CNC findings (P =.002). Treatment effect, based on CNC, is large (d = 1.88, 95% CI = 0.77, 3.00). Number needed to treat is 2. FAST patients had more fMRI activation in language regions and whole brain (P values <.05) resembling healthy controls activation. Conclusions. For persons with DOC 29 to 170 days after TBI, FAST resulted in CNC gains and increased neural responsivity to vocal stimuli in language regions. Clinicians should consider providing the FAST to support patient engagement in neurorehabilitation.
Original language | English (US) |
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Pages (from-to) | 537-547 |
Number of pages | 11 |
Journal | Neurorehabilitation and Neural Repair |
Volume | 29 |
Issue number | 6 |
DOIs | |
State | Published - Jul 11 2015 |
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Department of Veterans Affairs, Office of Research and Development, Rehabilitation Research and Development Merit Grant # B4591R and career development transition award #B4949N. Northwestern University’s Clinical and Translation Sciences Institute, which is supported by the National Center for Research Resources, National Institutes of Health (Grant UL1RR025741). The Nick Kot Charity for traumatic brain injury ( www.nkc4tbi.com ).
Keywords
- auditory plasticity
- disordered consciousness
- neurorehabilitation
- sensory stimulation
- traumatic brain injury
- treatment
ASJC Scopus subject areas
- Clinical Neurology
- Neurology
- Rehabilitation