REHABILITATION OF MODERATE TO SEVERE TBI: COMA: SENSORY STIMULATION PROGRAMS

  1. Nonpharmacologic
    • Prevent complications, due to prolonged immobility, with a regular exercise program, including daily range of motion exercises, skin care, bowel and bladder care, and a sitting program (which also stimulates the visual and vestibular systems and facilitates arousal)

    • Create the most supportive environment possible for coma emergence
      • Individualized sensory stimulation program
        • Stabilize the patient medically with the minimum medication program
        • Assess the baseline level of cognitive function, through numerous periods of observation and discussion with caregivers
        • Involve the direct stimulation of all five senses frequently throughout each day, recording patient response using a graded scale, and monitoring patient progress

      • Family education

  2. Pharmacologic - Dopamine agonists in minimally responsive patients
    • Bromocriptine (Parlodel), a direct dopamine agonist, is commonly used and may also be efficacious in patients with nonfluent aphasia
    • Levodopa, an indirect dopamine agonist, in combination with carbidopa (Sinemet) is commonly used
    • Amantadine (Symmetryl) is used somewhat less often and may be associated with greater recovery than dentrolene sodium (Whyte, et al 2005), but may not have an effect on recovery of consciousness (Hughes, et al 2005).

  3. Surgical - Placement of stimulators in the mesencephalic reticular formation or spinal dorsal column at the C2 level

Based on information in Medical Rehabilitation of Traumatic Brain Injury, L.J. Horn and N.D. Zasler, eds. St. Louis, MO, Mosby, 1996, except for information where other papers are cited.