Background: Disorder of consciousness (DOC) is a medical state in which the person's ability
to be aware of himself and his surroundings is impaired due to an acquired brain injury.
Neuroimaging during nociceptive stimulation in patients with DOC shows an activation in the
network affiliated with the affective dimension of pain, providing evidence that patients can
feel pain without behavioral signs. While patients not experiencing DOC receive medical care
for reducing pain derived from daily medical procedures, patients with DOC receiving these
same medical procedures do not receive such care for pain alleviation. Sensory stimulation
has been found as an effective intervention for the stabilization and improvement of
physiological signs, yet its' effectiveness in reducing pain in patients with DOC has not
been studied.
Methods: Crossover experimental research will be conducted on one focus group without a
control group, that includes recurring tests prior and after intervention. At the first stage
of the research, the data will be collected twice a day, for fourteen days, once when the
patient is in rest and once pre- and post-endotracheal suction. The second stage will include
interventions based on two arms - auditory stimulation and a combination of auditory and
tactile stimulations at the same time. Measures will be collected in days one, seven and
fourteen in each arm. All measures will be applied pre- and post-endotracheal suction which
will be conducted after the intervention period, as specified above, and during a patient
rest period before and after intervention. Both interventions will be conducted for ten
minutes each, twice daily, for fourteen days.
Population: After receiving consent to participate in the study from a guardian,15 adults
aged 30-75, diagnosed with DOC, hospitalized in prolonged respiratory department will
participate.
Tools: Physiological signs, behavioral pain scale, Modify Ashworth Scale, Brain Engagement
Index.
Expected Results:
Statistical significance will be found between measurements prior to interventions
(control) and after interventions, both during rest (clinical pain) and during medical
procedures, in the following measures:
Physiological signs (blood pressure, pulse and respiratory indices) post
intervention will be lower.
Degree of spasticity post intervention will be lower.
Pain levels post intervention will be lower.
Statistical significance will be found in the levels of attention during interventions
(sensory stimulations) in comparison to before the interventions (control), where the
former will be higher in comparison to the latter.
Statistical significance will be found in the efficiency of multi-sensory stimulations
in comparison to a single sensory stimulation, where the former will show lower
physiological signs, spasticity, and levels of pain during rest and medical procedures.
Findings may improve the quality of life in patients with respiratory distress, diagnosed
with DOC, providing additional treatment options for pain management other than medications.