Theresa Louise-Bender Pape1, Joshua M Rosenow2, Monica Steiner3, Todd Parrish4, Ann Guernon5, Brett Harton6, Vijaya Patil3, Dulal K Bhaumik7, Shane McNamee8, Matthew Walker9, Kathleen Froehlich10, Catherine Burress10, Cheryl Odle6, Xue Wang4, Amy A Herrold6, Weihan Zhao11, Domenic Reda6, Trudy Mallinson12, Mark Conneely13, Alexander J Nemeth4. 1. Edward Hines Jr VA Hospital, Hines, IL, USA Northwestern University Feinberg School of Medicine, Chicago, IL, USA Theresa.Pape@va.gov t-pape@northwestern.edu. 2. Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern Memorial Hospital, Chicago, IL, USA. 3. Edward Hines Jr VA Hospital, Hines, IL, USA Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA. 4. Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 5. Edward Hines Jr VA Hospital, Hines, IL, USA Marianjoy Rehabilitation Hospital, Wheaton, IL, USA. 6. Edward Hines Jr VA Hospital, Hines, IL, USA. 7. Edward Hines Jr VA Hospital, Hines, IL, USA University of Illinois at Chicago, Chicago, IL, USA. 8. Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA. 9. Northshore University Health Systems, Evanston, IL, USA. 10. The Rehabilitation Institute of Chicago, Chicago, IL, USA. 11. University of Illinois at Chicago, Chicago, IL, USA. 12. The George Washington University, Washington, DC, USA. 13. Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
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.
RCT Entities:
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.
Authors: Brian L Edlow; Leandro R D Sanz; Robert D Stevens; Olivia Gosseries; Len Polizzotto; Nader Pouratian; John D Rolston; Samuel B Snider; Aurore Thibaut Journal: Neurocrit Care Date: 2021-07-08 Impact factor: 3.210
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Authors: Jan Claassen; Yama Akbari; Sheila Alexander; Mary Kay Bader; Kathleen Bell; Thomas P Bleck; Melanie Boly; Jeremy Brown; Sherry H-Y Chou; Michael N Diringer; Brian L Edlow; Brandon Foreman; Joseph T Giacino; Olivia Gosseries; Theresa Green; David M Greer; Daniel F Hanley; Jed A Hartings; Raimund Helbok; J Claude Hemphill; H E Hinson; Karen Hirsch; Theresa Human; Michael L James; Nerissa Ko; Daniel Kondziella; Sarah Livesay; Lori K Madden; Shraddha Mainali; Stephan A Mayer; Victoria McCredie; Molly M McNett; Geert Meyfroidt; Martin M Monti; Susanne Muehlschlegel; Santosh Murthy; Paul Nyquist; DaiWai M Olson; J Javier Provencio; Eric Rosenthal; Gisele Sampaio Silva; Simone Sarasso; Nicholas D Schiff; Tarek Sharshar; Lori Shutter; Robert D Stevens; Paul Vespa; Walter Videtta; Amy Wagner; Wendy Ziai; John Whyte; Elizabeth Zink; Jose I Suarez Journal: Neurocrit Care Date: 2021-07-08 Impact factor: 3.210