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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2018.00826

Do sensory stimulation programs have an impact on consciousness recovery?

Lijuan Cheng1, Daniela Cortese2, Martin M. Monti3, 4, Fuyan Wang1, Francesco Riganello2, Francesco Arcuri2,  Haibo Di1* and  Caroline Schnakers5*
  • 1International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, China
  • 2Research in Advanced Neurorehabilitation, Istituto S.Anna Crotone, Italy
  • 3Psychology, University of California, Los Angeles, United States
  • 4Neurosurgery, University of California, Los Angeles, United States
  • 5Research, Casa Colina Centers for Rehabilitation, United States

Objectives. Considering sensory stimulation programs (SSP) as a treatment for disorders of consciousness is still debated today. Previous studies investigating its efficacy were affected by various biases among which small sample size and spontaneous recovery. In this study, treatment-related changes were assessed using time-series design in patients with disorders of consciousness (i.e., vegetative state – VS and minimally conscious state – MCS). Methods. A withdrawal design (ABAB) was used. During B phases, patients underwent a SSP (3 days a week, including emotional auditory, visual, tactile, olfactory and gustatory stimulation). The program was not applied during A phases. To assess behavioral changes, the Coma Recovery Scale-Revised (CRS-R) was administered by an independent rater on a weekly basis, across all phases. Each phase lasted 4 weeks. In a subset of patients, resting state functional magnetic resonance imaging (fMRI) data were collected at the end of each phase. Results. Twenty nine patients (48±19 years old; 15 traumatic; 21 > a year post-injury; 11 VS and 18 MCS) were included in our study. Higher CRS-R total scores as well as higher arousal and oromotor susbcores were observed in the B phases (treatment) as compared to A phases (no treatment), in the MCS group but not in the VS group. In the 3 patients who underwent fMRI analyses, a modulation of metabolic activity related to treatment was observed in middle frontal gyrus, superior temporal gyrus as well as ventro-anterior thalamic nucleus. Conclusion. Our results show higher CRS-R total scores when treatment is applied, and more exactly, increased arousal and oromotor function, which seems in line with our preliminary neuroimaging findings. Finally, our results suggest that, even if it may not be sufficient to restore consciousness, SSP might lead to improved behavioral responsiveness in MCS patients when using emotional stimulation.

Keywords: Brain Injuries, Consciousness, Persistent Vegetative State, Minimally Conscious State, sensory stimulation

Received: 29 Mar 2018; Accepted: 13 Sep 2018.

Edited by:

Roland Beisteiner, Medizinische Universität Wien, Austria

Reviewed by:

Friedemann Mueller, Schön Klinik, Germany
Martin Kronbichler, Centre for Cognitive Neuroscience, University of Salzburg, Austria
Ingrid Brands, Libra Rehabilitation & Audiology, Netherlands  

Copyright: © 2018 Cheng, Cortese, Monti, Wang, Riganello, Arcuri, Di and Schnakers. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Prof. Haibo Di, Hangzhou Normal University, International Vegetative State and Consciousness Science Institute, Hangzhou, China,
PhD. Caroline Schnakers, Casa Colina Centers for Rehabilitation, Research, Pomona, California, United States,