Effectiveness of direct and non-direct auditory stimulation on coma arousal after traumatic brain injury

The aim of this study was to evaluate the effect of direct and non-direct auditory stimulation on arousal in coma patients with severe traumatic brain injury and to compare the effects of direct vs. non-direct auditory stimulation. A crossover intervention study design was used. Nine participants who were comatose after a severe traumatic brain injury underwent direct and non-direct auditory stimulation. Direct auditory stimulation requires a higher level of interpersonal interaction between the patient and stimuli such as voices of family members, orientation by a nurse or family member and familiar music. In contrast, non-direct auditory stimuli were characterized as more general, less familiar, less interactive, indirect and not lively such as general music and TV sounds. Participants received both direct and non-direct auditory stimulation in randomized order for 15 minutes. Recovery of consciousness was measured with the Glasgow Coma Scale (GCS) and Sensory Stimulation Assessment Measure (SSAM). The Friedman test with post hoc analysis by Wilcoxon's signed-rank test comparisons was used for data analysis. Patients who received both direct and non-direct auditory stimulation exhibited significantly increased GCS (p=0.008) and SSAM scores (p=0.008) over baseline. The improvement in SSAM scores after direct auditory stimulation was significantly greater than that after non-direct auditory stimulation (p=0.021), but there was no statistically significant difference in GCS scores (p=0.139). Auditory stimulation, in particular direct auditory stimulation, might be useful for improving the recovery of consciousness and increasing the arousal of comatose patients. The SSAM is more useful for detecting subtle changes from stimulation intervention than the GCS.