Currently, relevant studies in the United States have shown that high-intensity multi-sensory stimulation is advocated for comatose patients, and these measures can stimulate the reticular activating system of the brain. The reticular activating system is primarily associated with arousal and wakefulness, and typically responds to all sensory stimuli including pain, pressure, touch, temperature, proprioception, vision and hearing. Repeated strong stimuli may help train parts of the brain that are "dormant," thereby promoting awakening.
Coma arousal treatment involves the frequency, intensity, and duration of external stimuli that the patient receives. Stimulation can be provided through the five sensory pathways (visual, auditory, tactile, gustatory, and olfactory) and the physical pathways through which the brain receives information from the outside world.
Visual: Visual and memory arousal therapy is performed by placing bright pictures, posters, and familiar photographs in an environment very close to the patient. Visual stimuli must be varied and can be broadened by having the patient sit in different positions in the ward. Visual stimulation can be done with the patient's favorite pre-injury television programs.
Auditory: Auditory arousal therapy through music and television should be varied in time, tone and content, because the brain has the ability to turn off regular sounds, and continuous sound stimulation with a constant frequency level has little effect. The startle reflex is the lowest level of auditory function, and noises that may cause startle in a normal awake person will not necessarily act as a stimulus in a comatose patient. Therefore, very loud noises (e.g., pounding metal next to the patient, ringing a bell, or blowing a very loud whistle) are needed to obtain a response from the patient. This noise stimulus should be irregular. At the same time, talking to the patient about a topic of interest to him helps with auditory arousal and stimulates memory. Therefore, talking to the unconscious patient and music therapy should be an essential part of the wakefulness-promoting therapy on a daily basis.
Taste: Changes in the patient's facial expression are an indicator of the effectiveness of the patient's gustatory stimulation. Like other forms of sensation, the intensity of the gustatory stimulus is important. Experts recommend substances like vinegar, lemon juice, mustard, soy sauce, red pepper and salt as a powerful stimulus. If the patient is intubated with an endotracheal tube, it is important to be safe.
Olfactory: peppermint oil, eucalyptus (leaf) oil, garlic, and strong perfumes can be applied as stimuli. If the patient shows a change in expression or attempts to avoid, it indicates that the stimulation has worked.
Tactile: Tactile arousal can be accomplished in many ways. Hair washing and bathing can be used to improve and enhance tactile stimulation. Try magnetic clothing and sandals to help stimulate tactile memory.
If the patient is relatively stable, motor stimulation can be used further. At first, simple passive movements can be performed, gradually transitioning to standing in a reclining bed. The patient can be placed passively on a barre ball in a prone or supine position to stimulate balance and head control. Other activities include rolling the patient from side to side on a mat. The coma-induced awakening process may be similar to the process of developing awareness of self and external environment that infants undergo. However, comatose patients are unable to explore their environment on their own, so someone else needs to assist in this process.
In addition, a combination of head and body acupuncture points has been used to promote the awakening of patients in a persistent vegetative state after traumatic brain injury.
Researchers believe that the brain can learn effectively through an increase in the frequency, intensity and duration of stimulation. For patients who are comatose or enter a persistent vegetative state after craniocerebral injury, their wakefulness-promoting treatment should include frequent high-intensity multisensory stimulation and limb strength training.