Summary of the Systematic Review

Article Citation

Quality of Evidence of Rehabilitation Interventions in Long-Term Care for People With Severe Disorders of Consciousness After Brain Injury: A Systematic Review

Klingshirn, H., Grill, E., et al. (2015).
Journal of Rehabilitation Medicine, 47(7), 577-585.
Go to Article

Sponsoring Body

German Research Foundation

Article Quality Ratings

Read about Our Rating Process

Indicators of Review Quality

  • Yes The review states a clearly focused question/aim.
  • Yes Criteria for inclusion of studies are provided.
  • No Search strategy described in sufficient detail for replication.
  • Yes Included studies are assessed for study quality.
  • No Quality assessments are reproducible.
  • Yes Characteristics of the included studies are provided.

Quality Rating Notes

Article Details

Description

This is a systematic review examining the literature on a variety of rehabilitation interventions, including speech-language pathology treatment, for adults and adolescents with severe disorders of consciousness following traumatic or non-traumatic brain injury.

Questions/Aims Addressed

"The specific aims of this review are:

  • to characterize the rehabilitation interventions applied in long-term care; and
  • to evaluate the quality of evidence of these rehabilitation interventions" (p. 578).

Population

Adolescents and adults with disorders of consciousness (i.e., coma, minimally conscious, or vegetative state) receiving rehabilitation in the long-term care setting

Intervention/Assessment

Any rehabilitation intervention "defined as non-pharmaceutical and non-surgical interventions provided by therapists including nurses (e.g. rehabilitation nursing, physical therapy, occupational therapy, speech therapy or related)" (p. 578)

Number of Studies Included

53

Years Included

2003-July 2013


Conclusions from This Systematic Review

What are Conclusions?

Go to Map

Treatment

Several studies addressed weaning from ventilator and tracheostomy, or prevention of respiratory infections for individuals with severe acquired brain injury. However, no specific conclusions were made regarding these interventions, and further systematic research is needed in this population.

Keywords: Adult, Pediatric, Speech/Voice Treatment (Not Otherwise Specified)

Implementation of enteral or parenteral via endoscopic gastrostomy (PEG) tube, weaning from a PEG tube, independent swallowing, and re-introducing oral feeding were reported as rehabilitation interventions for individuals in a minimally conscious or vegetative state. Evidence was not strong enough to make firm conclusions about these interventions.

Keywords: Tube Feeding, Swallowing Treatment (Not Otherwise Specified), Acquired/Traumatic Brain Injury, Acquired Brain Injury, Swallowing, Swallowing, Traumatic Brain Injury

Clinical expertise, a descriptive review, and several small studies reported provision of communication support within rehabilitation interventions. This included developing simple strategies (e.g., code for yes/no) and complex communication technology. Evidence, however, is weak and this requires further study.

Keywords: Diagnosis/Condition, AAC Treatment (Not Otherwise Specified), AAC Treatments, Acquired Brain Injury

Sensory stimulation techniques, partly combined with assistive devices such as microswitches for environmental control, were the most frequently reported treatment concepts. However, a systematic review found insufficient evidence for or against sensory stimulation for individuals in a coma or vegetative state.

Keywords: Severe, Sensory Stimulation (Coma Stimulation), Multisensory Stimulation

Go to Map

Treatment

Clinical expertise, a descriptive review, and several small studies reported provision of communication support within rehabilitation interventions. This included developing simple strategies (e.g., code for yes/no) and complex communication technology. Evidence, however, is weak and this requires further study.

Keywords: Diagnosis/Condition, AAC Treatment (Not Otherwise Specified), AAC Treatments, Acquired Brain Injury

Go to Map

Treatment

Implementation of enteral or parenteral via endoscopic gastrostomy (PEG) tube, weaning from a PEG tube, independent swallowing, and re-introducing oral feeding were reported as rehabilitation interventions for individuals in a minimally conscious or vegetative state. Evidence was not strong enough to make firm conclusions about these interventions.

Keywords: Tube Feeding, Swallowing Treatment (Not Otherwise Specified), Acquired/Traumatic Brain Injury, Acquired Brain Injury, Swallowing, Swallowing, Traumatic Brain Injury

Go to Map

Treatment

Implementation of enteral or parenteral via endoscopic gastrostomy (PEG) tube, weaning from a PEG tube, independent swallowing, and re-introducing oral feeding were reported as rehabilitation interventions for individuals in a minimally conscious or vegetative state. Evidence was not strong enough to make firm conclusions about these interventions.

Keywords: Tube Feeding, Swallowing Treatment (Not Otherwise Specified), Acquired/Traumatic Brain Injury, Acquired Brain Injury, Swallowing, Swallowing, Traumatic Brain Injury

Go to Map

Treatment

Implementation of enteral or parenteral via endoscopic gastrostomy (PEG) tube, weaning from a PEG tube, independent swallowing, and re-introducing oral feeding were reported as rehabilitation interventions for individuals in a minimally conscious or vegetative state. Evidence was not strong enough to make firm conclusions about these interventions.

Keywords: Tube Feeding, Swallowing Treatment (Not Otherwise Specified), Acquired/Traumatic Brain Injury, Acquired Brain Injury, Swallowing, Swallowing, Traumatic Brain Injury

Clinical expertise, a descriptive review, and several small studies reported provision of communication support within rehabilitation interventions. This included developing simple strategies (e.g., code for yes/no) and complex communication technology. Evidence, however, is weak and this requires further study.

Keywords: Diagnosis/Condition, AAC Treatment (Not Otherwise Specified), AAC Treatments, Acquired Brain Injury

Sensory stimulation techniques, partly combined with assistive devices such as microswitches for environmental control, were the most frequently reported treatment concepts. However, a systematic review found insufficient evidence for or against sensory stimulation for individuals in a coma or vegetative state.

Keywords: Severe, Sensory Stimulation (Coma Stimulation), Multisensory Stimulation

Provision of education and counseling to families of individuals with disorders of consciousness was supported during rehabilitation in one guideline (as clinical expertise) and addressed in several small studies. However, current evidence is weak. Further research is needed.

Keywords: Education/Counseling, Education/Counseling

Our Partners