Coma
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Basic Principles
for Coma Stimulation
1. Build meaningfulness into
activities whenever possible
2. Interpret all behaviors
as meaningful
3. Create situations in
which sincere communication needs
could
exist
4. Decrease emphasis on
repetition of activities; make
changes
based upon patient's responses
Garrett, Muehhng, Morrow, & Riggs.
(1990). Communicative sensory
stimulation activities and sample dialogues.
Madonna
Centers, Lincoln, NE (Handout).
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Coma Stimulation
Suggestions
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Auditory
Noise should be intermittent
otherwise the brain "turns off" continual sound
Stimulus items need to be loud
to evoke a startle response
Speak to the patient when working/visiting
with them
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Tactile
Include various elements
such as temperature, touch, and pressure (the most important factor in
obtaining a response is intensity)
Touch the patient when working/visiting
with them
Keep in mind tactile stimulation
when bathing (i.e., vary water temperature, rough textured washcloth, slippery
soap)
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Visual
Place and label colorful familiar
objects and family photographs in the patient's room
Items should be placed at bedside
or within the patient's visual field
Use contrasting items (i.e.,
green writing on a yellow background)
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Olfactory
Stimulus items should include
pleasant smells
Avoid items that may damage
the nasal cavity
Upon presentation of a stimulus,
the mouth should be closed (trachs also need to be occluded) momentarily
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Taste
Make sure the patient has no
previous/current history of swallowing difficulty, can handle their own
secretions, and is alert
Present stimulus items on swabs/sponges
Keep in mind oral stimulation
when providing routine mouth care (i.e., vary flavor of cleansing agents)
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Proprioception
Often provided by nursing staff,
physical therapists, and occupational therapists
Routine change of position helps
provide an increased awareness of limb/body position
Bathing and dressing provide
opportunities for head, trunk, and limb movement
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Adapted from: Malkmus, D., Booth, B.J.,
& Kodimer, C. (1980) |
