Music, occupational, physical, and speech therapy interventions for patients in disorders of consciousness: An umbrella review

Issue title: Disorders of Consciousness: A Field in Flux

Guest editors: Caroline Schnakers and Nathan D. Zasler

Article type: Review Article

Authors: Murtaugh, Brooke^{a; *} | Morrissey, Ann-Marie^b | Fager, Susan^c | Knight, Heather E.^d | Rushing, Jess^e | Weaver, Jennifer^f

Affiliations: [a] Department of Rehabilitation Programs, Madonna Rehabilitation Hospitals, Lincoln, NE, USA | [b] School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland | [c] Communication Center, Madonna Rehabilitation Hospitals, Lincoln, NE, USA | [d] Department of Physical Therapy, School of Pharmacy & Health Professions, Creighton University, Omaha, NE, USA | [e] Colorado State University, Fort Collins, CO, USA | [f] Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA

Correspondence: [*] Address for correspondence: Brooke Murtaugh, OTD, OTR/L, CBIST, Brain Injury Program Manager, Department of Rehabilitation Programs, Madonna Rehabilitation Hospitals, Lincoln, NE, USA. E-mail: bmurtaugh@madonna.org..

Abstract: BACKGROUND: Current clinical guidelines recommend that a multidisciplinary team inclusive of allied healthcare practitioners deliver assessment and intervention for disorders of consciousness. Allied health professionals include music, occupational, physical, and speech therapists. These allied health clinicians are challenged to select interventions due to a lack of evidence-based recommendations regarding rehabilitation interventions that support recovery of consciousness. This umbrella review synthesizes available systematic reviews (SRs) that describe occupational, speech and language, physical and/or musical therapeutic interventions for people with disorders of consciousness. OBJECTIVES: Identify and summarize evidence from systematic reviews (SRs) that examine allied healthcare interventions for patients with disorders of consciousness. Additionally, this umbrella review aims to evaluate the impact of allied health interventions on recovery of consciousness, methodological quality and risk of bias for the included systematic reviews. METHODS: An umbrella review was completed. The review was reported according to the Preferred Reporting Items for Overview of Reviews (PRIOR) guidance. Five academic databases (PubMed, CINAHL, PsycInfo, Web of Science, and the Cochrane Library) were searched for SRs and/or meta-analyses of allied health (i.e., music, occupational, physical, and speech therapy) interventions for disorders of consciousness. For included studies, data were extracted and quality of the SRs appraised using the A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 checklist. Data extracted from each SR identified the authors and years of primary studies, interventions, comparators, and outcomes related to recovery of consciousness (i.e., neurobehavioral/cognitive), functional status, physiological response pain, and adverse events. Rehabilitation interventions were categorized and described. RESULTS: Fifteen SRs were included and three of these reviews conducted meta-analyses. Identified rehabilitation interventions included: 1) sensory stimulation, 2) median nerve stimulation, 3) communication/environmental control through assistive technology, 4) mobilization, and 5) music-based therapy. SRs were published between 2002 and 2022 and included 2286 participants. Using the AMSTAR 2, the quality of reviews was critically low (k = 6), low (k = 3), moderate (k = 4), and high (k = 2). SRs within this umbrella review demonstrated significant heterogeneity in research methods and use of outcome measures to evaluate the recovery of consciousness within the primary studies. These factors influenced the ability to conduct meta-analyses. CONCLUSIONS:Sensory stimulation, median nerve stimulation, music therapy and mobilization are all interventions that demonstrate some level of benefit, but current SRs fail to prove benefit through high-level quality evidence. There is an indisputable need for continued rehabilitation research to expand options for treatment modalities and to ensure that the interventions being applied to DoC rehabilitation are evidence-based to improve consciousness and recovery.

Keywords: Consciousness disorders, rehabilitation, systematic review, allied health, brain injury

DOI: 10.3233/NRE-230149

Journal: NeuroRehabilitation, vol. 54, no. 1, pp. 109-127, 2024