Effekte multisensorischer Stimulationsverfahren bei hirngeschädigten Patienten

Zusammenfassung

Klassische Programme der multisensorischen Stimulation (MSS) enthalten u. a. Module zur visuellen, akustischen, olfaktorischen und vestibulären Anregung. Therapeutisches Ziel ist die Herstellung einer möglichst optimal strukturierten und fördernden Umgebung, die angepasst ist an die reduzierte Wahrnehmungs- und Kognitionsfähigkeit von komatösen, dementen und lernbehinderten Patienten. Bei kritischer Durchsicht von Effektivitätsstudien (recherchiert in den Datenbanken EMBASE und PubMed) wird deutlich, dass einerseits ein Mangel im Hinblick auf vergleichbare und aussagekräftige Studien besteht sowie andererseits die Evidenz für die Wirksamkeit von MSS-Verfahren insgesamt ge-ring ist. Zwar zeigen einige Studien positive Kurz-zeiteffekte von MSS in Bezug auf Verhaltens-änderungen bei komatösen, dementen und lernbehinderten Patienten, jedoch keine evidenten Langzeitwirkungen. Der Nachweis transienter Effekte legitimiert jedoch die Anwendung von MSS bei hirngeschädigten Patienten.

Abstract

Classical multisensory stimulation (MSS) programmes comprises modules for visual, acoustical, olfactorial and vestibularic stimulation. Therapeutic goal is a near-optimally structured and supporting environment adapted to the reduced abilities in perception and cognition of patients in a coma, with dementia, or with a learning disability. A critical review (based on the EMBASE and PubMed databases) shows that there is a shortage of studies as well as poor evidence of the effectiveness of multisensory stimulation approaches in general. A few studies show positive short-term effects concerning behavioural changes in patients in a coma, with dementia or with a learning disability but no evident long-term effects. Verifiable short-term effects, however, legitimate multisensory interventions in brain-damaged patients.

Schlüsselwörter

multisensorische Stimulation (MSS) - Effektivitätsstudien - Komatherapie - Kurzzeiteffekte

Key words

multi-sensory stimulation (MSS) - studies on effectiveness - coma-therapy - short-term effects

Literatur

• 1 Hulsegge J, Verheul A. Snoezelen Eine andere Welt. 9. unveränd. Aufl. Marburg: Lebenshilfe-Verlag 2001
• 2 Champagne T, Stromberg N. Sensory approaches in inpatient psychia-tric settings.  J Psychosoc Nurs Ment Health Serv. 2004;  42 ((9)) 1-8
• 3 van Weert JCM. Multi-Sensory Stimulation in 24-hour Dementia Care. Effects of snoezelen on residents and caregivers.. 2004;  , - verfügbar unter: http://www.nivel.nl/pdf/Multi-Sensory-Stimulation-in-24-hour-dementia-care.pdf
• 4 Chitsey AM, Haight BK, Jones MM. Snoezelen: a multisensory environmental intervention.  J Gerontol Nurs. 2002;  28 ((3)) 41-49
• 5 Merrick J, Cahana C, Lotan M, Kandel I, Carmeli E. Snoezelen or controlled multisensory stimulation. Treatment aspects from Israel.  Scientific World Journal. 2004;  11 ((4)) 307-314
• 6 Lippert-Grüner M. Frühstimulation. Ein multimodaler Therapieansatz in der Behandlung von Komapatienten. München: Pflaum 2002
• 7 Nasser K, Cahana C, Kandel I, Kessel S, Merrick J. Snoezelen: children with intellectual disability and working with the hole family.  Scientific World Journal. 2004;  3 ((4)) 500-506
• 8 Kainz M. Snoezelen mit Klangschalen.  Not. 2006;  (3) 48-50
• 9 Freeman EA. Coma arousal therapy.  Clin Rehabil. 1991;  5 ((3)) 241-249
• 10 Wood RL. Critical analysis of the concept of sensory stimulation for patients in vegetative states.  Brain Inj. 1991;  5 ((4)) 401-409
• 11 Chung JC, Lai CK, Chung PM, French HP. Snoezelen for dementia.  Cochrane Database Syst Rev. 2002;  4 CD003152
• 12 Cornell A. Evaluating the effectiveness of snoezelen on women who have a dementing illness.  Int J Psychiatr Nurs Res. 2004;  9 ((2)) 1045-1062
• 13 Freeman EA. The catastrophe of coma: a way back. Queensland, Australien: Bateman 1987
• 14 Baker J. Explaning coma arousal therapy. 2002;  , - verfügbar unter: http://www.comarecovery.org/comaarousal.shtm
• 15 DeYoung S, Grass RB. Coma Recovery Program.. 2006;  , - verfügbar unter: http://www.comarecovery.org/comarecoveryprogram.shtm
• 16 Burns I, Cox H, Plant H. Leisure or therapeutics? Snoezelen and the care of older persons with dementia.  Int J Nurs Pract. 2000;  6 ((3)) 118-126
• 17 Lombardi F, Taricco M, De Tanti A, Telaro E, Liberati A. Sensory stimulation of brain-injured individuals in coma or vegetative state: results of a Cochrane systematic review.  Clin Rehabil. 2002;  16 464-472
• 18 Tolle P, Reimer M. Do we need stimulation programs as a part of nursing care for patients in “persistent vegetative state”? A conceptual analysis.  Axone. 2003;  25 ((2)) 20-26
• 19 Laureys S, Lemaire C, Maquet P, Phillips C, Franck G. Cerebral metabolism during vegetative state and after recovery to consciousness.  J Neurol Neurosurg Psychiatry. 1999;  67 121-122
• 20 Laureys S, Antoine S, Boly M, Elincx S, Faymonville M-E, Berré J. et al . Brain function in the vegetative state.  Acta Neurol Belg. 2002;  102 ((4)) 177-185
• 21 Kotchoubey B, Lang S, Bostanov V, Birbaumer N. Is there a mind? Electrophysiology of unconscious patients.  News Physiol Sci. 2002;  17 38-42
• 22 Schiff N, Ribary U, Rodriguez Moreno D, Beattie B, Kronberg E, Blasberg R. et al . Residual cerebral activity and behavioural fragments can remain in the persistently vegetative brain.  Brain. 2002;  125 1210-1234
• 23 Owen AM, Menon DK, Johnsrude IS, Bor D, Scott SK, Manly T. et al . Detecting residual cognitive function in persistent vegetative state.  Neurocase. 2002;  8 ((5)) 394-403
• 24 Kotchoubey B, Lang S, Mezger G, Schmalohr D, Schneck M, Semmler A. et al . Information processing in severe disorders of consciousness: vegetative state and minimally conscious state.  Clin Neurophysiol. 2005;  116 ((10)) 2441-2453
• 25 Lippert-Grüner M, Wedekind C, Ernestus RI, Klug, N. Early rehabilitative concepts in therapy of the comatose brain injury patients.  Acta Neurochir Suppl. 2002;  79 21-23
• 26 Boly M, Faymonville ME, Peigneux P, Lambermont B, Damas P, Del Fiore G. et al . Auditory processing in severely brain injured patients: differences between the minimally conscious state and the persistent vegetative state.  Arch Neurol. 2004;  61 ((2)) 233-238
• 27 Laureys S, Perrin F, Faymonville ME, Schnakers C, Boly M, Bartsch V. et al . Cerebral processing in the minimally conscious state.  Neurology. 2004;  63 ((5)) 916-918
• 28 Schiff N, Ribary U, Plum F, Llinas R. Words without mind.  J Cogn Neurosci. 1999;  11 ((6)) 650-656
• 29 Laureys S, Faymonville ME, Degueldre C, Del Fiore G, Damas P, Lambermont B. et al . Auditory processing in the vegetative state.  Brain. 2000;  123 1589-1601
• 30 Klein M. Schmerzempfindung und erhaltenes Bewusstsein im apallischen Syndrom? Beiträge aus dem DGSS-Arbeitskreis „Schmerz und Ethik”. 2001;  , - verfügbar unter: http://www.dgss.org/PDF/AKEthik801.PDF
• 31 Simmons A. TBI, coma and sensory stimulation. Review of the effectiveness of sensory stimulation on coma, TBI patients, 1989-2002.. 2002;  , - verfügbar unter: http://www2.ups.edu/ot/evidence/2002/asimmons.htm
• 32 Johnson DA, Roethig-Johnson K, Richards D. Biochemical and physiological parameters of recovery in acute severe head injury: responses to multisensory stimulation.  Brain Inj. 1993;  7 ((6)) 491-499
• 33 Pierce JP, Lyle DM, Quine S, Evans NJ, Morris J, Fearnside MR. The effectiveness of coma arousal intervention.  Brain Inj. 1990;  4 ((2)) 191-197
• 34 Oh H, Seo W. Sensory stimulation programme to improve recovery in comatose patients.  J Clin Nurs. 2003;  12 ((3)) 394-404
• 35 Wilson SL, Powell GE, Brock D, Thwaites H. Vegetative state and responses to sensory stimulation: an analysis of 24 cases.  Brain Inj. 1996;  10 ((11)) 807-818
• 36 Brown J, Cooper-Kuhn CM, Kempermann G, van Praag H, Winkler J, Gage FH, Kuhn HG. Enriched environment and physical activity stimulate hippocampal but not olfactory bulb neurogenesis.  Eur J Neurosci. 2003;  17 ((10)) 2042-2046
• 37 Zieger A. Neuropsychologisch orientierte Frührehabilitation aus ärztlicher Sicht. In: Zieger A, Schönle PW (Hrsg): Neurorehabilitation bei diffuser Hirnschädigung. Bad Honnef: Hippocampus 2004: 3-70
• 38 Rader MA, Ellis DW. The Sensory Stimulation Assessment Measure (SSAM): a tool for early evaluation of severly brain-injured patients.  Brain Inj. 1994;  8 ((4)) 309-321
• 39 Wilson SL, Brock D, Powell GE, Thwaites H, Elliott K. Constructing arousal profiles for vegetative state patients - a preliminary report.  Brain Inj. 1996;  10 ((2)) 105-113
• 40 Nydahl P. Wo kommst Du her? Die Notwendigkeit einer Biographiearbeit. In: Nydahl P (Hrsg): Wachkoma. Betreuung, Pflege und Förderung eines Menschen im Wachkoma. München: Urban & Fischer 2005: 17-20
• 41 Lavie E, Shapiro M, Julius M. Hydrotherapy combined with Snoezelen multi-sensory therapy.  Int J Adolesc Med Health. 2005;  17 ((1)) 83-87
• 42 Baker R, Bell S, Baker E, Gibson S, Holloway J, Pearce R. et al . A randomized controlled trial of the effects of multi-sensory stimulation (MSS) for people with dementia.  Br J Clin Psychol. 2001;  40 81-96
• 43 Chan S, Chien WT, Yuen MFT. An evaluation of the clinical effectiveness of a multisensory therapy on clients with learning disability.  Final report HCPF. no;  215016
• 44 Baillon S, Van Diepen E, Prettyman R, Redman J, Rooke N, Campbell R. A comparison of the effects of snoezelen and reminiscence therapy on the agitated behaviour of patients with dementia.  Int J Geriatr Psychiatry. 2004;  19 ((11)) 1047-1052
• 45 Lindsay WR, Pitcaithly D, Geelen N, Buntin L, Broxholme S, Ashby M. A comparison of the effects of four therapy procedures on concentration and responsiveness in people with profound learning disabilities.  J Intellect Disabil Res. 1997;  41 ((Pt 3)) 201-207
• 46 Forbes D. Multisensory stimulation was not better than usual activities for changing cognition, behavior, and mood in dementia.  Evid Based Nurs. 2004;  7 55
• 47 Slevin E, McClelland A. Multisensory environments: are they therapeutic? A single-subject evaluation of the clinical effectiveness of a multisensory environment.  J Clin Nurs. 1999;  8 ((1)) 48-56
• 48 Charlesworth G. Both multisensory stimulation and activity sessions improved mood and behavior in dementia in the short term.  Evid Based Ment Health. 2001;  4 106
• 49 Baker R, Holloway J, Holtkamp CC, Larsson A, Hartman LC, Pearce R. et al . Effects of multi-sensory stimulation for people with dementia.  J Adv Nurs. 2003;  43 ((5)) 465-477
• 50 Lindsay WR, Black E, Broxholme S, Pitcaithly D, Hornsby N. Effects of four procedures on communication in people with profound intellectual disabilities.  J Appl Res Int Dis. 2001;  14 ((2)) 110-119
• 51 Singh NN, Lancioni GE, Winton AS, Molina EJ, Sage M, Brown S, Groeneweg J. Effects of snoezelen room, activities of daily living skills training, and vocational skills training on aggression and self-injury by adults with mental retardation and mental illness.  Res Dev Disabil. 2004;  25 ((3)) 285-293
• 52 Gustorff D. Wachkoma auf Intensivstationen aus musiktherapeutischer Sicht. In: Nydahl P (Hrsg): Wachkoma. Betreuung, Pflege und Förderung eines Menschen im Wachkoma. München: Urban & Fischer 2005: 98-110
• 53 Koelsch S, Fritz T, von Cramon DY, Friederici AD. Music and emotion Annual Report 2001. Leipzig: Max Planck Institute of Cognitive Neuroscience 2001 : 63-64 - verfügbar unter: http://www.cbs.mpg.de/files/publications/annual/resources/AnnualReport2001.pdf
• 54 Buckle J. The role of aromatherapy in nursing care.  Nurs Clin North Am. 2001;  36 ((1)) 57-72
• 55 Dunning T. Applying a quality use of medicines framework to using essential oils in nursing practice.  Complement Ther Clin Pract. 2005;  11 ((3)) 172-181
• 56 Thomas DV. Aromatherapy: mythical, magical, or medical?.  Holist Nurs Pract. 2002;  16 ((5)) 8-16
• 57 Cannard G. The effect of aromatherapy in promoting relaxation and stress reduction in a general hospital.  Complement Ther Nurs Midwifery. 1996;  2 ((2)) 38-40
• 58 Maddocks-Jennings W, Wilkinson JM. Aromatherapy practice in nursing: literature review.  J Adv Nurs. 2004;  48 ((1)) 93-103
• 59 Cooke B, Ernst E. Aromatherapy: a systematic review.  Br J Gen Pract. 2000;  50 493-496
• 60 Nydahl P. Basale Stimulation in der Pflege. In: Nydahl P (Hrsg): Wachkoma. Betreuung, Pflege und Förderung eines Menschen im Wachkoma. München: Urban & Fischer 2005: 32-42
• 61 Wood RL, Winkowski TB, Miller JL, Tierney L, Goldman L. Evaluating sensory regulation as a method to improve awareness in patients with altered consciousness: a pilot study.  Brain Inj. 1992;  6 ((5)) 411-418
• 62 Zieger A. Komastimulationstherapie - was wissen wir?.  Neurol Rehabil. 2003;  9 ((1)) 42-45

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