CAM 20124

Sensory Stimulation for Coma Patients

Category:Medicine   Last Reviewed:September 2019
Department(s):Medical Affairs   Next Review:September 2999
Original Date:November 1996    

Description:
Sensory stimulation (also known as coma stimulation sessions, coma arousal therapy, multisensory stimulation programs and coma care) is intended to promote awakening and enhance the rehabilitative potential of coma patients.

Protocols may involve stimulation of ANY or ALL of the following senses: visual, auditory, olfactory, gustatory, cutaneous and kinesthetic. Various stimuli may be used for each sense. Protocols may differ with respect to who performs the stimulation and where. Professionals include nurses, occupational therapists, physical therapists and speech-language therapists. In some cases, family members may be trained in the techniques and are given primary responsibility for providing the therapy. Treatment may be delivered in the hospital, the patient’s home or a nursing home.

Policy:
Sensory stimulation for coma patients is considered INVESTIGATIONAL.   

Rationale
This policy is based in part on a 1989 TEC Assessment that considered whether there was adequate scientific evidence to determine if sensory stimulation either led to quicker emergence from coma or improved rehabilitative potential. (1) The TEC Assessment concluded that to validate the effectiveness of coma stimulation, controlled clinical trials of comparable patients were required. The literature available in 1989 did not meet these criteria; the 5 identified studies varied greatly in focus, design, methods and degree of detail in the study's description. Therefore, the TEC Assessment concluded that scientific data were inadequate to permit conclusions regarding the effectiveness of coma stimulation.

A literature search from 1989 to June 1998 did not identify controlled studies of coma stimulation. The identified studies reported case series or descriptive studies of coma stimulation techniques. (2-5) In 1991, Wood and colleagues published a critique of coma stimulation. The authors pointed out that the incomplete knowledge regarding information processing in the brain-injured state does not permit a scientific or theoretical basis of coma stimulation. (6) For example, Wood reports that the brain-injured patient is constantly exposed to sensory stimulation (i.e., skin care, range of motion exercises, bowel and bladder procedures, ambient noise in an intensive care unit) aside from any specific program of sensory stimulation. In many cases, continual background stimulation may lead to habituation and, thus, ultimately undermine arousal.

2006 Update
A review of the peer-reviewed literature on MEDLINE for the period of 1998 through January 2006 found no controlled clinical trials. However, a Cochrane systematic review concluded there is no reliable evidence to demonstrate that sensory stimulation in coma patients is effective. (7) Therefore, the policy statement is unchanged.

2007 Update
A search of the MEDLINE database for the period of October 2005 through January 2007 identified no additional studies. Recovery from prolonged vegetative or minimally conscious states can be a slow and variable process that is influenced by a number of factors. (8) High quality studies that control for these factors and use objective markers of recovery are lacking. Therefore, evidence remains insufficient to evaluate the efficacy of this treatment; the policy statement is unchanged.

References:

  1. TEC Assessment, 1989, p 269-77.
  2. Wood RL, Winkowski TB, Miller JL et al. Evaluating sensory regulation as a method to improve awareness in patients with altered states of consciousness: a pilot study. Brain Inj 1992; 6(5):411-8.
  3. Mitchell S, Bradley V, Welch JL et al. Coma arousal procedure: a therapeutic intervention in the treatment of head injury. Brain Inj 1990; 4(3):273-9.
  4. Hall ME, MacDonald S, Young GC. The effectiveness of directed multisensory stimulation versus non-directed stimulation in comatose CHI patients: pilot study of a single subject design. Brain Inj 1992; 6(5):435-45.
  5. Davis AE, White JJ. Innovative sensory input for the comatose brain-injured patient. Crit Care Nurs Clin North Am 1995; 7(2):351-61.
  6. Wood RL. Critical analysis of the concept of sensory stimulation for patients in vegetative states. Brain Inj 1991; 5(4):401-9.
  7. Lombardi F, Taricco M, De Tanti A, et al. Sensory stimulation for brain injured individuals in coma or vegetative state. Cochrane Database Syst Rev. 2002;(2):CD001427. (Also available in Clin Rehabil 2002;16(5):464-72.
  8. Laureys S, Giancino JT, Schiff ND et al. How should functional imaging of patients with disorders of consciousness contribute to their clinical rehabilitation needs? Curr Opin Neurol 2006; 19(6):520-7.

Coding Section

Codes Number Description
CPT 97139 Unlisted therapeutic procedure (specify)
  97799 Unlisted physical medicine/rehabilitation service or procedure
ICD-9 Procedure 93.89 Rehabilitation, not elsewhere classified
ICD-9 Diagnosis   Investigational for all diagnosis codes
HCPCS S9056 Coma stimulation, per diem
ICD-10-PCS (effective 10/01/15) F06ZDZZ Swallowing Dysfunction Treatment
  F07Z4ZZ Wheelchair Mobility Treatment
  F07Z5ZZ Bed Mobility Treatment
  F08Z6ZZ Psychosocial Skills Treatment
ICD-10-CM (effective 10/01/15)   Investigational for all diagnosis codes
Type of Service    
Place of Service    

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive. 

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology© American Medical Association.  All Rights Reserved" 

History From 2014 Forward     

09/04/2019 

Annual review, no change to policy intent. 

09/10/2018 

Annual review, no change to policy intent. 

09/21/2017 

Annual review, no change to policy intent. 

09/19/2016 

Annual review, no change to policy intent. 

09/02/2015 

Annual review, no change to policy intent. Added coding.

09/11/2014

Annual review, no changes made.


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