Controlled sensory environments on hospital wards with adults in Prolonged Disorders of Consciousness (PDoC)

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Aims & Objectives

Main aims of this project

  • To provide an understanding of the needs of adults in PDoC
  • To evaluate the benefits to adults in PDoC, if any, of a controlled auditory and sensory environment Secondary aims of this project
  • To evaluate the process and challenges of facilitating a sensory regulated environment
  • To evaluate the benefits of joint working with 2+ disciplines
  • To offer a structure to how this may be facilitated within other healthcare settings

Contact Details Rosanne Tyas, Programme Lead Music Therapy, rtyas@rhn.org.uk Bernice Chu, Music Therapist bchu@rhn.org.uk  Royal Hospital for Neuro-disabilty (RHN) www.rhn.org.uk This information was referenced from a poster presentation given by Jumana Ghor, Russel Wigley and Alison Kempshall who no longer work at the RHN. Use of information from their project was allowed by verbal consent.

Funding Sources

This project was a collaboration between medical consultants, occupational therapy, music therapy and nursing. These disciplines are funded by separate streams within the hospital. The project was approved by senior managers at the time. Occupational therapy and nursing funded by the NHS England (relevant Care Commissioning Groups) and music therapists funded by the RHN Charity.  

Intervention Timescale

The data was gathered from 20 May 2013 to 4 August 2013. Three rest periods per day. Please note: ‘rest’ is defined as a period of 30 minutes which participants receive minimal to no stimulation for all their senses including: sight, sound, smell, taste and touch.  
Location and Setting

Rest periods took place on a hospital ward day area. This area was blocked off by a room divider for the entire duration of the rest period.

Type of arts intervention

Regulated music, visual arts, theatre, digital / electronic

Description of the arts activity

This activity was a collaborative effort between therapists and nursing. It can be replicated with joint commitment of all team members. Staff facilitating must be mindful of stimuli presented e.g. turn off television and radios, turn off lights, closed curtains, no touch and no movement in wheelchairs if applicable. Family and friends informed of the purpose of sensory regulation and benefits it may have in therapy sessions. 

Details of the project participants

12 participants involved. Adults 18+. Range of socio-economic and cultural backgrounds. Range of diagnosis. All in prolonged disorder of consciousness.  All participants observed were on the relevant ward at the time.

Project management

Staff facilitating the project took it in turn to ensure rest periods took place. The facilitator turned off lights, closed curtains and put up the room divider. They monitored the position of participant e.g. sitting, lying down, duration of time and any changes in arousal. Details of evaluation methods below.

Ethics and consent

There was no cost to the participants of this project. This project was designed and facilitated in their best interests as all participants were in PDoC and did not have capacity to engage. It was determined that rest periods did not put participants at any risk of harm or neglect. No video or audio recordings were made at this time – only observation records. These records were anonymised to protect the identity of participants involved.

Evaluation methods and findings

Arousal charts with a scale between 1-6 (1 = awake and 6 = unrousable) were used. This measure also recorded whether someone was sitting or lying down. This was designed by the facilitating team to be most relevant to group participants. Other standardised outcome measures were reviewed and were not appropriate for this project. Due to admissions and discharges throughout the evaluation period, participants varied in number of rest periods taken part.  

The aim of evaluation was to examine if there was an increase in participant awakeness/arousal levels throughout the day. The other aim was to observe any short term benefits of rest periods e.g. how awake participants were immediately after rest periods, later in the day after having had rest periods compared to when they had no rest periods.

A total of twelve participants were involved in the study and six had enough data for full analysis due to limited recordings on outcome measures. There was an overall improved wakefulness of 18%. 4 of 6 participants showed an improvement in wakefulness. Factors that may have influenced the results include: small sample size and improvements in tone/postural management, changes in medication and improved medical stability. The results suggest some improvement in arousal for adults in PDoC within a sensory regulated environment. Rest periods may optimise their alertness during therapy sessions. Implementation of sensory regulation continues to the present time post-project.

Supported using public funding by the Arts Council England