{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:35:47Z","timestamp":1790699747731,"version":"4.1.0"},"reference-count":43,"publisher":"SAGE Publications","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NRE"],"published-print":{"date-parts":[[2024,1,23]]},"abstract":"<jats:p>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\u200a=\u200a6), low (k\u200a=\u200a3), moderate (k\u200a=\u200a4), and high (k\u200a=\u200a2). 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.<\/jats:p>","DOI":"10.3233\/nre-230149","type":"journal-article","created":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T13:42:13Z","timestamp":1706017333000},"page":"109-127","source":"Crossref","is-referenced-by-count":11,"title":["Music, occupational, physical, and speech therapy interventions for patients in disorders of consciousness: An umbrella review"],"prefix":"10.1177","volume":"54","author":[{"given":"Brooke","family":"Murtaugh","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Programs, Madonna Rehabilitation Hospitals, Lincoln, NE, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann-Marie","family":"Morrissey","sequence":"additional","affiliation":[{"name":"School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Fager","sequence":"additional","affiliation":[{"name":"Communication Center, Madonna Rehabilitation Hospitals, Lincoln, NE, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather E.","family":"Knight","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, School of Pharmacy & Health Professions, Creighton University, Omaha, NE, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jess","family":"Rushing","sequence":"additional","affiliation":[{"name":"Colorado State University, Fort Collins, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Weaver","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"issue":"3","key":"10.3233\/NRE-230149_ref1","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1097\/XEB.0000000000000055","article-title":"Summarizing systematic reviews: Methodological development, conduct and reporting of an umbrella review approach","volume":"13","author":"Aromataris,","year":"2015","journal-title":"International Journal of Evidence-Based Healthcare"},{"issue":"9","key":"10.3233\/NRE-230149_ref2","doi-asserted-by":"crossref","first-page":"715","DOI":"10.2340\/16501977-2269","article-title":"Mobilization in early rehabilitation in intensive care unit patients with severe acquired brain injury: An observational study","volume":"49","author":"Bartolo,","year":"2017","journal-title":"Journal of Rehabilitation Medicine"},{"issue":"23","key":"10.3233\/NRE-230149_ref3","doi-asserted-by":"crossref","first-page":"3295","DOI":"10.1089\/neu.2021.0199","article-title":"Diagnosing Level of Consciousness: The Limits of the Glasgow Coma Scale Total Score","volume":"38","author":"Bodien,","year":"2021","journal-title":"Journal of Neurotrauma"},{"issue":"1","key":"10.3233\/NRE-230149_ref4","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s00134-019-05820-w","article-title":"Coma science: Intensive care as the new frontier","volume":"46","author":"Claassen,","year":"2020","journal-title":"Intensive Care Medicine"},{"issue":"4","key":"10.3233\/NRE-230149_ref5","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1080\/026990599121638","article-title":"Right median nerve electrical stimulation to hasten awakening from coma","volume":"13","author":"Cooper,","year":"1999","journal-title":"Brain Injury"},{"issue":"2","key":"10.3233\/NRE-230149_ref6","doi-asserted-by":"crossref","first-page":"187","DOI":"10.3109\/02688697.2013.841845","article-title":"Therapeutic options to enhance coma arousal after traumatic brain injury: State of the art of current treatments to improve coma recovery","volume":"28","author":"Cossu,","year":"2014","journal-title":"British Journal of Neurosurgery"},{"issue":"4","key":"10.3233\/NRE-230149_ref7","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/01376517-200308000-00006","article-title":"Cognitive-behavioral recovery in comatose patients following auditory sensory stimulation","volume":"35","author":"Davis,","year":"2003","journal-title":"The Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses"},{"issue":"4","key":"10.3233\/NRE-230149_ref8","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1080\/02699052.2021.1887522","article-title":"The effectiveness of median nerve electrical stimulation in patients with disorders of consciousness: A systematic review","volume":"35","author":"Feller,","year":"2021","journal-title":"Brain Injury"},{"key":"10.3233\/NRE-230149_ref9","doi-asserted-by":"crossref","first-page":"e070849","DOI":"10.1136\/bmj-2022-070849","article-title":"Reporting guideline for overviews of reviews of healthcare interventions: Development of the PRIOR statement","author":"Gates,","year":"2022","journal-title":"BMJ"},{"issue":"9","key":"10.3233\/NRE-230149_ref10","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1016\/j.apmr.2018.07.001","article-title":"Practice Guideline Update Recommendations Summary: Disorders of Consciousness","volume":"99","author":"Giacino,","year":"2018","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"issue":"6","key":"10.3233\/NRE-230149_ref11","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1016\/j.apmr.2020.01.013","article-title":"Minimum Competency Recommendations for Programs That Provide Rehabilitation Services for Persons With Disorders of Consciousness: A Position Statement of the American Congress of Rehabilitation Medicine and the National Institute on Disability, Independent Living and Rehabilitation Research Traumatic Brain Injury Model Systems","volume":"101","author":"Giacino,","year":"2020","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"issue":"6","key":"10.3233\/NRE-230149_ref13","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1080\/02699052.2018.1451657","article-title":"Music interventions in disorders of consciousness (DOC)\u2014A systematic review","volume":"32","author":"Grimm,","year":"2018","journal-title":"Brain Injury"},{"issue":"7","key":"10.3233\/NRE-230149_ref14","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1089\/neu.2018.5954","article-title":"Disorders of Consciousness due to Traumatic Brain Injury: Functional Status Ten Years Post-Injury","volume":"36","author":"Hammond,","year":"2019","journal-title":"Journal of Neurotrauma"},{"issue":"6","key":"10.3233\/NRE-230149_ref16","doi-asserted-by":"crossref","first-page":"491","DOI":"10.3109\/02699059309008176","article-title":"Biochemical and physiological parameters of recovery in acute severe head injury: Responses to multisensory stimulation","volume":"7","author":"Johnson,","year":"1993","journal-title":"Brain Injury"},{"issue":"7","key":"10.3233\/NRE-230149_ref17","doi-asserted-by":"crossref","first-page":"577","DOI":"10.2340\/16501977-1983","article-title":"Quality of evidence of rehabilitation interventions in long-term care for people with severe disorders of consciousness after brain injury: A systematic review","volume":"47","author":"Klingshirn,","year":"2015","journal-title":"Journal of Rehabilitation Medicine"},{"issue":"5","key":"10.3233\/NRE-230149_ref18","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1001\/jamaneurol.2021.0084","article-title":"Recovery of Consciousness and Functional Outcome in Moderate and Severe Traumatic Brain Injury","volume":"78","author":"Kowalski,","year":"2021","journal-title":"JAMA Neurology"},{"issue":"12","key":"10.3233\/NRE-230149_ref19","doi-asserted-by":"crossref","first-page":"e0143180","DOI":"10.1371\/journal.pone.0143180","article-title":"Tilt Table Therapies for Patients with Severe Disorders of Consciousness: A Randomized, Controlled Trial","volume":"10","author":"Krewer,","year":"2015","journal-title":"PloS One"},{"issue":"6","key":"10.3233\/NRE-230149_ref20","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.ridd.2010.06.019","article-title":"An overview of intervention options for promoting adaptive behavior of persons with acquired brain injury and minimally conscious state","volume":"31","author":"Lancioni,","year":"2010","journal-title":"Research in Developmental Disabilities"},{"key":"10.3233\/NRE-230149_ref21","first-page":"219","article-title":"Technology-based intervention to help persons with minimally conscious state and pervasive motor disabilities perform environmentally relevant adaptive behavior. S","author":"Lancioni,","year":"2012","journal-title":"Suppl"},{"issue":"6","key":"10.3233\/NRE-230149_ref22","doi-asserted-by":"crossref","first-page":"411","DOI":"10.3109\/17518420903200581","article-title":"Evaluation of technology-assisted learning setups for undertaking assessment and providing intervention to persons with a diagnosis of vegetative state","volume":"12","author":"Lancioni,","year":"2009","journal-title":"Developmental Neurorehabilitation"},{"issue":"9","key":"10.3233\/NRE-230149_ref23","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1007\/s10072-020-04410-9","article-title":"Sensory stimulation to improve arousal in comatose patients after traumatic brain injury: A systematic review of the literature","volume":"41","author":"Li,","year":"2020","journal-title":"Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology"},{"issue":"4","key":"10.3233\/NRE-230149_ref24","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1097\/JNN.0000000000000511","article-title":"Music Interventions for Disorders of Consciousness: A Systematic Review and Meta-analysis","volume":"52","author":"Li,","year":"2020","journal-title":"The Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses"},{"issue":"2","key":"10.3233\/NRE-230149_ref25","first-page":"CD001427","article-title":"Sensory stimulation for brain injured individuals in coma or vegetative state","volume":"2002","author":"Lombardi,","year":"2002","journal-title":"The Cochrane Database of Systematic Reviews"},{"issue":"7","key":"10.3233\/NRE-230149_ref26","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1080\/02699050701481639","article-title":"Orthostatic circulatory disorders in early neurorehabilitation: A case report and management overview","volume":"21","author":"Luther,","year":"2007","journal-title":"Brain Injury"},{"key":"10.3233\/NRE-230149_ref27","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.3389\/fneur.2019.01314","article-title":"Participation Following Inpatient Rehabilitation for Traumatic Disorders of Consciousness: A TBI Model Systems Study","volume":"10","author":"Malone,","year":"2019","journal-title":"Frontiers in Neurology"},{"issue":"12","key":"10.3233\/NRE-230149_ref28","doi-asserted-by":"crossref","first-page":"162","DOI":"10.3390\/brainsci7120162","article-title":"Spasticity Management in Disorders of Consciousness","volume":"7","author":"Martens,","year":"2017","journal-title":"Brain Sciences"},{"issue":"8","key":"10.3233\/NRE-230149_ref29","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1001\/jamaneurol.2021.2043","article-title":"Functional Outcomes Over the First Year After Moderate to Severe Traumatic Brain Injury in the Prospective, Longitudinal TRACK-TBI Study","volume":"78","author":"McCrea,","year":"2021","journal-title":"JAMA Neurology"},{"issue":"5","key":"10.3233\/NRE-230149_ref30","doi-asserted-by":"crossref","first-page":"722","DOI":"10.3109\/02699051003692134","article-title":"Acute management of acquired brain injury Part III: An evidence-based review of interventions used to promote arousal from coma","volume":"24","author":"Meyer,","year":"2010","journal-title":"Brain Injury"},{"issue":"3","key":"10.3233\/NRE-230149_ref31","doi-asserted-by":"crossref","first-page":"273","DOI":"10.3109\/02699059009026177","article-title":"Coma arousal procedure: A therapeutic intervention in the treatment of head injury","volume":"4","author":"Mitchell,","year":"1990","journal-title":"Brain Injury"},{"issue":"1","key":"10.3233\/NRE-230149_ref32","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/0269215520946696","article-title":"A systematic review of head-up tilt to improve consciousness in people with a prolonged disorder of consciousness","volume":"35","author":"Ng,","year":"2021","journal-title":"Clinical Rehabilitation"},{"issue":"3","key":"10.3233\/NRE-230149_ref33","doi-asserted-by":"crossref","first-page":"7003180030p1","DOI":"10.5014\/ajot.2016.021022","article-title":"Effectiveness of Sensory Stimulation to Improve Arousal and Alertness of People in a Coma or Persistent Vegetative State After Traumatic Brain Injury: A Systematic Review","volume":"70","author":"Padilla,","year":"2016","journal-title":"The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association"},{"issue":"4","key":"10.3233\/NRE-230149_ref34","doi-asserted-by":"crossref","first-page":"e0267194","DOI":"10.1371\/journal.pone.0267194","article-title":"Fluctuation is the norm\u201d: Rehabilitation practitioner perspectives on ambiguity and uncertainty in their work with persons in disordered states of consciousness after traumatic brain injury","volume":"17","author":"Papadimitriou,","year":"2022","journal-title":"PLOS ONE"},{"key":"10.3233\/NRE-230149_ref35","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.jclinepi.2020.09.046","article-title":"Authors should clearly report how they derived the overall rating when applying AMSTAR 2\u2014A cross-sectional study","volume":"129","author":"Pieper,","year":"2021","journal-title":"Journal of Clinical Epidemiology"},{"issue":"1","key":"10.3233\/NRE-230149_ref36","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s12028-012-9799-5","article-title":"Effect of Early Physiotherapy on Intracranial Pressure and Cerebral Perfusion Pressure","volume":"18","author":"Roth,","year":"2013","journal-title":"Neurocritical Care"},{"issue":"1","key":"10.3233\/NRE-230149_ref37","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.apmr.2019.07.010","article-title":"Effect of Rehabilitation Treatments on Disability in Persons With Disorders of Consciousness: A Propensity Score Study","volume":"101","author":"Sattin,","year":"2020","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"issue":"2","key":"10.3233\/NRE-230149_ref38","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s00134-019-05528-x","article-title":"Influence of the initial level of consciousness on early, goal-directed mobilization: A post hoc analysis","volume":"45","author":"Schaller,","year":"2019","journal-title":"Intensive Care Medicine"},{"issue":"10","key":"10.3233\/NRE-230149_ref39","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1016\/j.apmr.2012.11.052","article-title":"Specialized Early Treatment for Persons With Disorders of Consciousness: Program Components and Outcomes","volume":"94","author":"Seel,","year":"2013","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"key":"10.3233\/NRE-230149_ref40","doi-asserted-by":"crossref","first-page":"4008","DOI":"10.1136\/bmj.j4008","article-title":"AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. j","volume":"358","author":"Shea,","year":"2017","journal-title":"BMJ (Clinical Research Ed.)"},{"issue":"7-8","key":"10.3233\/NRE-230149_ref41","doi-asserted-by":"crossref","first-page":"830","DOI":"10.3109\/02699052.2015.1005132","article-title":"Impact of soft splints on upper limb spasticity in chronic patients with disorders of consciousness: A randomized, single-blind, controlled trial","volume":"29","author":"Thibaut,","year":"2015","journal-title":"Brain Injury"},{"issue":"12","key":"10.3233\/NRE-230149_ref42","doi-asserted-by":"crossref","first-page":"030006052211344","DOI":"10.1177\/03000605221134467","article-title":"Efficacy of median nerve electrical stimulation on the recovery of patients with consciousness disorders: A systematic review and meta-analysis","volume":"50","author":"Wang,","year":"2022","journal-title":"Journal of International Medical Research"},{"issue":"2","key":"10.3233\/NRE-230149_ref43","first-page":"322","article-title":"Interventions Facilitating Recovery of Consciousness Following Traumatic Brain Injury: A Systematic Review","volume":"43","author":"Weaver,","year":"2023","journal-title":"OTJR: Occupation, Participation and Health"},{"issue":"10","key":"10.3233\/NRE-230149_ref44","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1016\/j.apmr.2013.07.003","article-title":"Disorders of Consciousness: Outcomes, Comorbidities, and Care Needs","volume":"94","author":"Whyte,","year":"2013","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"key":"10.3233\/NRE-230149_ref45","doi-asserted-by":"crossref","first-page":"103846","DOI":"10.1016\/j.ijnurstu.2020.103846","article-title":"The effect of family-centered sensory and affective stimulation on comatose patients with traumatic brain injury: A systematic review and meta-analysis","volume":"115","author":"Zuo,","year":"2021","journal-title":"International Journal of Nursing Studies"}],"container-title":["NeuroRehabilitation"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/NRE-230149","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:08:21Z","timestamp":1777615701000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.3233\/NRE-230149"}},"subtitle":[],"editor":[{"given":"Caroline","family":"Schnakers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Nathan D.","family":"Zasler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,1,23]]},"references-count":43,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3233\/nre-230149","relation":{},"ISSN":["1053-8135","1878-6448"],"issn-type":[{"value":"1053-8135","type":"print"},{"value":"1878-6448","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,23]]}}}