Family-Centered Affective Stimulation for Patients With Traumatic Brain Injury: Its Effects on Coma Recovery

June 2, 2026 updated by: Mahmoud Ahmed Ahmed Ahmed Elsheikh, Cairo University

Family-centered affective stimulation involves creating an environment in which family members actively participate in the patient's recovery by providing emotional support, positive reinforcement, and a supportive presence. The family-centered affective simulation effects on coma recovery in patients afflicted with traumatic brain injury were the aim of this study.

A quasi-experimental design was employed with 120 patients, who were assigned to either the family stimulation group (n = 60) or the control group (n = 60) in a random manner. Validated instruments, encompassing the Modified Early Warning Score (MEWS), Full Outline of Unresponsiveness (FOUR) score, and Coma Recovery Scale-Revised (CRS-R), were used to assess outcomes of coma recovery. Chi-square tests, independent and paired t-tests, and correlation coefficients were employed to analyze the data.

Following the implementation of family stimulation, highly statistically significant differences were evident in patients' deterioration risk scores, consciousness level scores, and mean coma recovery scores among the studied groups (p = 0.001). Additionally, the family stimulation group showed significant improvement between pre- and post-study phases (p < 0.001).

The application of family-centered organized affective stimulation is an efficient and practical approach to enhance consciousness levels and coma recovery outcomes in comatose patients. Nurses can integrate sensory stimulation into existing therapeutic interventions, either independently or in collaboration with patients' families.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Traumatic brain injury poses as remarkable health burden worldwide, with about 69 million cases in the world every year. It can lead to a wide range of cognitive, emotional, and physical impairments, profoundly impacting both patients and their families. Recovery from TBI is a complex and multifaceted process that often requires not only medical and rehabilitative interventions but also comprehensive psychosocial and emotional support.

Acute or severe brain injury is among the most life-threatening consequences related to cerebral hemorrhage or traumatic injury. Prolonged coma is associated with worsening long-term cognitive, behavioral, and emotional impairments, which significantly limit patients' ability to resume normal activities. Multimodal sensory stimulation is an intervention aimed at enhancing arousal, awareness, and behavioral responses through the systematic activation of multiple sensory pathways. Exposure to sensory stimulation has been shown to promote dendritic growth and improve cognitive functioning in addition to social interaction. Accordingly, this study was concerned with determining the impact of multimodal sensory stimulation upon consciousness level across unconscious patients.

Disturbed level of consciousness (DOC) refer to a range of impairments in conscious state that may arise following traumatic brain injury (TBI) or stroke. Consciousness is generally understood to consist of two key elements: wakefulness, indicated by the opening of the eyes in response to external stimuli, and awareness, demonstrated through measurable behavioral and physical reactions. The DOC progression starts within occurrence of injury and continues through the emergency stage to management in the intensive care unit (ICU). The acute stage commonly covers the initial 28 days after the injury occurs. In recent decades, developments in clinical management and neuroscience have fostered greater optimism about the possibility of meaningful recovery for certain patients impacted by TBI.

Traumatic brain injury (TBI) is now widely viewed as a long-term health condition, as accumulating evidence indicates that its consequences can persist for extended periods, particularly in cases of moderate to severe injury. Although many patients with mild TBI experience recovery within a relatively short time, recent research suggests that symptoms in both children and adults may continue for a year or even longer. These observations highlight the importance of enhancing follow-up care and implementing long-term management approaches that are tailored to different age groups.

One emerging scope of interest in TBI recovery is the role of family involvement, particularly through interventions aimed at enhancing affective stimulation. Family-centered care, which places the family at the core of the patient's recovery process, has been identified as a critical component in improving outcomes for individuals with TBI.

Recent research emphasizes the essential role of family involvement in the rehabilitation process, particularly in providing emotional and affective support. Family-centered care (FCC) has emerged as a key model of care delivery, promoting collaboration between healthcare providers and family members to support patients holistically. FCC has been associated with improved recovery outcomes and may reduce healthcare costs by decreasing the need for prolonged hospital stays or frequent medical interventions. Within this framework, family-centered affective stimulation including structured emotional and psychosocial engagement by family members, has gained attention as an effective strategy to enhance recovery as well as functional outcomes in patients with traumatic brain injury (TBI).

It had been revealed by a systematic review and meta-analysis that it is more efficient to early stimulation family-centered sensory and affective than routine care or nurse-implemented sensory stimulation in terms of enhancing both the level of consciousness and cognitive functioning in comatose patients with traumatic brain injury. Furthermore, the review indicated that in terms of recovery outcomes promotion, multi-sensory stimulation turned out to be more efficient than single-modality stimulation.

Study Type

Interventional

Enrollment (Actual)

120

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Egypt
    • Abbasia
      • Cairo, Abbasia, Egypt, 11591
        • Ain Shams University Hospitals

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • comprised adult patients admitted to the intensive care unit
  • adults who were diagnosed with traumatic brain injury (TBI)
  • the patients are ranging from mild to severe, with a Glasgow Coma Scale (GCS) score of 5-8
  • the patients without significant co-existing medical or psychiatric conditions that could affect recovery.

Exclusion Criteria:

  • None

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intervention group: Family-Centered Affective Stimulation (FCAS)
The intervention phase involved the systematic implementation of Family-Centered Affective Stimulation (FCAS). Family members were guided to provide structured emotional and sensory stimulation, including verbal communication, familiar voices, emotional reassurance, and gentle touch, in accordance with the prescribed protocol. The intervention was administered for a specified duration and frequency, under continuous clinical supervision to ensure patient safety and adherence to the protocol. During the intervention period, patients were continuously monitored, and periodic assessments were conducted to evaluate their responses. Changes in level of consciousness, behavioral reactions, and physiological parameters were observed and documented at regular intervals. The research team closely supervised the sessions to ensure consistency and provided ongoing support to participating family members. Any adverse responses or deviations from the protocol were promptly recorded and addressed.
Behavioral: Family-Centered Affective Stimulation (FCAS)
Family members were guided to provide structured emotional and sensory stimulation, including verbal communication, familiar voices, emotional reassurance, and gentle touch, in accordance with the prescribed protocol. The intervention was administered for a specified duration and frequency, under continuous clinical supervision to ensure patient safety and adherence to the protocol. During the intervention period, patients were continuously monitored, and periodic assessments were conducted to evaluate their responses. Changes in level of consciousness, behavioral reactions, and physiological parameters were observed and documented at regular intervals. The research team closely supervised the sessions to ensure consistency and provided ongoing support to participating family members. Any adverse responses or deviations from the protocol were promptly recorded and addressed.
No Intervention: Control group: Standard care

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Coma Recovery Assessment
Time Frame: Two timepoints, : T0 at baseline and at T1 at 6 months
The Coma Recovery Assessment is a standardized tool designed to measure neurobehavioral function. The Coma Recovery Scale-Revised (CRS-R) is a reference standard for assessing neurobehavioral function and diagnosing disorders of consciousness. It is made up by six subscales: auditory, visual, motor, or motor/verbal, communication, and arousal. The items of CRS-R as well as rating scale categories were refined to enhance clinical utility, construct validity, and diagnostic accuracy. Each subscale follows a hierarchical scoring system, with higher scores indicating greater neurobehavioral function. The number of scoring categories differs across the subscales. For example, the communication subscale includes three response options (0, 1, and 2), while the motor subscale contains seven categories ranging from 0 to 6. Consequently, the total raw score of the CRS-R can vary between 0 and 23.
Two timepoints, : T0 at baseline and at T1 at 6 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Modified Early Warning Score (MEWS)
Time Frame: Two timepoints, : T0 at baseline and at T1 at 6 months
The Modified Early Warning Score (MEWS) provides a simple and practical model for measuring risk of illness deterioration, with higher scores indicating an increased likelihood of clinical decline. Vital signs and level of consciousness are assessed on a five-point scale ranging from 0 to 4. The scoring system was adopted from Veldhuis et al. to assess physiological parameters and identify early indicators of deterioration, including vital signs and level of consciousness. This Early Warning Score (EWS) provides a simple and practical model for evaluating illness severity, with higher scores indicating an increased likelihood of clinical decline. Vital signs and level of consciousness are assessed on a five-point scale ranging from 0 to 4. Total scores are categorized as follows: 0-4, low risk of deterioration; 5-6, moderate risk; and ≥7, high risk, requiring immediate clinical attention
Two timepoints, : T0 at baseline and at T1 at 6 months
Full Outline of Unresponsiveness (FOUR) Score
Time Frame: Two timepoints, : T0 at baseline and at T1 at 6 months
The Full Outline of Unresponsiveness (FOUR) score is a recently validated coma scale used to evaluate the level of consciousness. The Full Outline of Unresponsiveness (FOUR) score is a recently validated coma scale used to evaluate the level of consciousness. It was adopted from Wijdicks et al. (2005). The scale consists of four components, each with a maximum score of four: eye response (E4), motor response (M4), brainstem reflexes (B4), and respiration (R4). Each component is scored on a five-point scale ranging from 0 to 4. Total scores are interpreted as follows: 15-16, conscious; 8-14, semiconscious; and 0-7, unconscious. The FOUR score provides a comprehensive assessment of neurological function, including bra
Two timepoints, : T0 at baseline and at T1 at 6 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cairo University

Collaborators

Helwan University
Prince Sattam Bin Abdulaziz University

Investigators

  • Study Chair: Walid Elsayed Hemaida, PhD, Prince Sattam Bin Abdulaziz University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 2, 2025

Primary Completion (Actual)

October 30, 2025

Study Completion (Actual)

October 30, 2025

Study Registration Dates

First Submitted

April 12, 2026

First Submitted That Met QC Criteria

April 12, 2026

First Posted (Actual)

April 17, 2026

Study Record Updates

Last Update Posted (Actual)

June 4, 2026

Last Update Submitted That Met QC Criteria

June 2, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • HUNURSERC42

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

The data will be submitted to the data repository platform. It will be selected based on the journal recommendations during the peer review process.

IPD Sharing Time Frame

The data will be submitted to the data repository platform. It will be selected based on the journal recommendations during the peer review process.

IPD Sharing Access Criteria

Data will be available publicly. Anonymous data. data related to study variables.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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