Promoting Consciousness Recovery in Patients with Acquired Brain Injury Through Multimodal Sensory Stimulation: A Randomized Controlled Trial of Median Nerve and Auricular Stimulation.

BACKGROUND

Addressing disorders of consciousness (DOC) secondary to acquired brain injury (ABI) remains challenging in neurorehabilitation. Median nerve electrical stimulation (MNES) is a noninvasive therapeutic option, but its benefits as monotherapy are restricted. The auricular intradermal needle, a prolonged-stimulation traditional Chinese medicine technique, has not been assessed for consciousness restoration. This study examined the safety and effectiveness of combining MNES with auricular needling for patients with DOC post-ABI.

METHODS

This randomized controlled trial enrolled 116 patients with DOC (GCS 4-8), randomly assigned to a treatment group (n = 58, standard care + MNES + auricular intradermal needling) or a comparison group (n = 58, standard care + MNES). MNES was administered twice daily for 60 min per session; auricular needles were embedded for 3 days (three pressings/day), with the total protocol spanning 11 days. Primary outcome was Coma Recovery Scale-Revised (CRS-R) score, evaluated at 4 weeks postintervention and 3 months post-ABI. Secondary outcomes included GCS score, awakening rate, Glasgow Outcome Scale (GOS) score, and family satisfaction.

RESULTS

Intent-to-treat (ITT) analysis showed that the experimental group had a significantly greater CRS-R score increase than controls at 4 weeks (mean difference: 1.62, P = 0.022) and 3 months (mean difference: 2.05, P = 0.006). All secondary outcomes differed significantly: higher GCS scores, higher awakening rates (48.28% vs. 27.59% at 4 weeks; 62.07% vs. 41.38% at 3 months), more favorable GOS outcomes (4-5: 55.17% vs. 31.03%), and improved family satisfaction. No serious treatment-related adverse events occurred.

CONCLUSIONS

Integrating MNES with auricular intradermal needle enhances therapeutic outcomes for DOC following ABI, proving more effective than MNES alone in promoting consciousness recovery and neurological improvement without compromising safety. This complementary method represents a viable and promising advancement in noninvasive DOC management. Trial registration ClinicalTrials.gov Identifier: NCT07273864.