Introduction: Traumatic Brain Injury is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force [1]. Traumatic Brain injury is also associated with neurological or neuro psychological abnormalities, skull fracture, intracranial lesions. In India and other developing countries traumatic brain injuries are a leading cause of morbidity, mortality, disability and socioeconomic losses. In India nearly 1.5 to 2 millions are injured and 1 million deaths are occurring [2,3]. Ganesan et al. reported statistical significant improvement in level of consciousness between the groups (p<0.05) and there was no significant improvement in the neurobehavioral function between the groups after right median nerve stimulation of traumatic brain injury. There may be relationship between superior levator palpebrae muscle, right median nerve and ascending reticular formulation in improving consciousness of traumatic brain injury subjects. None of the studies documented the relationship between them [22]. Aim of The Study: To analyze the effectiveness of sensory stimulation program with median nerve stimulation in post head injury subjects with decreased level of consciousness. Methods: The basis of inclusion and exclusion criteria 30 subjects were randomly divided into two groups. 15 subjects in experimental group (Group A) and 15 subjects in controlled group (Group B). A pretreatment scoring was done via Glasgow coma scale (GCS) and coma recovery scale (CRS). Group A is experimental group and received Sensory stimulation program with right median nerve stimulation (SSP) and Group B is controlled group & this group received conventional therapy as chest PT, Passive Movement, PNF and positioning of the patient. Discussion: Severe brain injury is a cause of for high morbidity and mortality rates. Individuals who sustained severe acquired brain injury, experience prolonged disorders of consciousness. The current study was conducted to compare the effectiveness of multisensory stimulation program with median nerve stimulation in post head injury subjects with decreased level of consciousness. The present study suggested that the sensory stimulation programme along with median nerve stimulation is associated with higher level of consciousness determined by the GCS when compared to the other group in comatose TBI patients. There is a gradual increase in the level of consciousness in the experimental group during 4 weeks of intervention. These findings demonstrated that the significant changes in the GCS, CRS scores are not representative of single day intervention but are rather related to the effect of collective intervention over the course of 4 weeks. Kater, mitchell et al. The result of this study suggested that implementation of sensory stimulation long with median nerve stimulation can enhance consciousness recovery in comatose traumatic brain injury patients. Samond et al. The changes in the ANS while regaining consciousness could be due to the recovery of higher cortical structures controlling the ANS and nuclei releasing the neuro transmitters involved in the ANS. Johnsons et al. considered other indices such as catecholamine, serotonin, acetylcholine esterase 3-methoxy 4-hydoxyphenylgycol skin conductance and heart rate as evidence of the effects of sensory stimulation. The control group (Group B) showed non- significant result of p>0.05. In this group conventional physiotherapy with passive exercise and shows non- significant results after 4 weeks when compared to pre- intervention scores. This states that conventional physiotherapy with passive exercise and chest physiotherapy are not sufficient for speedy and significant outcomes. Clinically, this study demonstrates that sensory stimulation programme along with median nerve stimulation as a treatment tool, improve the level of consciousness post treatment brain injury subjects. Future Research: Further studies are recommended to minimize these limitations in such a way that larger sample sizes of both the sexes, the duration of the study can be increased, Sensory stimulation should be applied for more than 4 weeks, sensory stimulation could focus on performing long term follow up to compare cognitive and functional activities outcomes in unconscious patients with traumatic brain injury. Limitation of the Study: Duration of the study was short. There was no follow up. Half of the patients were surgically operated on for brain injury and these patients were not uniformly distributed across the sample. It was not ascertained whether the improvement were maintained for a longer period or not due to lack of follow up in the study. Conclusion: Sensory stimulation programme with median nerve stimulation was found to be effective in improving levels of consciousness in subjects with traumatic brain injury. When sensory stimulation programme with median nerve stimulation is administered to the patients suffering from traumatic brain injury over a periods of 4 weeks results in improving the levels of consciousness and there by promotes faster recovery due to significant effects on GCS and CRS when compare to patients who did not receive sensory stimulation programme with median nerve stimulation.

Keywords: Head injury; Sensory Stimulation Programme; Glasgow coma scale; Coma Recovery Scale; Median nerve stimulation.