Active music therapy approach in disorders of consciousness: a controlled observational case series.

Abstract

Disorders of Consciousness (DoC) represent a serious difficulty for caring interventions and they are a diagnostic, clinical and rehabilitative problem [1]. In the last few years, great attention has been developed towards rehabilitative treatments and protocols of different interventions to better define improvements and variations of the consciousness state level [2]. The literature concerning music therapy (active and receptive techniques) is scant and based mainly on single cases or small samples [3–6]. The present study aimed at evaluating the effects of active music therapy (AMT) on some physiological parameters and on behavioural responses in DoC. This controlled observational case series study involved 10 patients with severe brain injuries (5 with a Cerebral Anoxia, 4 with a Brain Haemorrhage and 1 with Head Injury). Informed consent was obtained from proxies of all patients. The patients were divided into two sub-groups. Four of those were in a minimally conscious state (Glasgow Outcome Scale score = 4) and six in a vegetative state (Glasgow Outcome Scale score = 2). All patients had undergone two cycles of 15 AMT sessions (T1 and T3) spaced out by 2 weeks of a pause period (T2). Pharmacological treatments and other conditions did not change during treatment time. The administered individual AMT sessions (three times a week, 30 min each) were based on a direct contact between patient and music therapist. The therapist stimulated patients mostly using rhythmic and melodic patterns, modulating and adapting the sonorousmusical proposals: these matched the arousal level and emotional, motor, behavioural and sonorous-musical responses of patients to stimuli [6, 7]. To measure the effect of AMT some physiological parameters (blood pressure, heart and respiration rate, blood oxygenation) and behavioural responses were evaluated. Physiological parameters were monitored immediately before and after each session and everyday (at the same time) during T2 by nursing staff. Behavioural responses were observed by trained music therapists (not involved in the therapeutic process) using an observational scheme while watching of video-recorded sessions. Effects of both cycles of AMT on physiological parameters were assessed by means of repeated measures analysis of variance. Bonferroni correction was applied as multiplicity test. Behaviours of patients following AMT intervention were summarised as medians and interquartile ranges. The main results concerning the assessed physiological parameters are summarised in Table 1. A significant difference was found comparing T3 with T2 data in the vegetative state group, both in the systolic (p = 0.023) and diastolic pressure (p = 0.050). Systematic observations showed improvements, mainly in the minimally conscious state group, in some observed behaviours: eye contacts, smiles, communicative use of instruments/ voice, reduction of annoyance and suffering expressions. In the vegetative state group only eye contacts strongly increased during the treatment (Table 2). A. Raglio (&) E. Granieri Department of Biomedical and Specialistic Surgical Sciences, Section of Neurology, University of Ferrara, Via A. Moro 8, Cona 44124, Ferrara, Italy e-mail: raglioa@tin.it; alfredo.raglio@unife.it