Acquired brain injury may result in an altered level of consciousness including coma or a minimally conscious state. Different techniques have been attempted to help arouse a person in an altered state of consciousness. A new systematic review investigated different techniques represented in the research literature, including music therapy.

Meyer et al. (2010) reviewed research studies on interventions that sought to arouse persons with a ABI who were in a prolonged comatose state (<48 hours). Methods were scored based on the amount of quality evidence from high-quality/high-level evidence (1) to conflicting evidence (5) using a well-defined scoring system. Music Therapy was give a score of “4”, meaning that there was some initial evidence that warrants further study.

This is exciting, as music therapy was one of seven therapies mentioned in the review, of which four were pharmaceutical treatments. This led to the question of what was the music therapy intervention?

The cited study was by Noda et al. (2004) and used “musicokinetic” therapy. The procedure involved supporting the patient in a seated position on a trampoline, where they received vertical motion (bouncing) that was synchronized with live piano or saxophone playing. The exact phrase of “music therapy” is never used in this study and there was no mention of a “music therapist”. The patients in the study showed improvements in the standard measurement scales that were utilized; however, the authors state that with no control group, gains resulting directly from the therapy cannot be measured.

A few thing I take away for these studies. First of all, the importance of going back to the original source to see what the original authors discussed and reported. Although there was a brief description in the systematic review, the original study was not what I expected. In reading the study, I question if results were due to vestibular stimulation, the music, or the combination of the two.  Without different treatment groups, this simply cannot be determined. Also, I was left wondering what kind of music was used.

Secondly, although the definition and use of music varies greatly, it is exciting that systematic reviews are identifying music therapy as a potential treatment methodology.  Due to this trend, researchers in our field should identify themselves a music therapist to make a clear indication that the research is being completed by professionals who have the training to make informed treatment decisions.

References:

Meyer MJ, Megyesi J, Meythaler J, et al. (2010). Acute management of acquired brain injury Part III: an evidence-based review of interventions used to promote arousal from coma. Brain Inj., 24(5):722-9. PMID:  20334468

Noda R, Maeda Y, Yoshino A. (2004). Therapeutic time window for musicokinetic therapy in a persistent vegetative state after severe brain damage. Brain Inj, 18(5), 509-15. PMID: 15195795