Julian O'Kelly

Music therapy with disorders of consciousness: current evidence and emergent evidence-based practice

Patients with prolonged disorders of consciousness (PDOC) stemming from acquired brain injury present one of the most challenging clinical populations in neurological rehabilitation. Because of the complex clinical presentation of PDOC patients, treatment teams are confronted with many medicolegal, ethical, philosophical, moral, and religious issues in day‐to‐day care. Accurate diagnosis is of central concern, relying on creative approaches from skilled clinical professionals using combined behavioral and neurophysiological measures. This paper presents the latest evidence for using music as a diagnostic tool with PDOC, including recent developments in music therapy interventions and measurement. We outline standardized clinical protocols and behavioral measures to produce diagnostic outcomes and examine recent research illustrating a range of benefits of music‐based methods at behavioral, cardiorespiratory, and cortical levels using video, electrocardiography, and electroencephalography methods. These latest developments are discussed in the context of evidence‐based practice in rehabilitation with clinical populations.

Music therapy with disorders of consciousness and neuroscience: the need for dialogue

Music therapy may be effective in promoting arousal and awareness for those with disorders of consciousness. This feature may be used to enhance our ability to diagnose accurately whether individuals are in vegetative or minimally conscious states. Accurate diagnosis is crucial for decisions regarding prognosis and resource allocation. However, it is a challenging process, where subtle responses to stimuli may be hard to discern through behavioural assessment alone. The literature detailing music therapy in the assessment and rehabilitation in this field spans the last 30 years, although robust research is scarce. Differences in paradigms persist in thinking about and describing clinical work with this population, where two contrasting approaches are found with humanist/music centred and behavioural/pragmatic influences. Whilst standardised behavioural assessment techniques are being developed, there is little evidence to support music therapy in rehabilitation programmes. In contrast, advances in neuroscience have improved our understanding of both brain damage and brain/music interactions. There is increasing support for the role of musical activity in promoting neuroplasticity and functional improvements for people with neuro-disabilities, although music therapy specific studies are lacking. Collaborations between the fields of neuroscience and music therapy may yield fruitful progress for both disciplines as well as for patient populations. By outlining the key findings and the remaining questions offered by the neuroscience literature, this paper sets out the future challenges to address for clinicians and researchers in developing evidence-based approaches to their work.

The complementary role of music therapy in the detection of awareness in disorders of consciousness: An audit of concurrent SMART and MATADOC assessments

In the behavioural assessment of disorders of consciousness (DOC), best practice is for several different assessment tools to be used to encourage a variety of different responses indicative of awareness. Anecdotal evidence suggests a range of musical stimuli may be particularly effective in eliciting responses to guide the assessment process, although comparative data regarding behavioural domains is lacking. This study examined 42 concurrent records of patients assessed using the Sensory Modality Assessment and Rehabilitation Technique (SMART), and the Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) to explore the relationship between diagnosis and behavioural characteristics of the cohort. Whilst the two tools produced a high level of agreement in diagnostic outcome (Spearman Rho .80), divergent diagnosis and weaker correlations between behavioural response items highlight contrasting sensitivities of the tools. Whilst MATADOC has higher sensitivity within auditory and visual domains relative to SMART, SMART has higher sensitivity in the motor domain. The significant contribution of musical response items in MATADOC, and the tactile response item in SMART, indicates both tools provide unique behavioural data predictive of awareness. Multidisciplinary assessment using SMART and MATADOC provides complementary data contributing to a fuller understanding of a patients level of awareness.

Music therapy assessment tool for low awareness states (MATLAS):Establishing reliability and validity

Endogenous free radical production by NADPH oxidase 2 contributes to the secondary injury cascade after traumatic brain injury in miceAccepted Abstracts from the International Brain Injury Association’s Ninth World Congress on Brain InjuryObjectives: Studies have shown that occupational therapy interventions for clients with cognitive impairment following acquired brain injury (CIABI) have a positive effect on performance of activities of daily living, although the exact nature of the interventions are not clearly described. A better understanding of current practice is therefore needed to move further in the search for evidence based occupational therapy for clients with CIABI. Research on occupational therapists’ (OTs’) practice can play an important role to explore and describe current practice and furthermore define and evaluate the effectiveness of different components in OT interventions. The aim of this study was to survey Swedish OTs’ practice patterns for clients having CIABI.Methods: The study had a cross-sectional design using a questionnaire developed in two former studies. A stratified random sample was done with 250 OTs each from the following areas: regional care, somatic county care, primary care and municipal eldercare. The questionnaire was sent out using on-line survey software and 462 participants responded. Data is currently analyzed by descriptive and comparative statistics.Results: Preliminary results show that the interventions targeted a wide range of cognitive impairments and its consequences. Interventions were both remedial and compensatory with graded activity as the most common remediating intervention. To compensate for activity limitations prescription, or recommendation, of assistive devices (AD) as well as supporting clients in finding internal strategies were used extensively. The ADs used consisted of both high and low technology devices. Eighty-two percent also included different specific interventions to improve clients’ decreased self-awareness in their practice. A vast majority of the OTs (94%) preferred to use observations in daily activities to assess both activity limitations and cognitive impairment. Almost all participants also used interviews and sixty-two percent used tests on impairment level. To support practice general Occupational Therapy models were widely used while theories focusing on cognitive impairments specifically were used less. The participants’ answers reflected a client-centered attitude with collaborative goal-setting and feedback discussions after each session. Eighty- four percent felt dependent on relatives to reach a successful outcome and most of them worked deliberately to involve relatives in the rehabilitation. The OTs responses were evenly distributed over the spheres of activity. Ninety-two percent of the participants worked in team and the most common diagnoses were stroke and traumatic brain injury. There were some differences in responses between the spheres.Conclusions: Preliminary conclusions are that the OTs practice patterns included interventions targeting most cognitive impairments and their consequences in daily activities. The use of daily activities as a mean was preferred irrespective of whether the interventions were remediative or compensatory. Interventions targeting decreased self-awareness as well as the use of ADs were common. A client-centered approach was dominating including collaboration with relatives.For personalcentered approach was dominating including collaborationwith relatives.Diagnosis of Disorders of Consciousness : Evoked Potentials and Behavioural Assessment in clinical practice

Editorial: Dialogues in Music Therapy and Music Neuroscience: Collaborative Understanding Driving Clinical Advances

Music is a complex, dynamic stimulus with an un-paralleled ability to stimulate a global network of neural activity involved in attention, emotion, memory, communication, motor co-ordination and cognition. As such, it provides neuroscience with a highly effective tool to develop our understanding of brain function, connectivity and plasticity. Increasingly sophisticated neuroimaging technologies have enabled the expanding field of music neuroscience to reveal how musical experience, perception and cognition may support neuroplasticity, with important implications for the rehabilitation and assessment of those with acquired brain injuries and neurodegenerative conditions. Other studies have indicated the potential for music to support arousal, attention and emotional regulation, suggesting therapeutic applications for conditions including ADHD, PTSD, autism, learning disorders and mood disorders. In common with neuroscience, the music therapy profession has advanced significantly in the past 20 years. Various interventions designed to address functional deficits and health care needs have been developed, alongside standardised behavioural assessments. Historically, music therapy has drawn its evidence base from a number of contrasting theoretical frameworks. Clinicians are now turning to neuroscience, which offers a unifying knowledge base and frame of reference to understand and measure therapeutic interventions from a biomedical perspective. Conversely, neuroscience is becoming more enriched by learning about the neural effects of ‘real world’ clinical applications in music therapy. While neuroscientific imaging methods may provide biomarking evidence for the efficacy of music therapy interventions it also offers important tools to describe time-locked interactive therapy processes and feeds into the emerging field of 3 June 2017 | Dialogues in Music Therapy and Music Neuroscience social neuroscience. Music therapy is bound to the process of creating and experiencing music together in improvisation, listening and reflection. Thus the situated cognition and experience of music developing over time and in differing contexts is of interest in time series data. We encouraged researchers to submit papers illustrating the mutual benefits of dialogue between music therapy and other disciplines important to this field, particularly neuroscience, neurophysiology, and neuropsychology. The current eBook consists of the peer reviewed responses to our call for papers.