SMPC Day 3: Session 1 (Music therapy)

Saturday comes fast and it is time for one of the most packed days of the conference. Today I was really looking forward to the Music Therapy session that took place in the morning. It is great to see that the professional disciplines that are aligned to music cognition are playing a much bigger role in the sharing of research.

I was excited to see my friends from the Royal Hospital for Neuro-disability in London who are pioneering work into music therapy for minimally conscious patients. The first speaker, Julian O’Kelly, is a practitioner and academic from this wonderful facility and he was presenting his research into the impact of auditory therapies on patients with disorders of consciousness (DOC). DOC can be divided into two areas; vegetative state (VS) and minimally conscious (MCS). The former may transition into the latter state if level of consciousness improves.

VS patients only present with their vegetative functions such as cycles of sleep and waking but they do no respond to the stimuli in their environment. MCS patients show limited and variable responses that indicate a conscious awareness of their environment. Currently there is a worryingly high rate of misdiagnosis of these conditions of around 37-43%; a situation that calls for most careful consideration and, as we shall see later in this blog, more up to date work on diagnosis tools.

Julian’s research focused on the use of different sound stimuli during therapy, including patient preferred music (which he sings live), disliked music, entrained improvisation, white noise, and silence.  Julian measured multiple outcomes including behavioural indicators (e.g. eye blinks), EEG, ECG, respiration rate and heart rate variability (HRV).

In the healthy control population Julian observed no changes in HRV but a reliable increase in respiration to liked music, marking a standard arousal response. He observed no changes in patients due to the high levels of variability in their responses but at an individual level there were VS patients who showed interesting responses like higher blink rates to liked music. Blink rates have been linked to arousal response, attention and dopamine release, so this finding indicates a possible interesting residual emotional/memory response in a VS patient to their favourite music.

In terms of EEG, Julian reported that healthy people had peaks in right temporal alpha responses and frontal beta to liked music and that this pattern was also observed in a VS patient. One MCS patient also showed more frontal midline theta responses to their favourite music, and the whole group of MCS patients showed higher frontal alpha peaks in this condition.

In conclusion, it appears that music therapy, in particular the use of a patients favourite music, can trigger enhanced arousal responses that can be observed in limited behaviours and brain reactivity. The hope is that we can learn better how to harness this cortical activity for rehabilitation.

The next speaker was Deanna Hanson-Abromeit (University of Kanses, USA) who has been working for over a decade as a music therapist in neonatal intensive care units (NICU). Premature birth affects around 11% of births worldwide and in the majority of cases the reasons for a premature birth are unknown.

As well as having to overcome physical challenges, in particular related to the underdevelopment of the lungs, NICU babies are at risk for delayed neurodevelopment. Deanna is interested in music’s potential to support both physical and neural development in these young infants by providing sensory stimulation, procedural support, facilitating neural growth, and improving sleep quality.

In her talk she did not present any data but instead focused on emphasizing the need for greater emphasis on the nature of music that is selected in this therapeutic environment. She stressed that music is a complex intervention with many elements which should each be considered in relation to the problem that needs to be addressed and the potential efficacy of different musical constructions (e.g. pitch, contour, timbre and rhythm)

Her model, the ‘Therapeutic Functions of Music’ will provide a great framework for more research directed choices about music for therapy in the NICU and could very easily be adapted to other environments.

Lastly in this session we heard from Wendy Magee (Temple University, USA) with regard to the development of the Musical Therapy Assessment Tool for Awareness in Disorders of Consciousness or MATADOC. This new diagnostic tool is one answer to the call, detailed earlier in this blog, regarding the need to more accurate assessment tools when it comes to diagnosis of VS.

The two central questions that differentiate a diagnosis of MCS and VS are 1) is the patient aware of their surroundings? and 2) Are their responses contingent on outside stimuli? Given that the auditory sense is one of the most sensitive in patients with DOC is makes sense that it is one of, if not the best, modality for assessment, when hearing remains in tact.

MATADOC is a 14 item measure of behavioural response that uses both live and recorded music. Over 20 years Wendy and her colleagues have developed this standardised protocol which is based on building up from very simple elements of music, much like that approach put forward in the last talk by Deanna.

Wendy showed some initial assessment of the scale. In particular the first subscale, which relates most directly to diagnosis, has been rated as having high inter-rater and test-retest reliability as well as good construct and concurrent validity. The rest of the scale has not, to date, had such good results but Wendy assured us that it scores high on clinimetric utility, meaning that is has high relevance to real patient outcomes and is translatable across a multi-disciplinary team.

A very informative and inspiring session overall. Hopefully this kind of session is a look forward to a future when we can continue this level of cross discipline and practice vs. research based interaction in music psychology. Such an interdisciplinary approach should be close to the heart of our research world.