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

Abstract

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.

Keywords:

• music therapy
• disorders of consciousness
• neuroscience
• low awareness
• brain injury

Acknowledgements

The authors would like to acknowledge the support of Dr Sophie Duport, Head of Research at the Royal Hospital for Neuro-disability, and funding from Aalborg University, the Neuro-disability Research Trust and the Music Therapy Charity.