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

Abstract

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 patient's level of awareness.

Intervenciones musicoterapéuticas para la activación del sistema reticular

“…También se encuentra la improvisación desde la voz, teniendo en cuenta que las frases suban y bajen con el patrón de respiración del paciente. Estas intervenciones serán planificadas según las necesidades del paciente y en colaboración con el equipo interdisciplinario (O'Kelly & Magee, 2013b).…”

Feasibility of the music therapy assessment tool for awareness in disorders of consciousness (MATADOC) for use with pediatric populations

“…However, the higher level behaviors observed for this item might be explained once more by the use of musical stimuli facilitating greater responsiveness than non-musical stimuli. Clearly further investigation is warranted of item sensitivity in the visual and auditory domains with children, as the MATADOC has been found to have greater sensitivities in the auditory and visual domains than another standardized DOC measure in adults with DOC ( O’Kelly and Magee, 2013 ).…”

Neurophysiological and Behavioral Responses to Music Therapy in Vegetative and Minimally Conscious States

“…As such it may provide the optimal stimuli in a field where cognition is severely compromised and stimuli with personal meaning produce greatest behavioral change (Boly et al, 2004; Perrin et al, 2006; Machado et al, 2007). The auditory modality has been established as particularly sensitive to identifying responses indicative of awareness using language based stimuli (Monti et al, 2010), mixed language and non-language based stimuli (Gill-Thwaites, 1997; Gill-Thwaites and Munday, 2004), and musical stimuli (O’Kelly and Magee, 2013b). Differences in the effectiveness of contrasting auditory stimuli in eliciting awareness responses have not been established; however O’Kelly and Magee (2013b) highlight how musical stimuli may be more effective than basic auditory stimuli such as wood blocks, as found in commonly used assessment tools.…”