Julian O'Kelly
Contact info:
Title of PhD research study:
The development of an evidence-based music therapy treatment for low awareness states
Supervisors:
Dr Hanne Mette Ridder
Dr Wendy Magee
Summary
Background
Low Awareness States (LAS) comprise vegetative states (VS) where there is no level of consciousness despite evidence of wakefulness or minimally conscious states (MCS), where consciousness is very limited, but exclude comatose states where consciousness and wakefulness are absent.
Diagnosis, misdiagnosis and treatment are critically important issues in the field of LAS. Whilst the auditory domain in LAS may be the most sensitive and reliable for clinicians attempting to establish awareness and communication, evidence-based guidelines are lacking in this area. Studies of LAS rehabilitation programmes incorporating sensory stimulation treatments vary widely in content and structure, and are considered to be of poor methodological quality. Similarly, in the field of music therapy work with LAS, there is no consensus amongst clinicians on which of a range of methods to use, and little evidence on the effectiveness of different methods.
Research questions
Over 4 stages, this study will systematically address the issue of poor evidence in this field by developing an evidence based music therapy treatment for LAS. The stages of the study will explore the following research questions:
• what is the role of auditory responses in relation to other factors such as aetiology and diagnosis in LAS?
• how can this data inform music therapy assessment, referral criteria and practice?
• can a music therapy treatment be effective in supporting awareness and cognitive activity with LAS?
Further to a critical appraisal of the literature, a 2-year retrospective audit of data from LAS patients’ records will be conducted to examine responses to auditory and musical stimuli in relation to other factors such as diagnosis. A treatment protocol will then be developed based on a study estimating the music therapy methods that elicit the most significant physiological, neurological and behavioural responses in controls and LAS. The final stage of this research will establish the clinical effectiveness of this treatment using a randomised controlled crossover study to compare the effect of music therapy with a ‘sham’ treatment (listening to an audio book).
This original study aims to make a significant contribution to our understanding of LAS, by establishing data on the optimal music therapy methods for assessment and rehabilitation across the LAS continuum, and by providing clinicians with the first rigorous trial of a music therapy treatment for this population.