Research Updates
Validating the Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) against the best practice external reference standard.
PI: Dr. Wendy Magee
Professor, Music Therapy Program
Co-ordinator, Undergraduate Program
Temple University
Room 311 (3rd floor)
Presser Hall, 2001 North 13th Street
Philadelphia, PA 19122
Email: wmagee@temple.edu
Collaborators:
Caroline Schnakers, UCLA, Los Angeles, USA
Richard Siegert, Auckland University of Technology, NZ
Collaborating clinical centers:
Spectrum Health, Grand Rapids, MI, USA
Royal Hospital for Neuro-disability, London, UK
National Rehabilitation Hospital, Dublin, Eire
Aim:
The purpose of this project is to further develop a standardized music-based measure used in music therapy with adults who have emerged from coma following profound brain injury, but are not able to demonstrate responsiveness to their environment due to complex clinical needs. Building on previous work, the project aims to strengthen the psychometric properties (e.g. concurrent validity, responsiveness) of the measure for its use with adults with profound brain damage.
We propose to further validate the Music Therapy Assessment for Awareness in Disorders of Consciousness (MATADOC) against the existing “gold standard” measure (the CRS-R).
Lead organisation: Temple University
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Characterising Brain Function in Vegetative and Minimally Conscious State Patients (with ERP) and optimisation of circadian rhythms, led by Dr K Yelden.
Contact details:
Kudret C. Yelden, MRCP
Consultant in Rehabilitation Medicine
LLM-Medical law and Ethics
collaborators: Leon James, Kudret Yelden, Sophie Duport, Simon F Farmer, Diane
E Playford, Alexander P Leff,
In this research study we examined the effect of circadian rhythm and sleep optimization on behavioural and electrophysiological responses in PDOC patients.
10 people with PDOC were included in the study. Coma recovery scale-revised (CRS_R) assessments, 24-hour PolySomnography and 4-hourly saliva melatonin measurements, mismatch negativity and subject’s own name experiments were performed twice at baseline and following five weeks’ intervention.
This research showed that baseline sleep architecture was abnormal in all patients. With intervention, improvement of sleep stages and/or sleep-wake patterns were detected in 8/10 patients.
Cosinor analysis of saliva melatonin results revealed that averaged baseline % rhythmicity was low but increase in %Melatonin Rhythm following intervention was statistically significant.
More importantly, 7 patients had improvement of CRS-R scores with intervention. All the patients who had improvement of clinical scores also had statistically significant improvement of neurophysiological responses.
It was concluded that sleep and circadian rhythms are severely deranged in PDOC. Optimization of circadian rhythms and sleep with melatonin, caffeine and blue light treatment led to improvement of all physiological parameters measured- and most importantly of CRS-R scores and event-related potentials
Lead organisation: Royal Hospital for Neuro-disability
Funding: The Neuro-disability Research Trust
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Characterising Brain Function in Vegetative and Minimally Conscious States Patients (with EEG and NIRS signals)
Contact: Agnieszka Kempny agnieszka.kempny@gmail.com
Collaborators: Leon James, Kudret Yelden, Sophie Duport, Simon F Farmer, Diane
E Playford, Alexander P Leff,
Near infrared spectroscopy (NIRS) is a non-invasive technique which measures changes in brain tissue oxygenation. Until now, NIRS has not been used to detect residual cognitive functions in patients with prolonged disorders of consciousness (DOC).
We studied 16 DOC patients in total, split into two groups: five had a diagnosis of Vegetative state, and eleven had a diagnosis of Minimally Conscious State. In the control subjects we found a greater oxy-haemoglobin (oxyHb) response during real movement compared with imagined movement. For the between group comparison, we found a main effect of hemisphere, with greater depression of oxyHb signal in the right > left hemisphere compared with rest period for all three groups. A post-hoc analysis including only the two DOC patient groups was also significant suggesting that this effect was not just being driven by the control subjects. This study demonstrates for the first time the feasibility of using NIRS for the assessment of brain function in DOC patients using a motor imagery task.
Lead organisation: Royal Hospital for Neuro-disability
Funding: The Neuro-disability Research Trust
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Publications:
Kempny AM, James L, Yelden K, Duport S, Farmer SF, Diane Playford E, Leff AP (2018) Patients with a severe prolonged Disorder of Consciousness can show classical EEG responses to their own name compared with others' names. Neuroimage Clin. Apr 30;19:311-319.
Soeterik SM, Connolly S, Playford ED, Duport S, Riazi A.(2017) The psychological impact of prolonged disorders of consciousness on caregivers: a systematic review of quantitative studies. Clin Rehabil. Oct;31(10):1374-1385.
Morrissey AM, Gill-Thwaites H, Wilson B, Leonard R, McLellan L, Pundole A, Shiel A. (2017) The role of the SMART and WHIM in behavioural assessment of disorders of consciousness: clinical utility and scope for a symbiotic relationship. Neuropsychol Rehabil. Aug 1:1-12.
Yelden K, Duport S, James LM, Kempny A, Farmer SF, Leff AP, Playford ED.(2017) Late recovery of awareness in prolonged disorders of consciousness -a cross-sectional cohort study. Disabil Rehabil. Jun 21:1-6.
Illman NA, Crawford S. (2017) Late-recovery from "permanent" vegetative state in the context of severe traumatic brain injury: A case report exploring objective and subjective aspects of recovery and rehabilitation. Neuropsychol Rehabil. Apr 26:1-15.
Gill-Thwaites H, Elliott KE, Munday R.(2017) SMART - Recognising the value of existing practice and introducing recent developments: leaving no stone unturned in the assessment and treatment of the PDOC patient. Neuropsychol Rehabil. Apr 18:1-12.
Yelden K, Sargent S, Samanta J. (2017)Understanding the decision-making environment for people in minimally conscious state. Neuropsychol Rehabil. Apr 11:1-12.
Tennant A, Gill-Thwaites H. (2017) A study of the internal construct and predictive validity of the SMART assessment for emergence from vegetative state. Brain Inj.;31(2):185-192.
da Conceição Teixeira L, Gill-Thwaites H, Reynolds F, Duport S. (2016) Can behavioural observations made during the SMART assessment detect the potential for later emergence from vegetative state? Neuropsychol Rehabil. 2016 Oct 27:1-10.
Elliott K, McVicar A.(2016) The impact of prolonged disorders of consciousness on the occupational life of family members. Neuropsychol Rehabil. Oct 27:1-17.