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

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.