Use of Music and Voice Stimulus on Patients With Disorders of Consciousness

The Effect of Video Call with Family Members on Physiological Parameters of Critically Ill Patients in Intensive Care Unit: A Quasi-experimental Study

Aim and background

There are not enough studies on the direct effect of virtual patient visits on patients' vital signs in intensive care. The aim of this study is to determine the effect of video calls made between conscious patients and their families on the patient's vital signs and to determine the level of satisfaction.

Materials and methods

The research was carried out quasi-experimentally. Study data were collected from 135 patients and their relatives. The data were collected from the vital signs monitoring form and the Glasgow Coma Scale (GCS). Satisfaction with the video call was measured with a score scale between 0 and 5. Video calls were conducted by an intensive care unit (ICU) nurse every day between 13:00 and 15:00 for 5 days. Physiological parameters were measured 30 minutes before, during, and 30 minutes after the video calls.

Results

The mean patient pulse rate (PR) value was 92.04 ± 12.87, respiratory rate (RR) value was 22.89 ± 3.63, and GCS total score was 14.01 ± 0.12 during the call. There was a statistically significant difference between these values measured during the video calls and the values measured before and after the interview (p < 0.00). The mean score of patient satisfaction with the video call was 4.80 ± 0.44; for relatives, the mean score was 4.87 ± 0.33.

Conclusion

This study revealed that video calls with family members affected PR, RR, and GCS of patients hospitalized in ICU.

Clinical significance

Video calls can be implemented in all ICUs where visits are restricted. This practice is well recognized by both families and patients.

How to cite this article

Uysal N, Vaizoğlu D. The Effect of Video Call with Family Members on Physiological Parameters of Critically Ill Patients in Intensive Care Unit: A Quasi-experimental Study. Indian J Crit Care Med 2023;27(10):732-736.

Critical Care Rehabilitation of the Burn Patient

Despite the fact that modern burn care has significantly reduced the mortality associated with severe burn injuries, the rehabilitation and community reintegration of survivors continues to be a challenge. An interprofessional team approach is essential for optimal outcomes. This includes early occupational and physical therapy, beginning in the intensive care unit (ICU). Burn-specific techniques (edema management, wound healing, and contracture prevention) are successfully integrated into the burn ICU. Research demonstrates that early intensive rehabilitation of critically ill burn patients is safe and effective. Further work on the physiologic, functional, and long-term impact of this care is needed.

Behavioral intervention approaches for people with disorders of consciousness: a scoping review

PURPOSE

This review was intended to provide an overall picture of work conducted during the last decade to assess the impact of behavioral intervention strategies on people with disorders of consciousness (i.e., comatose state, vegetative state/unresponsive wakefulness, or minimally conscious state). The intervention strategies considered were those not based on music or including music as a component of the intervention package.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist, a scoping review was carried out to identify and provide a synthesis of eligible studies published in English during the 2010-2021 period. Three databases (i.e., PubMed, PsycINFO, and Web of Science) were employed for the literature search.

RESULTS

Forty studies met the inclusion criteria. Those studies were grouped into three categories based on whether they assessed the effects of: (i) verbal stories/messages, (ii) multiple stimulation, and (iii) response-contingent stimulation. Then, a narrative synthesis of the studies of each of the three categories was provided to specify the types of patients involved, the intervention and assessment conditions implemented, and the outcome attained.

CONCLUSIONS

The evidence reported in most of the studies might be considered encouraging and convincing. Even so, it might be very difficult to view the evidence of the various studies cumulatively and make general/conclusive statements due to a number of differences in the intervention conditions applied.Implications for rehabilitationAn informative picture of the studies using behavioral interventions with people with disorders of consciousness is essential to any professional working in the area.Such picture can be highly useful in providing a view of the intervention strategies used for those people, of the variations existing within and across strategies, and of the evidence available.An analysis of the strategies, their implementation and their effects may provide new insights for improving those strategies and eventually increasing their impact.The individuals charged with the implementation process (e.g., family members or nurses) may have a relevant influence on the overall impact of the strategy.

Exploring the influence of scheduled meetings on physiological indicators of hospitalized patients satisfaction facing acute myocardial infarction in the intensive care unit

BACKGROUND

Satisfaction of patients is among the top priorities of health-care providers. Meeting with families is essential for patients who are admitted to various wards, although it has been restricted for many reasons such as its impact on physiologic indicators. This present research study aimed to exploring the influence of scheduled meetings on physiological indicators of hospitalized patients satisfaction facing acute myocardial infarction in the intensive care unit.

MATERIALS AND METHODS

This study was a nonrandomized clinical trial with a control group conducted in the cardiac care unit ward of Hamadan's Ekbatan Hospital. Sixty patients with acute myocardial infarction were chosen through convenient sampling and assigned to intervention (planned meeting) and control (routine meeting) groups in a nonrandomized manner. Data were collected by a researcher-made questionnaire of patient satisfaction and the observatory checklist of physiologic indicators and then analyzed in IBM SPSS Statistics v23.

RESULTS

The total mean score of satisfaction did not significantly differ between the two groups (P = 0.921). The satisfaction of patients for "the conduct of visitors" was significantly higher in the intervention group (P = 0.005). During the study, no meaningful difference was found between the two groups for physiologic indicators (P > 0.05), while these indicators, except for blood O2 saturation, were meaningfully increased in the control group during routine meetings (P < 0.05).

CONCLUSION

Planned meetings did not promote total satisfaction of patients with meetings, but improved some aspects of satisfaction, such as the conduct of visitors. The planned meeting is recommended as an alternative for a routine meeting, as it did not affect the physiologic indicators of patients in the intervention group.

Music Stimulation for People with Disorders of Consciousness: A Scoping Review

Music stimulation is considered to be a valuable form of intervention for people with severe brain injuries and prolonged disorders of consciousness (i.e., unresponsive wakefulness/vegetative state or minimally conscious state). This review was intended to provide an overall picture of work conducted during the last decade to assess the impact of music on behavioral and non-behavioral responses of people with disorders of consciousness. Following the PRISMA-ScR checklist, a scoping review was carried out to identify and provide a synthesis of eligible studies published in English during the 2010–2021 period. Three databases (i.e., PubMed, PsycINFO, and Web of Science) were employed for the literature search. Thirty-four studies met the inclusion criteria. Those studies were grouped into three categories based on whether they assessed the effects of: (i) recorded music, (ii) interactive music, or (iii) response-contingent music. A narrative synthesis of the studies of each of the three categories was eventually provided. While the studies of all three categories reported fairly positive/encouraging results, several methodological questions make it difficult to draw conclusions about those results and their implications for intervention programs in daily contexts.

Music Interventions for Disorders of Consciousness: A Systematic Review and Meta-analysis

BACKGROUND

Quantitative evidence for the effects of music on patients with disorders of consciousness (DOCs) was presented. This study was based on available studies to summarize the effect estimates of music for DOC patients.

METHODS

Three electronic databases were searched for studies that investigated the effects of music for DOC patients from start to July 2018. The summary results included functional scale, general physical indexes, electroencephalogram indexes, and favorable outcomes. The weighted mean difference and odds ratio with a corresponding 95% confidence interval were used to calculate continuous and frequency data using a random-effects model. This report adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Randomized controlled trials (3) and cohort studies (8) involving 201 DOC patients were included. Patients with DOCs receiving music interventions were associated with high levels of California Verbal Learning Test (P = .038) and persistent vegetative state (P < .001), whereas no significant differences were detected for agitated behavior scale (P = .982), Glasgow Coma Scale (P = .216), Mini-Mental State Examination (P = .215), music therapy in a vegetative or minimally conscious state (P = .590), and Stroop (P = 1.000). Furthermore, DOC patients receiving music intervention showed a significantly increased facial expression (P = .003) and reduced systolic blood pressure (P = .036), whereas no significant effects were observed on diastolic blood pressure (P = .777), heart rate (P = .666), oxygen saturation (P = .911), pulse (P = .899), respiratory frequency (P = .427), and temperature (P = .864). Moreover, music did not contribute significantly to electroencephalogram indexes including alpha (α), beta (β), delta (δ), and theta (θ) in the left and right hemispheres (P > .050). Finally, DOC patients receiving music intervention showed an increased incidence of favorable outcomes (P = .015).

CONCLUSION

This quantitative meta-analysis indicated that music might play a critical role on the functional scale, general physical indexes, and favorable outcomes for DOC patients. Music therapy can easily be provided at the bedside by nurses working with DOC patients.

The effects of musical stimulation on the level of consciousness among patients with head trauma hospitalized in intensive care units: A randomized control trial

BACKGROUND

Improvement in the level of consciousness (LOC) is considered as an indicator of recovery among patients with head trauma (HT). musical stimulation is a simple noninvasive intervention with potential positive effects on LOC. This study evaluated the effects of musical stimulation on LOC among patients with HT hospitalized in intensive care unit.

METHODS

This clinical trial was conducted in 2018-2019. Fifty-four patients with HT were purposively and consecutively recruited from two trauma intensive care units in Qazvin, Iran, and randomly allocated to a control (n = 27) and an intervention (n = 27) group. Participants in the intervention group received fifteen-minute musical stimulation once daily for seven consecutive days using an MP3 player and a headphone for their counterparts, the headphones were silent for 15 min without receiving any musical stimulation once daily for seven consecutive days. A demographic questionnaire, the Glasgow Coma Scale, and the Richmond Agitation-Sedation Scale were used for data collection. LOC was daily assessed before and after each musical stimulation session. The SPSS program (v. 23.0) was used for data analysis at a significance level of less than 0.05.

FINDINGS

There were significant between-group differences respecting the posttest mean score of LOC in the third, fourth, fifth, sixth, and seventh days of the study intervention (P < 0.05)., the posttest mean score of LOC in the intervention group significantly increased in the intervention group (P < 0.0001), while it did not significantly change in the control group (P > 0.05).

CONCLUSION

musical stimulation is effective in significantly improving LOC among hospitalized patients with HT. Therefore, it can be used as a non-expensive noninvasive intervention to improve treatment outcomes among these patients.

Effect of Auditory Stimulation on the Level of Consciousness in Comatose Patients Admitted to the Intensive Care Unit: A Randomized Controlled Trial

BACKGROUND

Comatose patients are exposed to sensory deprivation in the intensive care units. Auditory stimulation of patients who are unconscious is a nonmedical procedure. This study examines the effect of organized voice, performed by a nurse, on the state of consciousness of comatose patients in intensive care units.

METHOD

This randomized controlled trial study of 60 patients was conducted fitting between August 2017 and February 2018. For 10 days, patients received the voice of a male nurse twice a day in the morning and night shifts, recorded on MP3 and repeated at least 3 to 4 times. Glasgow Coma Scale (GCS) scores were recorded by the researcher before and after auditory stimulation.

RESULTS

Patient mean age was 69.2 years; 56.7% of the experimental group and 53.3% of the control group were male. On the first day in the morning and evening after auditory stimulation, the mean GCS was 4.8 in the experimental group and 4.7 in the control group. Before and after the intervention on the 10th day after auditory stimulation, the mean GCS of patients was 9.5 in the experimental group and 7.1 in the control group in the morning and 9.6 and 7.2, respectively, in the evening. No significant differences in mean GCS by group were observed for the first 3 days (P > .05). However, the difference in mean GCS scores of the 2 groups was statistically significant after the third day (P < .05).

CONCLUSIONS

Auditory stimulation is associated with higher GCS in comatose patients.

The impact of the arts in healthcare on patients and service users: A critical review

This review provides an updated evaluation of the emerging body of literature on the value of the arts in healthcare settings. Internationally, there is growing interest in the use of the arts in the healthcare context supported by the number of research studies reported in the nursing and medical literature. There is evidence that arts interventions have positive effects on psychological and physiological outcomes on patients in a hospital environment. A critical review of the literature between 2011 and 2016 was undertaken. The following databases were searched: MedLine, CINAHL, AMED, Web of Science and ASSIA. Searches included words from three categories: cultural activities, outcomes and healthcare settings. Initial searches identified 131 potentially relevant articles. Following screening and review by the research team, a total of 69 studies were included in the final review. The majority of studies examined the effect of music listening on patients/service users (76.8%). These studies were primarily quantitative focusing on the measurable effects of music listening in a surgical context. Overall, the studies in the review support the growing evidence base on the value of the arts in a variety of healthcare settings for patients/service users. The review findings suggest that now is the time for different voices and art forms to be considered and represented in the research on arts in healthcare. Further research is also required to strengthen the existing evidence base.

Music interventions in disorders of consciousness (DOC) - a systematic review

OBJECTIVES

The effects of music interventions including active and receptive music therapy for people living with neurogenic disorders of consciousness (DOC) have been subject to empirical studies in the past. The aim of this systematic review was to find and analyse the current research about the effects of musical interventions on people with DOC.

METHODS

For this purpose, studies with music interventions and patients with DOC from the year 1900 to 2017 were searched in English, German, and French in different databases. Risk-of-bias-analyses were conducted for each study that fulfilled the inclusion criteria.

RESULTS

Twenty-two quantitative studies (three randomised controlled trials with more than 10 participants) were found eligible for review. They include a total of 329 participants living with either coma, unresponsive wakefulness syndrome, or minimally conscious state. Music interventions were associated with favourable behavioural and physiological responses in several studies, but methodological quality and outcomes were heterogeneous.

CONCLUSIONS

More studies with a larger number of participants are needed as well as a consensus on key characteristics of effective short-term and long-term music interventions for DOC.

Effects of prenatal music stimulation on fetal cardiac state, newborn anthropometric measurements and vital signs of pregnant women: A randomized controlled trial

BACKGROUND

Music has been used for medicinal purposes throughout history due to its variety of physiological, psychological and social effects.

OBJECTIVE

To identify the effects of prenatal music stimulation on the vital signs of pregnant women at full term, on the modification of fetal cardiac status during a fetal monitoring cardiotocograph, and on anthropometric measurements of newborns taken after birth.

MATERIAL AND METHOD

A randomized controlled trial was implemented. The four hundred and nine pregnant women coming for routine prenatal care were randomized in the third trimester to receive either music (n = 204) or no music (n = 205) during a fetal monitoring cardiotocograph. All of the pregnant women were evaluated by measuring fetal cardiac status (basal fetal heart rate and fetal reactivity), vital signs before and after a fetal monitoring cardiotocograph (maternal heart rate and systolic and diastolic blood pressure), and anthropometric measurements of the newborns were taken after birth (weight, height, head circumference and chest circumference).

RESULTS

The strip charts showed a significantly increased basal fetal heart rate and higher fetal reactivity, with accelerations of fetal heart rate in pregnant women with music stimulation. After the fetal monitoring cardiotocograph, a statistically significant decrease in systolic blood pressure, diastolic blood pressure and heart rate in women receiving music stimulation was observed.

CONCLUSION

Music can be used as a tool which improves the vital signs of pregnant women during the third trimester, and can influence the fetus by increasing fetal heart rate and fetal reactivity.

Music interventions for acquired brain injury

BACKGROUND

Acquired brain injury (ABI) can result in impairments in motor function, language, cognition, and sensory processing, and in emotional disturbances, which can severely reduce a survivor's quality of life. Music interventions have been used in rehabilitation to stimulate brain functions involved in movement, cognition, speech, emotions, and sensory perceptions. An update of the systematic review published in 2010 was needed to gauge the efficacy of music interventions in rehabilitation for people with ABI.

OBJECTIVES

To assess the effects of music interventions for functional outcomes in people with ABI. We expanded the criteria of our existing review to: 1) examine the efficacy of music interventions in addressing recovery in people with ABI including gait, upper extremity function, communication, mood and emotions, cognitive functioning, social skills, pain, behavioural outcomes, activities of daily living, and adverse events; 2) compare the efficacy of music interventions and standard care with a) standard care alone, b) standard care and placebo treatments, or c) standard care and other therapies; 3) compare the efficacy of different types of music interventions (music therapy delivered by trained music therapists versus music interventions delivered by other professionals).

SEARCH METHODS

We searched the Cochrane Stroke Group Trials Register (January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 6), MEDLINE (1946 to June 2015), Embase (1980 to June 2015), CINAHL (1982 to June 2015), PsycINFO (1806 to June 2015), LILACS (1982 to January 2016), and AMED (1985 to June 2015). We handsearched music therapy journals and conference proceedings, searched dissertation and specialist music databases, trials and research registers, reference lists, and contacted relevant experts and music therapy associations to identify unpublished research. We imposed no language restriction. We performed the original search in 2009.

SELECTION CRITERIA

We included all randomised controlled trials and controlled clinical trials that compared music interventions and standard care with standard care alone or combined with other therapies. We examined studies that included people older than 16 years of age who had ABI of a non-degenerative nature and were participating in treatment programmes offered in hospital, outpatient, or community settings. We included studies in any language, published and unpublished.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risk of bias of the included studies. We contacted trial researchers to obtain missing data or for additional information when necessary. Where possible, we presented results for continuous outcomes in meta-analyses using mean differences (MDs) and standardised mean differences (SMDs). We used post-test scores. In cases of significant baseline difference, we used change scores. We conducted a sensitivity analysis to assess the impact of the randomisation method.

MAIN RESULTS

We identified 22 new studies for this update. The evidence for this update is based on 29 trials involving 775 participants. A music intervention known as rhythmic auditory stimulation may be beneficial for improving the following gait parameters after stroke. We found a reported increase in gait velocity of 11.34 metres per minute (95% confidence interval (CI) 8.40 to 14.28; 9 trials; 268 participants; P < 0.00001; moderate-quality evidence). Stride length of the affected side may also benefit, with a reported average of 0.12 metres more (95% CI 0.04 to 0.20; 5 trials; 129 participants; P = 0.003; moderate-quality evidence). We found a reported average improvement for general gait of 7.67 units on the Dynamic Gait Index (95% CI 5.67 to 9.67; 2 trials; 48 participants; P < 0.00001). There may also be an improvement in gait cadence, with a reported average increase of 10.77 steps per minute (95% CI 4.36 to 17.18; 7 trials; 223 participants; P = 0.001; low-quality evidence).Music interventions may be beneficial for improving the timing of upper extremity function after stroke as scored by a reduction of 1.08 seconds on the Wolf Motor Function Test (95% CI -1.69 to -0.47; 2 trials; 122 participants; very low-quality evidence).Music interventions may be beneficial for communication outcomes in people with aphasia following stroke. Overall, communication improved by 0.75 standard deviations in the intervention group, a moderate effect (95% CI 0.11 to 1.39; 3 trials; 67 participants; P = 0.02; very low-quality evidence). Naming was reported as improving by 9.79 units on the Aachen Aphasia Test (95% CI 1.37 to 18.21; 2 trials; 35 participants; P = 0.02). Music interventions may have a beneficial effect on speech repetition, reported as an average increase of 8.90 score on the Aachen Aphasia Test (95% CI 3.25 to 14.55; 2 trials; 35 participants; P = 0.002).There may be an improvement in quality of life following stroke using rhythmic auditory stimulation, reported at 0.89 standard deviations improvement on the Stroke Specific Quality of Life Scale, which is considered to be a large effect (95% CI 0.32 to 1.46; 2 trials; 53 participants; P = 0.002; low-quality evidence). We found no strong evidence for effects on memory and attention. Data were insufficient to examine the effect of music interventions on other outcomes.The majority of studies included in this review update presented a high risk of bias, therefore the quality of the evidence is low.

AUTHORS' CONCLUSIONS

Music interventions may be beneficial for gait, the timing of upper extremity function, communication outcomes, and quality of life after stroke. These results are encouraging, but more high-quality randomised controlled trials are needed on all outcomes before recommendations can be made for clinical practice.

Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC): Reliability and Validity of a Measure to Assess Awareness in Patients with Disorders of Consciousness

BACKGROUND

Prolonged Disorders of Consciousness (PDOC) describes a population where a consciousness disorder has persisted for at least four weeks post injury but is still under investigation. Complex motor, sensory, communication, and cognitive impairments cause challenges with diagnosis, assessment, and intervention planning. Developing sensitive, reliable, and valid measures is a central concern. The auditory modality is the most sensitive for identifying awareness; however, the current standardized behavioral measures fail to provide adequate screening and measurement of auditory responsiveness. The Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) is a recently standardized measure for assessment with PDOC; however, psychometric values for two of its subscales require examination.

OBJECTIVE

To determine the measurement characteristics and properties of the MATADOC subscales two and three.

METHODS

In a convenience sample of 21participants with PDOC, a prospective repeated measures study examined inter-rater reliability (IRR) and test-retest reliability (TRR) for both subscales and internal consistency of subscale two.

RESULTS

Overall, the items from the MATADOC subscales two and three demonstrated good agreement across and within assessors, with some variability on two identified items.

CONCLUSIONS

The MATADOC is a standardized measure for assessment of auditory responsiveness in PDOC. Psychometric limitations for the two identified items may have resulted from variations in music therapist clinical experience and training, leading to variations in the administration and interpretation of PDOC patient responses to these two MATADOC assessment items. Although its psychometric properties could be improved, the MATADOC's clinimetric properties make it a valuable assessment to guide clinical work for patients with PDOC.

Promoting the use of personally relevant stimuli for investigating patients with disorders of consciousness

Sensory stimuli are used to evaluate and to restore cognitive functions and consciousness in patients with a disorder of consciousness (DOC) following a severe brain injury. Although sophisticated protocols can help assessing higher order cognitive functions and awareness, one major drawback is their lack of sensitivity. The aim of the present review is to show that stimulus selection is crucial for an accurate evaluation of the state of patients with disorders of consciousness as it determines the levels of processing that the patient can have with stimulation from his/her environment. The probability to observe a behavioral response or a cerebral response is increased when her/his personal history and/or her/his personal preferences are taken into account. We show that personally relevant stimuli (i.e., with emotional, autobiographical, or self-related characteristics) are associated with clearer signs of perception than are irrelevant stimuli in patients with DOC. Among personally relevant stimuli, music appears to be a promising clinical tool as it boosts perception and cognition in patients with DOC and could also serve as a prognostic tool. We suggest that the effect of music on cerebral processes in patients might reflect the music's capacity to act both on the external and internal neural networks supporting consciousness.

Comunicação verbal com pacientes inconscientes

OBJETIVO: A comunicação com pacientes críticos nas unidades de cuidados intensivos gera desafios para a equipe de enfermagem e demanda habilidades específicas. MÉTODOS: Trata-se de um estudo desenvolvido em duas etapas, por meio de métodos qualitativos, para caracterização e padronização da comunicaçao verbal utilizada com pacientes inconscientes. A primeira etapa consistiu de revisão sistemática e de análise de conteúdo da literatura disponível sobre comunicação e estimulação verbal em pacientes inconscientes. RESULTADOS: Os resultados da análise de conteúdo foram utilizados na segunda etapa do estudo e forneceram a base para a construção de uma mensagem padronizada de estímulo. Quatro áreas problemáticas foram identificadas: dificuldades básicas na comunicação com pacientes que não são capazes de responder, pressões do ambiente de trabalho, conhecimento limitado sobre as necessidades de pacientes insconscientes, e conhecimento detalhado limitado do porquê e de como se comunicar com pacientes insconscientes. CONCLUSÃO: A mensagem estímulo desenvolvida pode facilitar a comunicação com pacientes inconscientes.

Effects of familiar voices on brain activity

This study aimed to examine the extent to which a familiar voice influences brain activity. Participants were nine healthy female volunteers aged 21-34 years old (with a mean age of 25.78 ± 4.04 years). Brain activity was recorded during periods of silence, familiar and unfamiliar voices. Electroencephalographic data were collected and analyzed using a frequency rate set at 5 min. To account for emotional influences imbedded into the contents of the voice stimuli, both the voice of a familiar family member and the voice of a stranger were used to record a well-known Japanese fairy tale, 'Momotaro'. Results revealed that listening to familiar voices increased the rate of the β band (13-30 Hz) in all four brain areas (F3, F4, C3 and C4). In particular, increased activity was observed at F4 and C4. Findings revealed that in study, participants' familiar voices activated cerebral functioning more than unfamiliar voices.