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Ginsberg JP, Raghunathan K, Bassi G, Ulloa L. Review of Perioperative Music Medicine: Mechanisms of Pain and Stress Reduction Around Surgery. Front Med (Lausanne) 2022; 9:821022. [PMID: 35187004 PMCID: PMC8854756 DOI: 10.3389/fmed.2022.821022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/12/2022] [Indexed: 12/19/2022] Open
Abstract
Clinical-experimental considerations and an approach to understanding the autonomic basis of improved surgical outcomes using Perioperative Music Medicine (PMM) are reviewed. Combined surgical, psycho-physiological, and experimental perspectives on Music Medicine (MM) and its relationship to autonomic nervous system (ANS) function are discussed. Considerations are given to the inter-related perioperative effects of MM on ANS, pain, and underlying vagal and other neural circuits involved in emotional regulation and dysregulation. Many surgical procedures are associated with significant pain, which is routinely treated with post-operative opioid medications, which cause detrimental side effects and delay recovery. Surgical trauma shifts the sympathetic ANS to a sustained activation impairing physiological homeostasis and causing psychological stress, as well as metabolic and immune dysfunction that contribute to postoperative mortality and morbidity. In this article, we propose a plan to operationalize the study of mechanisms mediating the effects of MM in perioperative settings of orthopedic surgery. These studies will be critical for the implementation of PMM as a routine clinical practice and to determine the potential limitations of MM in specific cohorts of patients and how to improve the treatment.
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Affiliation(s)
- J. P. Ginsberg
- Departments of Applied Psychophysiology, Psychology and Statistics, Saybrook University, Pasadena, CA, United States
| | - Karthik Raghunathan
- Critical Care and Perioperative Population Health Research Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
| | - Gabriel Bassi
- Department of Anesthesiology, Center for Perioperative Organ Protection, Duke University Medical Center, Durham, NC, United States
| | - Luis Ulloa
- Department of Anesthesiology, Center for Perioperative Organ Protection, Duke University Medical Center, Durham, NC, United States
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Riganello F, Larroque SK, Di Perri C, Prada V, Sannita WG, Laureys S. Measures of CNS-Autonomic Interaction and Responsiveness in Disorder of Consciousness. Front Neurosci 2019; 13:530. [PMID: 31293365 PMCID: PMC6598458 DOI: 10.3389/fnins.2019.00530] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 05/08/2019] [Indexed: 12/25/2022] Open
Abstract
Neuroimaging studies have demonstrated functional interactions between autonomic (ANS) and brain (CNS) structures involved in higher brain functions, including attention and conscious processes. These interactions have been described by the Central Autonomic Network (CAN), a concept model based on the brain-heart two-way integrated interaction. Heart rate variability (HRV) measures proved reliable as non-invasive descriptors of the ANS-CNS function setup and are thought to reflect higher brain functions. Autonomic function, ANS-mediated responsiveness and the ANS-CNS interaction qualify as possible independent indicators for clinical functional assessment and prognosis in Disorders of Consciousness (DoC). HRV has proved helpful to investigate residual responsiveness in DoC and predict clinical recovery. Variability due to internal (e.g., homeostatic and circadian processes) and environmental factors remains a key independent variable and systematic research with this regard is warranted. The interest in bidirectional ANS-CNS interactions in a variety of physiopathological conditions is growing, however, these interactions have not been extensively investigated in DoC. In this brief review we illustrate the potentiality of brain-heart investigation by means of HRV analysis in assessing patients with DoC. The authors' opinion is that this easy, inexpensive and non-invasive approach may provide useful information in the clinical assessment of this challenging patient population.
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Affiliation(s)
- Francesco Riganello
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University Hospital of Liège, Liège, Belgium
- S. Anna Institute, Research in Advanced Neurorehabilitation, Crotone, Italy
| | - Stephen Karl Larroque
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University Hospital of Liège, Liège, Belgium
| | - Carol Di Perri
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University Hospital of Liège, Liège, Belgium
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Valeria Prada
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal/Child Sciences, Polyclinic Hospital San Martino IRCCS, University of Genoa, Genoa, Italy
| | - Walter G. Sannita
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal/Child Sciences, Polyclinic Hospital San Martino IRCCS, University of Genoa, Genoa, Italy
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University Hospital of Liège, Liège, Belgium
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Riganello F, Larroque SK, Bahri MA, Heine L, Martial C, Carrière M, Charland-Verville V, Aubinet C, Vanhaudenhuyse A, Chatelle C, Laureys S, Di Perri C. A Heartbeat Away From Consciousness: Heart Rate Variability Entropy Can Discriminate Disorders of Consciousness and Is Correlated With Resting-State fMRI Brain Connectivity of the Central Autonomic Network. Front Neurol 2018; 9:769. [PMID: 30258400 PMCID: PMC6145008 DOI: 10.3389/fneur.2018.00769] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/24/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Disorders of consciousness are challenging to diagnose, with inconsistent behavioral responses, motor and cognitive disabilities, leading to approximately 40% misdiagnoses. Heart rate variability (HRV) reflects the complexity of the heart-brain two-way dynamic interactions. HRV entropy analysis quantifies the unpredictability and complexity of the heart rate beats intervals. We here investigate the complexity index (CI), a score of HRV complexity by aggregating the non-linear multi-scale entropies over a range of time scales, and its discriminative power in chronic patients with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS), and its relation to brain functional connectivity. Methods: We investigated the CI in short (CIs) and long (CIl) time scales in 14 UWS and 16 MCS sedated. CI for MCS and UWS groups were compared using a Mann-Whitney exact test. Spearman's correlation tests were conducted between the Coma Recovery Scale-revised (CRS-R) and both CI. Discriminative power of both CI was assessed with One-R machine learning model. Correlation between CI and brain connectivity (detected with functional magnetic resonance imagery using seed-based and hypothesis-free intrinsic connectivity) was investigated using a linear regression in a subgroup of 10 UWS and 11 MCS patients with sufficient image quality. Results: Higher CIs and CIl values were observed in MCS compared to UWS. Positive correlations were found between CRS-R and both CI. The One-R classifier selected CIl as the best discriminator between UWS and MCS with 90% accuracy, 7% false positive and 13% false negative rates after a 10-fold cross-validation test. Positive correlations were observed between both CI and the recovery of functional connectivity of brain areas belonging to the central autonomic networks (CAN). Conclusion: CI of MCS compared to UWS patients has high discriminative power and low false negative rate at one third of the estimated human assessors' misdiagnosis, providing an easy, inexpensive and non-invasive diagnostic tool. CI reflects functional connectivity changes in the CAN, suggesting that CI can provide an indirect way to screen and monitor connectivity changes in this neural system. Future studies should assess the extent of CI's predictive power in a larger cohort of patients and prognostic power in acute patients.
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Affiliation(s)
- Francesco Riganello
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
- Research in Advanced NeuroRehabilitation, Istituto S. Anna, Crotone, Italy
| | - Stephen Karl Larroque
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Mohamed Ali Bahri
- GIGA-Cyclotron Research Center in vivo Imaging, University of Liege, Liege, Belgium
| | - Lizette Heine
- Centre de Recherche en Neurosciences, Inserm U1028 - CNRS UMR5292, University of Lyon 1, Bron, France
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Manon Carrière
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | | | - Charlène Aubinet
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Audrey Vanhaudenhuyse
- Sensation & Perception Research Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Camille Chatelle
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Carol Di Perri
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Riganello F, Cortese MD, Arcuri F, Quintieri M, Dolce G. How Can Music Influence the Autonomic Nervous System Response in Patients with Severe Disorder of Consciousness? Front Neurosci 2015; 9:461. [PMID: 26696818 PMCID: PMC4674557 DOI: 10.3389/fnins.2015.00461] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/20/2015] [Indexed: 11/13/2022] Open
Abstract
Activations to pleasant and unpleasant musical stimuli were observed within an extensive neuronal network and different brain structures, as well as in the processing of the syntactic and semantic aspects of the music. Previous studies evidenced a correlation between autonomic activity and emotion evoked by music listening in patients with Disorders of Consciousness (DoC). In this study, we analyzed retrospectively the autonomic response to musical stimuli by mean of normalized units of Low Frequency (nuLF) and Sample Entropy (SampEn) of Heart Rate Variability (HRV) parameters, and their possible correlation to the different complexity of four musical samples (i.e., Mussorgsky, Tchaikovsky, Grieg, and Boccherini) in Healthy subjects and Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) patients. The complexity of musical sample was based on Formal Complexity and General Dynamics parameters defined by Imberty's semiology studies. The results showed a significant difference between the two groups for SampEn during the listening of Mussorgsky's music and for nuLF during the listening of Boccherini and Mussorgsky's music. Moreover, the VS/UWS group showed a reduction of nuLF as well as SampEn comparing music of increasing Formal Complexity and General Dynamics. These results put in evidence how the internal structure of the music can change the autonomic response in patients with DoC. Further investigations are required to better comprehend how musical stimulation can modify the autonomic response in DoC patients, in order to administer the stimuli in a more effective way.
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Affiliation(s)
| | - Maria D Cortese
- Research in Advanced Neurorehabilitation, Istituto S. Anna Crotone, Italy
| | - Francesco Arcuri
- Research in Advanced Neurorehabilitation, Istituto S. Anna Crotone, Italy
| | - Maria Quintieri
- Research in Advanced Neurorehabilitation, Istituto S. Anna Crotone, Italy
| | - Giuliano Dolce
- Research in Advanced Neurorehabilitation, Istituto S. Anna Crotone, Italy
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Kotchoubey B, Pavlov YG, Kleber B. Music in Research and Rehabilitation of Disorders of Consciousness: Psychological and Neurophysiological Foundations. Front Psychol 2015; 6:1763. [PMID: 26640445 PMCID: PMC4661237 DOI: 10.3389/fpsyg.2015.01763] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/03/2015] [Indexed: 01/18/2023] Open
Abstract
According to a prevailing view, the visual system works by dissecting stimuli into primitives, whereas the auditory system processes simple and complex stimuli with their corresponding features in parallel. This makes musical stimulation particularly suitable for patients with disorders of consciousness (DoC), because the processing pathways related to complex stimulus features can be preserved even when those related to simple features are no longer available. An additional factor speaking in favor of musical stimulation in DoC is the low efficiency of visual stimulation due to prevalent maladies of vision or gaze fixation in DoC patients. Hearing disorders, in contrast, are much less frequent in DoC, which allows us to use auditory stimulation at various levels of complexity. The current paper overviews empirical data concerning the four main domains of brain functioning in DoC patients that musical stimulation can address: perception (e.g., pitch, timbre, and harmony), cognition (e.g., musical syntax and meaning), emotions, and motor functions. Music can approach basic levels of patients' self-consciousness, which may even exist when all higher-level cognitions are lost, whereas music induced emotions and rhythmic stimulation can affect the dopaminergic reward-system and activity in the motor system respectively, thus serving as a starting point for rehabilitation.
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Affiliation(s)
- Boris Kotchoubey
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany
| | - Yuri G. Pavlov
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany
- Department of Psychology, Ural Federal University, Yekaterinburg, Russia
| | - Boris Kleber
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany
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Perrin F, Castro M, Tillmann B, Luauté J. Promoting the use of personally relevant stimuli for investigating patients with disorders of consciousness. Front Psychol 2015; 6:1102. [PMID: 26284020 PMCID: PMC4519656 DOI: 10.3389/fpsyg.2015.01102] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/17/2015] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Fabien Perrin
- Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028)Lyon, France
| | - Maïté Castro
- Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028)Lyon, France
| | - Barbara Tillmann
- Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028)Lyon, France
| | - Jacques Luauté
- Henry Gabrielle Hospital, Hospices Civils de LyonLyon, France
- Neurological Hospital, Hospices Civils de LyonLyon, France
- IMPACT, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028)Lyon, France
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Raglio A, Guizzetti GB, Bolognesi M, Antonaci D, Granieri E, Baiardi P, Maggioni G, Pistarini C. Active music therapy approach in disorders of consciousness: a controlled observational case series. J Neurol 2014; 261:2460-2. [PMID: 25319023 DOI: 10.1007/s00415-014-7543-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/09/2014] [Accepted: 10/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Alfredo Raglio
- Department of Biomedical and Specialistic Surgical Sciences, Section of Neurology, University of Ferrara, Via A. Moro 8, Cona, 44124, Ferrara, Italy,
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