Melbourne Conservatorium of Music - Theses
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ItemExploring the rehabilitative potential of familiar song for paediatric patients presenting with an acute disorder of consciousness( 2023)This thesis includes four studies that contribute to the exploration of the rehabilitative potential of familiar song for children presenting with an acute disorder of consciousness (DoC) following severe acquired brain injury (ABI). A DoC is common sequelae of severe ABI in children, and is the result of a sudden interruption in the complex interplay of arousal and awareness. While evidence supporting the use of music in the assessment and treatment of adults presenting with a DoC continues to emerge, the unique developmental context of paediatric ABI necessitates child specific research. Four discrete studies are included in thesis and contribute to the research agenda of describing the behavioural and neural responses to familiar song of children presenting with an acute DoC. The systematic review ‘The Neurophysiological Processing of Music in Children: A Systematic Review with Narrative Synthesis and Considerations for Clinical Practice in Music Therapy’ included 46 neuroimaging studies describing music processing in neurotypical children aged 0-18 years. The narrative synthesis yielded a timeline of significant developments of musical processing. Further, comprehensive considerations for clinical practice for music therapists working with paediatric neurologic population were developed. The results of the systematic review provide a theoretical foundation for the use of familiar song to support consciousness recovery in children presenting with a DoC. When developing the study to empirically describe the neural and behavioural responses to familiar song of children presenting with an acute DoC, it was necessary to first develop a tool to objectively describe behavioural responses. The Music Interventions in Paediatric DoC Behaviour Observation Record (MBR) was developed and piloted. Results of the pilot established that the MBR has content validity, and sufficient inter-rater-reliability to objectively capture the subtle and idiosyncratic responses of children presenting with a DoC during a music therapy intervention. Subsequent to the completion of the pilot, the MBR was utilised in the collection of behavioural data in the case study of a child presenting with an acute DoC The use of EEG in music therapy research with children presenting with a DoC affords the opportunity to describe responses even in the absence of an observable behaviour. To pilot the use of EEG with children, a feasibility study (n = 4) was undertaken using data pragmatically collected within the acute hospital setting. Unique changes in the underlying frequency components of the EEG were recorded during the song condition that were not observed in either the comparative speech or noise conditions. The study showed feasibility of a uniquely hypothesis driven method of multivariate EEG analysis, and added to the current knowledge base by describing the EEG signal in response to whole song as an ecologically valid music stimulus. The piloting of the MBR and multivariate method of EEG analysis ultimately supported the development of multiple baseline crossover case study, of an 11-year old presenting with an acute DoC, in which the behavioural and neural responses to song were described. For this child, familiar song was found to stimulate a greater behavioural and neural response, indicative of an increase in arousal and awareness, than comparative speech or noise conditions. This study provides foundational evidence supporting the use of familiar song to increase consciousness in children presenting with an acute DoC following severe ABI