The goal of this clinical trial is to compare the effect of live music therapy and recorded music on recovery of consciousness in children aged 1 to 18 years who have a disorder of consciousness (DoC) after a severe brain injury. Researchers also want to learn how children respond during music and noise, whether early responses to music are linked to recovery at 6 months, and how parents experience music therapy during their child's hospital stay at The Royal Children's Hospital (RCH) in Melbourne.
Participants will:
* Take part in a 10-day study period while in hospital. On 8 of the 10 days, they will receive either live or recorded familiar music in random order. Their level of consciousness will be measured before and after each session using a simple behavioural checklist. On the other 2 days, they will take part in video-recorded sessions to compare behavioural responses during live music, recorded music, and white noise. Videos will help capture small changes in movement, eye gaze, or facial expression. * Have their level of consciousness checked again at 6 months after injury to see if early responses relate to later recovery.
Parents and caregivers will be invited to take part in an interview about their experiences and observations of music therapy with their child.
This study will help researchers understand whether live music therapy provides benefits beyond recorded music and will guide how music therapy is best used to support children and families during recovery from severe brain injury.
Glasgow Coma Scale (GCS) 3-8 at admission to RCH
Mass pathology evident on neuroimaging
Expert opinion of treating consultant
Rancho Los Amigos Scale I, II, III or IV
ABI not compatible with life/child expected to die
ABI resulting from suspected non-accidental causes, including assault/abuse
Diagnosed premorbid or acquired severe hearing loss
Inability or unwillingness of legally acceptable representative to give written informed consent
Parallel
Live Music Therapy
BehavioralThe recorded music interventions will consist of the presentation of commercially available recordings of participant preferred music. The songs utilised in the recorded music interventions will be the same as those presented during the live music therapy interventions, and only the presentation format will be different. The same music therapist who facilitates the live music therapy interventions will be present in the participant's room during the presentation of the recorded music intervention and will present the recorded music via iPad and small portable speaker.
Recorded Music
BehavioralThe recorded music interventions will consist of the presentation of commercially available recordings of participant preferred music. The songs utilised in the recorded music interventions will be the same as those presented during the live music therapy interventions, and only the presentation format will be different. The same music therapist who facilitates the live music therapy interventions will be present in the participant's room during the presentation of the recorded music intervention and will present the recorded music via iPad and small portable speaker.
Pre-post intervention change in the 'Simplified Evaluation of Consciousness Disorders (SECONDs)'
The Simplified Evaluation of Consciousness Disorders (SECONDS) is an 8-item behavioural scale assessing responsiveness across the spectrum of disorders of consciousness (DoC). Items progress in complexity from arousal response (1) to functional communication (8). The SECONDS is adapted from the Coma Recovery Scale-Revised but is faster to administer, making it suitable in acute paediatric settings. It has strong validity and inter-rater reliability in diagnosing prolonged DoC. For this trial, child-friendly modifications are used (e.g., age-appropriate toys, picture books, and yes/no questions) to ensure suitability for children.
Changes in the 'Music interventions in paediatric DoC observation record (MBR)' outcomes across live music, recorded music, and control noise condition
The Music Behavioural Response Checklist (MBR) records behavioural responses during music interventions in children with disorders of consciousness (DoC). It has two sections: (1) arousal, capturing 13 discrete movement categories, and (2) awareness, capturing 15 categories of more complex behaviours linked to minimally conscious states and emergence. The MBR was developed and validated at the Royal Children's Hospital, showing content validity and fair to substantial inter-rater reliability. It is completed from video recordings to ensure subtle and idiosyncratic behaviours are captured.
Click on the lead sponsor to view all of their trials.
