Familiar voices and stories help coma patient recovery

Chuck Bednar for redOrbit.com – Your Universe Online
Hearing the soothing sound of a loved one’s voice and listening to familiar stories can help awaken the unconscious brain and speed the recovery of coma patients, according to research published Thursday in the journal Neurorehabilitation and Neural Repair.
In the study, researchers from Northwestern University and the Hines VA Hospital found that coma patients who heard familiar stories stored in their long-term memory from family members four times a day for six weeks regained consciousness significantly faster and tended to have an improved recovery compared to those who did not hear such stories.
“We believe hearing those stories in parents’ and siblings’ voices exercises the circuits in the brain responsible for long-term memories. That stimulation helped trigger the first glimmer of awareness,” said lead author Theresa Pape, a neuroscientist from the Northwestern University Feinberg School of Medicine and the Hines VA Hospital.
“It’s like coming out of anesthesia. It’s the first step in recovering full consciousness,” she added. “After the study treatment, I could tap them on the shoulder, and they would look at me. Before the treatment they wouldn’t do that.”
A coma is an unconscious state, typically caused by a traumatic brain injury, in which a patient is unable to open his or her eyes. Patients typically progress from a coma to a minimally conscious or vegetative state that can last for months or even years. Being more aware of their environment allows them to actively participate in physical, speech and occupational therapy.
In addition to benefiting the patient, the familiar voices treatment can also help friends and family members, who usually feel helpless and out of control when a loved one is such a state, Pape said. Recording to the stories can help them feel as though they are playing a role in the patient’s treatment and given them a sense of control over his or her recovery, she added.
The research
In their randomized, placebo-controlled study, the researchers enrolled 15 patients with traumatic head injuries who were in a minimally conscious or vegetative state. Those patients (12 men and 3 women) were an average of 35 years old and had started what is known as Familiar Auditory Sensory Training (FAST) therapy an average of 70 days after suffering their injuries.
First, Pape’s team conducted baseline testing to see whether or not patients would be responive to sounds such as bells and whistles, whether or not they followed directions to open their eyes, and if they were alert enough to visually track a person walking across the room. This data was used to measure if there was improvement following a six-week FAST treatment period.
The researchers also had patients listen to both familiar and non-familiar voices tell different stories in order to obtain a baseline MRI of how the blood oxygen levels in their brains changed while listening. Next, they recruited families to work with therapists to help come up with tales about events that both the patient and the family members participated in.
“It could be a family wedding or a special road trip together such as going to visit colleges,” said Pape. “It had to be something they’d remember, and we needed to bring the stories to life with sensations, temperature and movement. Families would describe the air rushing past the patient as he rode in the Corvette with the top down or the cold air on his face as he skied down a mountain slope.”
Parents and siblings recorded a total of at least eight different stories, and after those stories were played for the patients for six weeks, Pape repeated the earlier baseline tests in an MRI. In one of the tests, patients listened to familiar and unfamiliar voices telling the story they has originally heard at baseline, and the MRI image showed a change in the oxygen level that indicated greater responsiveness to the unfamiliar voice telling a story, but not the familiar one.
“This indicates the patient’s ability to process and understand what they’re hearing is much better,” she explained. “At baseline they didn’t pay attention to that non-familiar voice. But now they are processing what that person is saying.”
A second test
In another test, patients listened to a small bell ringing as before, but this time, their brains had less of a response to that sound, indicating that they were better able to discern which things were important to listen to. The biggest gains came during the first two weeks of the treatment, the study authors said, with smaller steps towards recovering coming over the next month.
Pape is in the process of reviewing the data to determine with the FAST treatment helped the brain’s circuitry (elongated fibers known as axons that transmit signals from between neurons) to become stronger. However, she said that it was only logical that people in a coma would respond favorably to the treatment, even those who had suffered a stroke and not brain trauma.
“This gives families hope and something they can control,” she noted. Pape went on to suggest that families should work with a therapist to help them construct the stories, so that the recorded tales can augment the other treatments that a patient is undergoing.
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