Those Coma Songs

[JayUK]

Hi all,

I was just wondering if there is any evidence to back up the claims that a particular song or voice has miraculously awoke people from their comas.

It has been said so often that's it's become a cliche and to solidify it's "clicheness" it's even become material for a "Little Britain" sketch.

But is it true?

Cheers

Jay

[Pebble]

Miraculous? Wrong forum!

[Trinoc]

Miraculous? Wrong forum!

I don't think "miraculous" here is meant in the spiritual sense ...

There is a valid question here: are there verified cases of people recovering from comas apparently as a result of hearing something familiar like a song, and if so, is there a plausible neurological mechanism for this?

[Matt]

I think it's a good question. Stories like this one are reported with a fair dose of post hoc ergo propter hoc. It seems that whatever was happening as the person began to rouse themselves, is cited as the cause of the recovery. Even in cases where the patient reports something as the cause of their recovery (like being told to sort themselves out) can we rely on their testimony or is it likely that other factors are in play?

[Pebble]

I suspect this is one for Dr B, however the nature of real coma is such that one can forget any significant beneficial effects of sounds in general or specific sounds in particular:

http://nerve.neurology.unc.edu/teaching_files/Coma.pdf

Clinicopathological correlation and neurophysiological experimentation has shown that coma is
caused by diVuse bilateral hemisphere damage, failure of the ascending reticular activating
system, or both. The reticular activating system is a core of grey matter continuous caudally with
the reticular intermediate grey lamina of the spinal cord and rostrally with the subthalamus,
hypothalamus, and thalamic nuclei. It runs in the dorsal par t of the brain stem in the paramedian
tegmental zone.


In other words extensive neurological damage to the nerve cells of the cortex or localised damage to the nerve cells within the reticular activating system is required - not just an imbalance of 'woo' factors that can be magically rebalanced.

[FarSideOfTheMoon]

I remember hearing, possibly Steve Novella on SKU podcast, someone saying very similar things. Possibly it was in a discussion about rapid awakening. Coma is a catch all - there are so many different states, that I think you have to understand the level of brain injury before looking into any such claims.

[Pebble]

I remember hearing, possibly Steve Novella on SKU podcast, someone saying very similar things. Possibly it was in a discussion about rapid awakening. Coma is a catch all - there are so many different states, that I think you have to understand the level of brain injury before looking into any such claims.

Catch all to whom? Media experts? Neurologically the requirements are pretty standard. So while one might refer to some one drugged into unconciousness as "comatosed", this would not qualify for a 'coma' as the latter requires brain injury as the cause.

[Trinoc]

Catch all to whom? Media experts? Neurologically the requirements are pretty standard. So while one might refer to some one drugged into unconciousness as "comatosed", this would not qualify for a 'coma' as the latter requires brain injury as the cause.

Presumably irreversible brain injury means irreversible coma, so for the current discussion we can restrict ourselves to cases where the injury either repairs itself or the brain somehow manages to shift the lost functions to another, uninjured area. In that case, does the patient automatically recover consciousness (in which case things like songs are irrelevant), or does the brain "reboot" into a state in which it is out of contact with the outside world and needs to learn how to operate muscles and senses all over again?

If this is the case then it seems at least plausible that providing familiar sensory stimulus like music could help, just as a new born baby needs to interact with the outside world in order to build motor and sensory nerve pathways. If the brain is basically in a state where it sees the outside world as a blank, then it seems unlikely that the sensory deprivation of just lying in a hospital bed will help it to get back in gear.

[Pebble]

Presumably irreversible brain injury means irreversible coma, so for the current discussion we can restrict ourselves to cases where the injury either repairs itself or the brain somehow manages to shift the lost functions to another, uninjured area. In that case, does the patient automatically recover consciousness (in which case things like songs are irrelevant), or does the brain "reboot" into a state in which it is out of contact with the outside world and needs to learn how to operate muscles and senses all over again?

The computer analogy doesn't work. This is to confuse awareness with arousal. Once arousal has occurred, one is no longer in a coma, one may still lack awareness of your environment, (who others are etc), and this aspect can certainly be facilitated by familiar sounds etc.

[Trinoc]

The computer analogy doesn't work. This is to confuse awareness with arousal. Once arousal has occurred, one is no longer in a coma, one may still lack awareness of your environment, (who others are etc), and this aspect can certainly be facilitated by familiar sounds etc.

OK, so we have a question of terminology about which I was unaware. If I understand correctly, while technically in a coma there is no way any sensory input can affect consciousness, but once out of the coma the patient often remains detached from reality, and it is during this period that familiar sounds etc., might help.

My "reboot" analogy was obviously an approximate one ... I just meant a process by which a brain which has regained its physical ability to function might go on to re-learn contact with the outside.

So, perhaps we should rephrase the original poster's question as whether or not "coma songs" have been shown with any confidence to be helpful in getting post-coma patients to regain contact with the outside world.

What are the observed differences in a patient by which it can be said that they are no longer in a coma but in a post-coma but unaware state?

Do patients who regain awareness some time after coming out of a coma typically report remembering experiences (real or imaginary) during that period, and if so, do these experiences include things like hearing familiar music?

[Pebble]

Beyond my area of knowledge, hopefully others will contribute. However, arousal would include things like spontaneous eye opening, responsiveness to pain etc. So would not expect even the casual observer to mistake this state for a coma.

[JayUK]

Thanks to everyone's contributions so far, I've been searching for any studies that might have been done on it but haven't seen anything yet. Is there perhaps a proper term for it that I could google? "Coma songs" is the best I could think of.

[lost thought]

It could be more a way of comforting the families of the coma victim making them feel more involved and feelling less useless/helpless. They would feel as if they are helping in some small way which would ease some distress.

[Pebble]

JayUK, since you appear determined that this is real, here are the relevant (thought sceintifically suspect articles).


Brain. 2000 May;123 ( Pt 5):1007-16.
Auditory evoked potentials to spectro-temporal modulation of complex tones in normal subjects and patients with severe brain injury.

Jones SJ, Vaz Pato M, Sprague L, Stokes M, Munday R, Haque N.
Department of Clinical Neurophysiology, The National Hospital for Neurology and Neurosurgery, The Royal Hospital for Neuro-disability, London, UK. sjjones@ion.ucl.ac.uk
In order to assess higher auditory processing capabilities, long-latency auditory evoked potentials (AEPs) were recorded to synthesized musical instrument tones in 22 post-comatose patients with severe brain injury causing variably attenuated behavioural responsiveness. On the basis of normative studies, three different types of spectro-temporal modulation were employed. When a continuous 'clarinet' tone changes pitch once every few seconds, N1/P2 potentials are evoked at latencies of approximately 90 and 180 ms, respectively. Their distribution in the fronto-central region is consistent with generators in the supratemporal cortex of both hemispheres. When the pitch is modulated at a much faster rate ( approximately 16 changes/s), responses to each change are virtually abolished but potentials with similar distribution are still elicited by changing the timbre (e.g. 'clarinet' to 'oboe') every few seconds. These responses appear to represent the cortical processes concerned with spectral pattern analysis and the grouping of frequency components to form sound 'objects'. Following a period of 16/s oscillation between two pitches, a more anteriorly distributed negativity is evoked on resumption of a steady pitch. Various lines of evidence suggest that this is probably equivalent to the 'mismatch negativity' (MMN), reflecting a pre-perceptual, memory-based process for detection of change in spectro-temporal sound patterns. This method requires no off-line subtraction of AEPs evoked by the onset of a tone, and the MMN is produced rapidly and robustly with considerably larger amplitude (usually >5 microV) than that to discontinuous pure tones. In the brain-injured patients, the presence of AEPs to two or more complex tone stimuli (in the combined assessment of two authors who were 'blind' to the clinical and behavioural data) was significantly associated with the demonstrable possession of discriminative hearing (the ability to respond differentially to verbal commands, in the assessment of a further author who was blind to the AEP findings). Behavioural and electrophysiological findings were in accordance in 18/22 patients, but no AEPs could be recorded in two patients who had clear behavioural evidence of discriminative hearing. The absence of long-latency AEPs should not, therefore, be considered indicative of complete functional deafness. Conversely, AEPs were substantially preserved in two patients without behavioural evidence of discriminative hearing. Although not necessarily indicative of conscious 'awareness', such AEP preservation might help to identify sentient patients who are prevented by severe motor disability from communicating their perception.

Brain Inj. 2000 Mar;14(3):295-302.
Music and the brain: the impact of music on an oboist's fight for recovery.

Seibert PS, Fee L, Basom J, Zimmerman C.
Idaho Neurological Institute at Saint Alphonsus Regional Medical Center, Boise 83706, USA. pseiber@boisestate.edu
A 20-year-old female, alias Sara, was an aspiring professional oboist who studied music performance at college level. While wading across a river she lost her balance, was swept down river, and suffered profound injuries including severe hypothermia, cardiac arrest, and hypoxic brain injury. While recovering, her family and friends surrounded Sara with music. Her oboe teacher placed Sara's oboe in her hand and played tapes of Sara's past performances. Her mother played recordings of her favourite music in hopes that the music would remind her of her life's passion and, thus, stimulate her mind and soul while she recovered. Two years post-injury, Sara continues to strive to improve her quality of life. In this case study, Sara's musical and medical recovery is detailed using quantitative and qualitative data. This data gathered allows one to provide an analysis of the powerful role of music in Sara's fight to recover.

Clin Electroencephalogr. 1998 Jul;29(3):109-19.
The "Mozart effect" on epileptiform activity.

Hughes JR, Daaboul Y, Fino JJ, Shaw GL.
University of Illinois Medical Center, Chicago 60612, USA.
The "Mozart Effect," using the Piano Sonata in D Major (K.448), was examined in patients with seizures. In 23 of 29 instances significant decreases in epileptiform activity were noted from patients even in coma, with status epilepticus or with periodic lateralized epileptiform discharges (PLEDs). The effect may be immediate or require 40-300 sec to manifest itself. The change in the amount of ictal activity in one patient in coma was from 62% before the music to 21% during Mozart. Amplitudes of these discharges also have often decreased. Examples of PLEDs on both temporal areas are shown in which the effect was only on the left temporal area but in other patients only on the right temporal area. Brain maps during the music showed theta and alpha activity decreased on the central areas, while delta waves increased on the frontal midline area. The basis of this effect is likely that the superorganization of the cerebral cortex with its highly structured radial columns seen throughout both hemispheres may resonate with the superior architecture of Mozart's music.

J Neurosci Nurs. 1995 Dec;27(6):348-54.
Effects of auditory stimuli on intracranial pressure and cerebral perfusion pressure in traumatic brain injury.

Schinner KM, Chisholm AH, Grap MJ, Siva P, Hallinan M, LaVoice-Hawkins AM.
Neuroscience ICU, Medical College of Virginia Hospitals, Richmond 23298-0007, USA.
The primary goal of medical and nursing management in the traumatic brain-injured patient is to decrease intracranial pressure (ICP) and maintain adequate cerebral perfusion pressure (CPP). Little is known about what effect, if any, auditory stimulation has on these parameters. Therefore, an experimental study was conducted to examine the effects of various auditory stimuli on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in traumatic brain-injured patients. A convenience sample of fifteen participants with admitting Glasgow Coma Scale scores between 3 and 8 was studied. Three types of auditory stimuli: earplugs, a music tape and a tape of ICU environmental noise were applied to patients in a computer-generated random order. The tapes delivered sound at 70 decibels. Each intervention lasted 15 minutes. ICP and CPP were recorded at a 30 second resolution time through a bedside computer. Data were analyzed using analysis of variance for a cross over design. Results showed no statistically significant change in ICP or CPP during the study period. Further studies are needed to examine the effects of auditory stimuli on ICP and CPP in traumatic brain-injured patients.


Rehabilitation (Stuttg). 1994 Feb;33(1):8-13.
[Establishing contact in the early stage of severe craniocerebral trauma: sound as the bridge to mute patients]

[Article in German]

Jochims S.
Both from a theoretical perspective and by means of several case examples, the article focuses on the issue of overcoming the disturbed pre-verbal communication behaviour presented by patients in the early stage following severe craniocerebral trauma. In patients with brain lesion, a pre-verbal, emotionally-focussed tonal language almost invariably is capable of reaching the still healthy sections of the person. Hence, it is possible for music therapy to both establish contact with the seemingly non-responsive patient and re-stimulate the person's fundamental communication competencies and experience at the emotional, social and cognitive levels.

[JayUK]

JayUK, since you appear determined that this is real

I beg your pardon?

Pebble, (Sigh) you are the reason I despair with the skeptic’s community sometimes, and why I don't post very often to skeptics forums (even though I’d like to). They aren’t the clear thinking, friendly places they really should be, basically because I've found there’s a lot of people, like you, who have crossed that line from skeptic to cynic. I appreciate you finding the information you posted (thank you) but I don’t appreciate the insinuation that I have come determined with an answer. I don’t know whether it is true or not, hence why I turned to a skeptics forum for some guidance. I thought that was fairly clear from my first post when I said

I was just wondering if there is any evidence to back up the claims that a particular song or voice has miraculously [woken] people from their comas.

Does that sound like somebody who is determined that this is true, or somebody enquiring about evidence?

Thanks again for the information; I’ll expect my apology in the morning.

Cheers