Family members are desperate to know when a loved one with a traumatic brain injury is in a coma and a new Northwestern Medicine and Hines VA Hospital study shows the voices of loved ones telling the patient familiar stories stored in his long-term memory can help awaken the unconscious brain and speed recovery from the coma.
Coma patients who heard familiar stories repeated by family members four times a day for six weeks, via recordings played over headphones, recovered consciousness significantly faster and had an improved recovery compared to patients who did not hear the stories, reports the study.
"We believe hearing those stories in parents' and siblings' voices, exercises the circuits in the brain responsible for long-term memories," said lead author Theresa Pape. "That stimulation helped trigger the first glimmer of awareness." As a result, the coma patients can wake more easily, become more aware of their environment and start responding to conversations and directions. "'like coming out of anesthesia," Pape said. "It's the first step in recovering full consciousness."
Pape, a neuroscientist in physical medicine and rehabilitation at Northwestern Universiity Feinberg School of Medicine and a neuroscientist at Hines VA, said: "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."
Being more aware of their environment means the patients can actively participate in physical, speech and occupational therapy, all essential for their rehabilitation.
The familiar voices treatment also benefits families. "Families feel helpless and out of control when a loved one is in a coma," Pape said. "It's a terrible feeling for them. This gives them a sense of control over the patient's recovery and the chance to be part of the treatment."
The randomised, placebo-controlled study, Familiar Auditory Sensory Training (FAST), enrolled 15 patients with traumatic closed head injuries who were in a vegetative or minimally conscious state. They were an average age of 35 (12 men and three women) with injuries caused by motorcycle or car accidents, bomb traumas or assaults. The FAST treatment began an average of 70 days after the injury.
Pape and colleagues first did baseline testing to see how responsive patients were to sensory information such as bells or whistles, if they followed directions to open their eyes and if they were alert enough to visually track someone walking across the room. Their responses provided a benchmark to see if they changed or improved after six weeks of treatment. (A person in a minimally conscious state can occasionally follow directions.)
Scientists also had the patients listen to familiar and non-familiar voices tell different stories to get a baseline MRI of how the blood oxygen levels in their brains changed while listening.
The next step was having families work with therapists to identify and construct the important stories about events that the patient and family participated in together. "It could be a family wedding or a special road trip together such as going to visit colleges," Pape said. "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."
Families brought in an armful of photo albums to come up with topics for the stories. Then parents and siblings recorded at least eight stories, which they practiced reciting naturally and using the patient’s nickname. After six weeks of listening to the recorded stories, Pape repeated the earlier baseline tests in an MRI. In one, patients listened to familiar and unfamiliar voices telling the same story they heard at baseline (a short joke about a man buying ice-cream and getting a pickle with it.)
The MRI image showed a change in the oxygen level, indicating greater responsiveness to the unfamiliar voice telling a story. The oxygen level did not change for the familiar voice, which remained the same as baseline. "This indicates the patient’s ability to process and understand what they’re hearing is much better," Pape said. "At baseline they didn't pay attention to that non-familiar voice. But now they are processing what that person is saying." In another test, patients listened to a small bell ringing as before. But this time, patients' brains responded less to the bell, indicating they were better able to discriminate what's important to listen to. The biggest gains in recovery came in the first two weeks of the treatment, with small incremental gains over the next four weeks.
Pape is currently analysing her data to determine if the FAST intervention strengthened the brain’s wiring, the elongated fibers called axons that transmit signals between neurons.
[link url="http://www.northwestern.edu/newscenter/stories/2015/01/family-voices-and-stories-speed-coma-recovery.html"]Northwestern University release[/link]
[link url="http://nnr.sagepub.com/content/early/2014/10/20/1545968314554626.abstract"]Neuro-rehabilitation and Neural Repair abstract[/link]