Dr. Wendy L. Magee, Temple University, Philadelphia
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The Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) is a standardized music-based assessment of awareness for adults with prolonged disorders of consciousness (PDoC). Assessing awareness is highly complex with this minimally responsive population. Auditory responsiveness is poorly assessed by existing PDoC measure protocols. Music has been found to boost arousal, attention and cognition in PDoC patients, and yet standardized assessments of awareness in PDoC use primarily verbal interventions. The MATADOC’s performance in comparison to the criterion standard assessment of awareness, the Coma Recovery Scale-Revised (CRS-R) remains unknown. We sought to establish concurrent validity of the MATADOC with the CRS-R and compare item functionality between comparable items (e.g. auditory, visual). In a repeated measures prospective trial we compared results of MATADOC and CRS-R assessments of 74 adults with PDoC. This is the largest dataset examining music interventions in PDoC. The MATADOC protocol elicits behavioural responsiveness using live music and rates responses across motor, communication, arousal, visual and auditory domains using a 14-item measure. The CRS-R protocol is primarily verbal and rates responses across six function scales. Fair (Cohen’s k=0.238, p=.006) ranging to moderate (k=0.419, p<.001) significant agreement was found between CRS-R/MATADOC diagnostic outcomes for each contact. Agreement increased over repeated contacts. Moderate agreement was found for overall diagnostic outcomes ranging across all diagnostic categories (k=0.397, p<.001). Moderate significant agreement found between measures for motor scores (k=.556, p<.001) and visual outcomes (mean k= 0.326). No agreement was found for item outcomes assessing auditory responsiveness. The MATADOC complements the CRS-R in treatment planning for PDoC. MATADOC measures of auditory responsiveness suggest musical stimuli may elicit more complex behaviours than non-music protocols. The MATADOC rates complexity of auditory localization as MCS in line with recent recommendations and this may explain diagnostic outcome differences with CRS-R outcomes. The MATADOC is a robust standardized measure of awareness in PDoC and a sensitive assessment of auditory responsiveness.
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