Evaluation Of The Matadoc And Comparison Of Auditory Musical, Non-Musical, And Live Music Therapy Stimuli To Increase Awareness And Sense Of Self In Patients With Moderate And Severe Dementia: An Exploratory Case Study

Background: The severe stage of dementia (SSD) can cause the loss of self-awareness, affecting the proper assessment, treatment, and care. The Music Therapy Assessment Tool for Awareness of Disorders of Consciousness (MATADOC) is a validated and reliable tool to measure awareness in DOC populations and it might be able to track awareness levels in people with SSD. Also, there is a need to identify effective treatments with people with SSD since pharmacological treatments have shown limited and even negative results. Both live music therapy and music listening of recorded songs have evidence of positive effects. Purpose: The purpose of this study is twofold: 1) To explore the use of the MATADOC for the assessment of patients with advanced dementia, 2) To compare the effects of live music therapy, recorded songs, and simulated presence therapy on increasing MATADOC scores and signs of an enhanced sense of self. Method: A case study with four participants was conducted by a graduate student. Participants underwent 4 sessions of baseline assessment with the MATADOC. Afterward, each participant completed a 30-minute minute session of listening of recorded songs, live music therapy, and auditory simulated presence therapy, in a different order, and each one on a different day. Each condition was immediately followed by a single MATADOC session as a post-test. All the sessions were recorded on video for behavioral/thematic analysis. Caregivers were interviewed to provide reports. Results: Most of the items of the MATADOC showed consistency with the level of deterioration of dementia. Two items of intentional behavior and non-verbal communication were consistently high with the four participants. While, the vocalization and the emotional response items showed consistency with the type of dementia, vocal/speech health, or location of brain damage. The protocol appeared to increase arousal, verbalizations, and/or mood. The researcher identified 18 adaptations or considerations to better fit the MATADOC to the dementia population. The musical conditions showed a better response in 100% of participants over control. Live music therapy showed a better response in 3 out of 4 participants and listening to recorded songs was better for the other remaining participant. Conclusion: MATADOC might be able to identify awareness deficits with people with SSD, but it could be improved by including cognitive, sensory, and declining factors appropriate for the dementia population. The positive effects of live music therapy could be addressed to its flexibility and multimodal approach suited to be adapted to the individual strengths and needs of the participants. Listening of recorded songs appeared as an important treatment but with risks of harm. Five recommendations for future research were identified and outlined