MUSICA - MUsic and Speech Induced Cerebral Activation

Project Summary/Abstract
Severe traumatic brain injury (TBI) has a high mortality, largely driven by the early withdrawal of life-sustaining
therapies during hospitalization. This critical decision is influenced by whether patients remain unresponsive
after TBI. Current models use age, basic neurological assessment, and radiological findings as predictors of
recovery. Bedside neurological examinations are examiner dependent, and often misclassify patients as
unresponsive despite preserved awareness. Current approaches to predicting recovery of consciousness and
functional recovery lack accuracy. Brain activation using a task-based functional magnetic resonance imaging
or electroencephalogram (EEG) measure preserved awareness in clinically unresponsive patients, known as
covert consciousness. Covert consciousness indicates a higher chance of recovery after acute brain injury. Most
research studies examining covert consciousness have not been performed in the acute, intensive care setting
(ICU) when clinicians discuss the patients’ goals of care with families. Music and spoken words are auditory
stimuli to which unresponsive brain-injured patients may easily attend. Our preliminary data provide the scientific
premise and the feasibility of using brain activation to music and spoken words in the ICU as a biomarker to
detect covert consciousness after TBI. We hypothesize that preserved brain activation to music and spoken
words may indicate preserved basic cognitive functions and subsequently predict recovery after TBI. In this
study, we propose using a personalized prognostication approach shortly after severe brain injury using our
assessment battery MUSICA (MUsic and Speech Induced Cerebral Activation). Our assessment battery
MUSICA encompasses brain activation to [1] classical music; [2] words, phrases, and sentences; [3] congruent
and incongruent sentences. Using MUSICA, we aim to identify covert consciousness in unresponsive TBI
patients in the ICU (AIM 1). We will also determine if brain activation to MUSICA can be used to predict recovery
after TBI (AIM 2). A total of 80 unresponsive TBI patients will be recruited from a high-volume level 1 trauma
center during the ICU stay. We will test patients’ brain activation to MUSICA and compare their responses to
responses from 20 healthy subjects (AIM 1). We will assess global, functional, and cognitive outcomes at 1-, 3-
and 6-month follow-up to determine the predictive value of MUSICA (AIM 2). Results from this study will change
the current prognostication paradigms in clinical practice after severe TBI using an electrophysiologic signature
to music and spoken words.

Grant Number: 5K23NS126577-04
NIH Institute/Center: NIH
Principal Investigator: Ayham Alkhachroum