MUSICA - MUsic and Speech Induced Cerebral Activation

音乐 - 音乐和言语诱发的大脑激活

• 批准号: 10426522
• 负责人: Ayham Alkhachroum
• 金额: $ 18.21万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10426522
• 关键词: Acute; Acute Brain Injuries; Age; Awareness; Biological Markers; Biometry; Brain; Brain Injuries; Caring; Cerebrum; Cessation of life; Clinical; Cognitive; Color; Coma; Conscious; Consciousness Disorders; Data; Data Science; Development; Electroencephalogram; Electrophysiology (science); Family; Family member; Functional Magnetic Resonance Imaging; Goals; Hospitalization; Injury; Intensive Care; Intensive Care Units; Knowledge; Language; Measures; Mentors; Modeling; Monitor; Motor; Music; Neurologic; Neurologic Examination; Neurosciences Research; Outcome; Outcome Measure; Patients; Pattern; Predictive Value; Prognosis; Prospective Studies; Radiologic Finding; Recovery; Recovery of Function; Research Personnel; Scientist; Signal Transduction; Societies; Speech; Stimulus; Testing; Training; Traumatic Brain Injury; Traumatic Brain Injury recovery; Uncertainty; United States National Institutes of Health; Withdrawal; auditory stimulus; base; clinical practice; cognitive function; cognitive neuroscience; follow-up; functional independence; life-sustaining therapy; loved ones; mortality; neurophysiology; novel; novel strategies; phrases; preservation; prognostication; recruit; relating to nervous system; research study; response; severe injury; trauma centers

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.

项目总结/摘要 严重创伤性脑损伤（TBI）死亡率高，主要是由于早期撤回维持生命的药物， 住院期间的治疗。这一关键决定受到患者是否保持无反应的影响 脑外伤后。目前的模型使用年龄、基本神经学评估和放射学结果作为预测因子。 复苏床旁神经系统检查取决于检查者，并且经常将患者错误分类为 尽管意识保留，但反应迟钝。目前预测意识恢复的方法， 功能恢复缺乏准确性。基于任务的脑功能磁共振成像研究 或脑电图（EEG）测量临床无反应患者的保留意识， 隐蔽意识急性脑损伤后，内隐意识预示着更高的康复机会。最 研究内隐意识的研究尚未在急性重症监护环境中进行 (ICU)当临床医生与家人讨论病人的护理目标时。音乐和口语是听觉的 脑损伤患者可能容易注意到的无反应刺激。我们的初步数据提供了 在ICU中使用音乐和口语的大脑激活作为生物标志物的前提和可行性， 检测TBI后的隐蔽意识。我们假设，音乐和口语的大脑激活 词语可以指示保留的基本认知功能，并随后预测TBI后的恢复。在这 研究中，我们建议在严重脑损伤后不久使用我们的 MUSICA（音乐和语音诱发的大脑激活）评估电池。我们的评估电池 MUSICA包括大脑激活[1]古典音乐; [2]单词，短语和句子; [3]一致性 和不一致的句子使用MUSICA，我们的目标是识别无反应TBI中的内隐意识 ICU中的患者（AIM 1）。我们还将确定大脑对MUSICA的激活是否可以用来预测恢复 TBI后（AIM 2）。将从高容量1级创伤中招募总计80名无反应的TBI患者 在ICU停留期间。我们将测试患者对MUSICA的大脑激活，并将他们的反应与 来自20名健康受试者的反应（AIM 1）。我们将在1-，3-， 并随访6个月，以确定MUSICA（AIM 2）的预测价值。这项研究的结果将改变 严重TBI后使用电生理特征的临床实践中的当前诊断范式 音乐和口语。