| BACKGROUNDTraumatic Brain Injury is a very serious community disease. Among multiple trauma, TBI is one of the most common injuries, it's incidence subordinate to the incidence of limb fracture.It was reported that did the autopsy of dead after severe car accident show TBI as a major death-causing factor of 75% dead. However,disability after TBI is worse than death.There are various kinds of disability types could follow patients with TBI all through their's life, such as physical handicap, mental handicap, cognitive deterioration. The disabled youth and adult caused by traumatic is the principal recipients of Rehabilititation Medicine at present, because the high social cost of death and disability caused by traumatic. Over the past 20 years, further research shows that primary craniocerebral trauma is still hard for clinics to intervene. So people now pay more attention to the secondarycraniocerebral injury mechanism and clinical treatment measures. Autopsy found that there are approximately 90% of patients died of brain injury with cerebral ischemia. So, the key lies in the treatment of ischemic damage to improve the prognosis of patients with traumatic brain injuries.Normal organization structure and metablism maintain spontaneous electrical activity of brain, otherwise EEG signals will take on abnormal waveform. The function of EEG signals can guide the clinical diagnosis and treatment. BAEP could evaluate the function of brain stem at the level of electrophysiology and show the function of auditory brainstem pathway and surrounding neural structure and unaffected by subjective consciousness and drugs. BAEP could provide evidence for prognosis judgement and effectiveness of treatment by show the function of different position of brain stem accurately.The treatment of TBI is a comprehensive treatment. There are lots of therapeutic measures to treat patients with TBI in varing degrees and different perieds in Rehabilitation Medicine.The definition of Somatosensory Vibro-music Therapy was defined by Olav Skille, a educator and therapist from Norway, on the 1st symposium of International Institute of Music and Medicine in 1982. Body perceive music by receive and conduct auditory and sense of vibration and touch to treat body and mind. Somatosensory Vibro-music Therapy makes body receive audio wave of music and enhance body perception of music to attain the goal of treatment.To human's brain,the most powerful audotory stimulus is music which has a lot of functions to effect patients.However, only a few reaserches report the effection of Somatosensory Vibro-music Therapy on TBI. We attempt to observe the treatment of music to the patients with TBI and discuss the effect and mechanics of treatment to provide theoretical and clinical evidence for further reaserch.OBJECTIVE1. To study the effects of Somatosensory Vibro-music Therapy on electroencephalogram and Brainstem Auditory Evoked Potential of patients with TBI;2. To study the influnences of Somatosensory Vibro-music Therapy on prognosis of patients with TBI; 3. To provide throretical and clinical evidence for the application of Somatosensory Vibro-music Therapy.METHODS1. Test objects and grouping:32 patients with mild or serious brain injury from May 2010 to December 2010 who hospitalized Rehabilitative Medicine Department of Nan Fang hospital, Southern Medical University. they were randomly divided into test group and control group,1 case withdrawal from the control group. At last,31 patients including 16 in experimental group and 15 in control group.2. Basic data:the test group has 12 males and 4 females, with an average age of 29.19±12.81 years old (froml8 to 55 years old). The duration of disease in these patients were ranged from 20 days to 67 days, with an average of 40.06±14.43 days. The control group has 11 males and 4 females, with an average age of 33.73±15.04 years old (from16 to 60 years old).The duration of disease in these patients were ranged from 23 days to 73 days,with an average of 51.87±17.40 days.3. Inclusion criteria:①All patients were conformed brain damage by skull CT or MRI; Glasgow Coma Score(GCS) were between 6～12 points;②They accepted brain surgery in the department of neurosurgery of Nan Fang Hospital and joined the study within 3 months medical history;③The age range is 16～60, one side has no hearing-defects at least;④The vital signs keep stable;⑤Agreed to join the study and signed informed consent by the treatment.4. Exclusion criteria:①Poor hearly or not at all;②They have drugs such as barbituate within 5 days, which can influence outcome of EEG;④Unstable vital signs or disease was progressive deterioration;④patients have mental disorder or cognitive impairment before getting hurt, and thess people who were addicted to drink.5. Treatment methods:Two groups of patients were given drugs,symptomatic supportive care and so on,with the hemiplgic limb passive movement, electrotherapy,acupuncture and other rehabilitation measures. On these basis,the test group was added Somatosensory Vibro-music Therapy after patients or guardian's consent and sign the informed consent form. All patients were given conventional rehabilitation therapy and Somatosensory Vibro-music Therapy for 4 weeks. patients who lay on the Somatosensory Vibro-music bed with supine position listen to the music which volume is less than 50 decibel.patients who were still unconsciousness listened to the music deduct from The Four Season, While conscious patients listened to the music deduct from the Sonata in D Major with Piano. During this period the test group were treated with Somatosensory Vibro-music Therapy for 30～40min once a day,5 days a week.6. Detection of indicators and evalution methods:In the first and 30th day after patients into the group, we measured EEG and BAEP, and evaluated their Glasgow outcome scale at 3 months.STATISTICAL METHODSThe statistical analysis was performed with SPSS 13.0 software package and the measurement data were presented with mean±standard deviation, while the categorical variable data and the rank material were presented with average rank. Comparisons of the clinical baseline between the two group before treatment were performed using Fisher probabilities in 2×2 table,rank sum test. Comparisons of the BAEP and EEG scores beteween the two groups before and after treatment were performed using Wilcoxon's two-sample test; Comparisons of the EEG and BAEP scores before and after treatment of the two groups were performed using Wilcoxon's one-sample test; Comparisons of the GOS in the two group at 3 months were performed using Wilcoxon's two-sample test.REAULTS A total 31 patients were completed in the whole trial.there was 1 patient dropt out because of roll-out from the department of rehabilitation in the control group.1. Comparisons of the clinical baseline before treatment:There were no significant difference between the control group and test group on the clinical baseline(include age,duration of disease, degree of TBI,postion of injury and GCS)(P>0.05).2.comparisons of the EEG and BAEP between the two group before treatment:There was no significant difference between the two group on the EEG before treatment (Wilcoxon W=251.00, P=0.550) (P>0.05); There was no significant difference between the two group on the BAEP before treatment (Wilcoxon W =218.00, P=0.343) (P>0.05).3. comparisons of the EEG and BAEP between the two group after treatment:There was significant difference between the two group on the EEG after treatment (Wilcoxon W=179.00, P=0.010)(P<0.05), the outcome showed that electric activities inside brain and organization structure and metabolism function of brain of test group were recovery better than that of control group. There was no significant difference between the two group on the BAEP after treatment (Wilcoxon W=218.00, P=0.257) (P>0.05), though the brain-stem conditions of test group got better than that of control ones.4. Intra-group comparisons of EEG between pre-and post-treatment of test group:There was significant difference between pre-and post-treatment on the EEG of test group (Marginal Homogeneity=45.00, P<0.001) (P<0.05); There was significant difference between pre-and post-treatment on the BAEP of test group (Marginal Homogeneity=19.00, P=0.014) (P<0.05), that is to say, the electric activities inside brain, organization structure and metabolism function of brain and brain-stem conditions after treatment got better than that before treatment. 5. Intra-group comparisons of EEG between pre-and post-treatment of control group:There was significant difference between pre-and post-treatment on the EEG (Marginal Homogeneity=21.50, P=0.007) (P<0.05) and BAEP (Marginal Homogeneity=14.00, P=0.046) (P<0.05) of control group, it is said that the electric activities inside brain, organization structure and metabolism function of brain and brain-stem conditions after treatment of control group got better than that before treatment.6. comparisons of the GOS between the two group after treatment at 3 months:There was significant difference between the two group on the GOS after treatment (Wilcoxon W=180.5, P=0.014) (P<0.05), the outcome showed that the patients of test gtoup have more better self-competence,low level dependence and more beeter prognosis.CONCLUSIONS1. Conventional rehabilitation therapy could improve the patients' organization structure and metabolism function of brain, auditory brainstem pathway and surrounding neural structure.2. Somatosensory Vibro-music Therapy could enhance the therapeutic effects of conventional rehabilitation therapy in patients with TBI.3. Somatosensory Vibro-music Therapy could improve electric activities inside brain of patients with TBI. It's beneficial to restore orgnization structure and function of damaged cell and structure of brain; But the effection on brain-stem was not obvious under the treatmrnt of Somatosensory Vibro-music Therapy.Although, it's likely that Somatosensory Vibro-music Therapy had little effection on brain-stem restore, we tended to believe that outcome was related to less samples.4. The outcome of GOS in experimental group was significantly improved. the outcome showed that the patients of test gtoup have more better self-competence,low level dependence and more beeter prognosis.5. Indicating that Somatosensory Vibro-music Therapy should have some clinical value in the treatment of brain injury patients. |
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