The Effect Of Music Stimulation On Cerebral Hemodynamics In Patients With Prolonged Disorder Of Consciousness Based On Functional Near Infrared Spectroscopy

Objective:Functional near-infrared spectroscopy(fNIRS)is used to monitor healthy subjects and patients with prolonged Disorders of Consciousness who exposed to pleasurable music and white noise stimuli.Aiming to observe and analyze the difference and activation of cerebral hemodynamic changes between patients with pDOC after brain injury and healthy subjects,evaluating the cerebral hemodynamic response of subjects with different levels of consciousness,in order to find a new tool for the evaluation of consciousness disorders.Methods:A total of 34 healthy subjects and 36 patients with pDOC who met the inclusion criteria and were hospitalized in the Department of Rehabilitation Medicine of Shenzhen Second People’s Hospital from December 2021 to August 2022 were recruited as subjects.Basic information and other initial data were collected,and CRS-R scale was evaluated for pDOC patients.All subjects were monitored under pleasure music(Spring Festival overture)and white noise stimulation of fNIRS.Both scale assessment and fNIRS monitoring were conducted in the morning with no more than 2 days between them.The oxygenated hemoglobin signal slope value(k activation value)from 2 to 7 seconds after the start of each task was used as the primary outcome indicator.Results:In healthy subjects,Frontopolar area(FPA),Dorsolateral prefrontal cortex(Dorsolateral prefrontal cortex,DLPFC,Broca area,Pre-Motor and Supplementary Motor Cortex(pSMC)were activated under the pleasurable music stimulation.The DLPFC was activated under white noise stimulation.In pDOC patients,FPA,DLPFC,and frontal eye field(FEF)were activated in pleasurable music stimulation.FPA and DLPFC were activated in white noise stimulation.The number of active channels in healthy subjects and pDOC patients stimulated by pleasure music was higher than that stimulated by white noise.There were significant differences in k activation values between pDOC patients and healthy subjects in 5 channels stimulated by pleasurable music,and in 1 channel stimulated by white noise.Healthy subjects showed relatively reliable and regular hemodynamic responses to music stimulation,while pDOC patients showed no obvious pattern.Among pDOC patients,the number of activated channels of minimally conscious state(MCS)group was more minimally conscious state than vegetative state(VS)group,and there was no obvious activation under white noise stimulation.Conclusions:FNIRS monitoring can be used to observe the hemodynamic changes and activation of cerebral cortex in all regions of healthy subjects and pDOC patients under music stimulation.The cortical response of subjects under pleasure music stimulation is higher than that under white noise stimulation.It is suggested that monitoring the cerebral cortex activation of pDOC patients under pleasurable musical stimulation may be an effective and feasible evaluation method for the evaluation and treatment of pDOC patients.