As a lecturer in Music and Wellbeing, I often asked my students how music might improve health. Despite the varied topics that come up (e.g. music can apparently cure snoring), no one ever mentioned coma. Yet the case of music and coma care is one of the most powerful for illustrating the impact of music, in a place of extreme isolation from the outside world. 

Can we hear music in a coma?

The idea of music listening in coma might seem odd. We tend to think of music as an active process where the receiver (audience/ patient) interacts with the provider (performer/ therapist). Even when listening alone at home we would assume it is essential that the person can respond to the music (dance/ sing/ change the track) or at least react emotionally or intellectually to what they hear. So why play music to someone in a coma

A ‘coma’ is not one state or condition but a continuum of consciousness; many coma patients have sufficient awareness to respond with a glance, a movement or a squeeze of the hand. They have body rhythms such as sleep and wake cycles, and show physical responses to heart rate and breathing when their environment changes. Ultimately, when there is an active brain then there is a chance that music can help.

Music reveals the true depths of the mind

Music is a super stimulant, it triggers activity in multiple, simultaneous areas of the brain. For this reason medical experts have dubbed music a ‘whole brain workout’. The true impact is illustrated by brain maps that show the extensive potential for change that exists when we engage in music training . We can literally shape our minds with music. 

Music can help people in coma because of this whole brain engagement. Even with extensive damage, some areas of the brain will remain active and could respond beneficially to musical sounds. We may only see a small regulation in breathing, a minor shift on a heart rate monitor, or a flicker in a brain wave, but doctors have evidence (and personal experience) of the positive effects of music even when a person is in a deep coma 

A case to remember

All this talk of music and coma reminds me of Scott Routley. Scott was 26 years old in 1999 when he was in a horrific high speed car accident that left him with severe brain trauma. His parents were devoted to his care and when the neuroscientist Adrian Owen visited Scott 12 years after his accident, Scott’s parents told him that their son loved listening to The Phantom of the Opera and Les Misérables – they were confident that he was responding expressively to music, even though Scott showed little awareness of his world. 

Dr. Owen developed a technique to ascertain if patients like Scott were conscious by placing them in an fMRI brain scanner and asking them to imagine playing tennis or walking around a familiar location like their home. These two imaginings activate distinct areas of our brain that doctors can use to represent ‘yes’ or ‘no’. A question in the fMRI scanner might be, do you like to listen to The Beatles? Imagine playing tennis if the answer is ‘yes’. At this point my brain would appear to be in a Wimbledon final. 

Scott passed away about a year after the amazing breakthrough that was captured on BBC television for the stunned medical team and the world. The whole world with the exception of his parents; thanks to his deep and emotional response to music even in a coma those who knew Scott the best knew all along that this was possible. 

Something for everyone

Our hearing has been described as the most robust and responsive of our senses. The case of music in coma care illustrates how our brain’s hunger for musical sounds has given us a powerful wellbeing tool even in an extreme cases of trauma. We can trust that the music that we love is buried deep in our minds, ready to soothe us when we need it the most.