Bower Janeen, Magee Wendy L, Catroppa Cathy, Baker Felicity Anne
Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, VIC, Australia.
Brain and Mind, Clinical Sciences, The Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Front Psychol. 2021 Apr 15;12:615209. doi: 10.3389/fpsyg.2021.615209. eCollection 2021.
Evidence supporting the use of music interventions to maximize arousal and awareness in adults presenting with a disorder of consciousness continues to grow. However, the brain of a child is not simply a small adult brain, and therefore adult theories are not directly translatable to the pediatric population. The present study aims to synthesize brain imaging data about the neural processing of music in children aged 0-18 years, to form a theoretical basis for music interventions with children presenting with a disorder of consciousness following acquired brain injury. We conducted a systematic review with narrative synthesis utilizing an adaptation of the methodology developed by Popay and colleagues. Following the development of the narrative that answered the central question "what does brain imaging data reveal about the receptive processing of music in children?", discussion was centered around the clinical implications of music therapy with children following acquired brain injury. The narrative synthesis included 46 studies that utilized EEG, MEG, fMRI, and fNIRS scanning techniques in children aged 0-18 years. From birth, musical stimuli elicit distinct but immature electrical responses, with components of the auditory evoked response having longer latencies and variable amplitudes compared to their adult counterparts. Hemodynamic responses are observed throughout cortical and subcortical structures however cortical immaturity impacts musical processing and the localization of function in infants and young children. The processing of complex musical stimuli continues to mature into late adolescence. While the ability to process fundamental musical elements is present from birth, infants and children process music more slowly and utilize different cortical areas compared to adults. Brain injury in childhood occurs in a period of rapid development and the ability to process music following brain injury will likely depend on pre-morbid musical processing. Further, a significant brain injury may disrupt the developmental trajectory of complex music processing. However, complex music processing may emerge earlier than comparative language processing, and occur throughout a more global circuitry.
支持使用音乐干预来使意识障碍的成年人达到最佳唤醒水平和意识状态的证据不断增加。然而，儿童的大脑并非仅仅是缩小版的成人大脑，因此成人理论不能直接应用于儿科人群。本研究旨在综合有关0至18岁儿童音乐神经加工的脑成像数据，为脑损伤后意识障碍儿童的音乐干预建立理论基础。我们采用了Popay及其同事开发的方法的改编版，进行了一项带有叙述性综合的系统评价。在形成了回答核心问题“脑成像数据揭示了儿童对音乐的接受性加工的哪些方面？”的叙述后，讨论集中在脑损伤后儿童音乐治疗的临床意义上。叙述性综合纳入了46项对0至18岁儿童使用脑电图（EEG）、脑磁图（MEG）、功能磁共振成像（fMRI）和功能近红外光谱（fNIRS）扫描技术的研究。从出生起，音乐刺激就会引发独特但不成熟的电反应，与成人相比，听觉诱发电反应的成分潜伏期更长且振幅可变。在整个皮质和皮质下结构中都观察到了血流动力学反应，然而皮质未成熟会影响婴儿和幼儿的音乐加工及功能定位。复杂音乐刺激的加工在青春期后期仍在持续成熟。虽然从出生起就具备处理基本音乐元素的能力，但与成人相比，婴儿和儿童处理音乐的速度较慢，且使用不同的皮质区域。儿童期脑损伤发生在快速发育阶段，脑损伤后处理音乐的能力可能取决于病前的音乐加工情况。此外，严重的脑损伤可能会扰乱复杂音乐加工的发育轨迹。然而，复杂音乐加工可能比语言加工出现得更早，并且发生在更广泛的神经回路中。
