Intervenciones musicoterapéuticas para la activación del sistema reticular / Music therapeutic interventions for reticular activating system

RESUMEN

La musicoterapia es una disciplina que progresivamente está ampliando su campo de abordaje. Dentro de las nuevas intervenciones se pueden mencionar las implementadas en pacientes con estado alterado de conciencia y cuadros patológicos, producto de lesiones neuronales adquiridas que involucran al sistema reticular. La formación reticular es una red neuronal que establece conexiones con gran parte del sistema nervioso, regulando el alerta general, la dirección de la atención y la transición entre sueño y vigilia. A partir de esto, el trabajo que se informa está centrado en una descripción general de los diferentes estados alterados de conciencia y las intervenciones de una disciplina científica, con técnicas no invasivas que utiliza el sonido y sus elementos específicamente en el diagnóstico y abordaje terapéutico de pacientes en estado de mínima conciencia y su efecto en la formación reticular, teniendo como objetivo principal la rehabilitación del paciente y el aumento de sus niveles de alerta. Las técnicas en musicoterapia se basan en los resultados positivos del efecto de ciertos parámetros sonoros tales como la melodía, los aspectos temporales, la armonía, sobre indicadores fisiológicos (frecuencia respiratoria y cardíaca, conductancia de la piel, niveles de cortisol, etc.), que proporcionan un marco organizativo. A través de dicho marco las personas pueden responder e interactuar por medio de las propuestas musicales, determinadas por características, tales como la simplicidad, la utilización de la voz sin acompañamiento, improvisando vocales, melodías repetitivas, música de baja densidad cronométrica unida a la velocidad respiratoria del paciente y que pertenezca a su entorno familiar.

ABSTRACT

Music-therapy is a scientific discipline that in the last years has extended its work fields, to multiple populations and pathologies. Among the new interventions is the one related to altered conscious states, which are pathological disorders product of acquired neuronal lesions that involved the reticular system. Currently, there are different and varied models music-therapy that works with patients with altered consciousness states and the pathologies associated to those disorders. Parallel to the cognitive rehabilitation a branch emerged called neurological music-therapy, which is based in the neuroscientific model of musical production and perception and it is defined as the therapeutic application of music and theirs discursive elements in people who suffered motor, cognitive and sensorial deficits caused by neurological diseases. The reticular system is a neuronal network, known as a complex area due to its anatomy and functional heterogeneity. This network stablish connections with a large portion of the nervous system, acts as a filter system as it is responsible for separating incoming stimuli, discriminating between those relevant and not relevant, and it regulates the general alert, direction of attention, transition between awake, and sleep states. The lesions and deficits that involved the reticular system had been a point of scientific interest for many years. There are two main components related to conscience the arousal or wakefulness (be aware) and the awareness (the content of conscience). The arousal is considered a preparation state to action that consists in primitive behaviors to the environment, i.e. involuntary behaviors. To maintain the arousal intervenes the ascendant reticular system. While awareness involved a complex process, a cognitive elaboration of thought. Such elaboration encompasses the process of information that is received through the senses and environmental demands. When these processes are interrupted because of traumas or anomalies could generated a coma or states where the content of conscious are affected. After the brain injury, the patients are in a coma state and from there they could emerged with different long-term results: Post-traumatic amnesia, Minimal conscious state, vegetative state or death. The music-therapy techniques used with this population are descripted in this work from a neurological model, which is based in empirical evidence. This evidence is result of the effect of specific sound parameters (as melody, rhythm, harmony) upon physiological indicators (as heart rate, respiratory frequency, skin conductance, cortisol levels, among others), as well as the use of familiar music for the patient, detecting physiological indicators during musical experiences. The music-therapy techniques provide and motivate an organizational framework through which patients with severe disorders of their expressive and receptive linguistic abilities could respond and interact through musical applications. These techniques are possible because music is an innate ability of all human beings, also because the auditive system is the first sense that develops in the intrauterine level. The characteristics of music-therapy techniques are defined for simplicity, the use of the voice, where repetitive melodies are improvised, without breaking the laws of musical expectation, with low chronometric density music; this type of music go along with the respiratory speed of the patient. Also the musical history of the patient is taken into account to enable a familiar environment. With this background, the current work focuses in a general description of the different conscious states, the implication of reticular system and the interventions of music-therapy as a scientific discipline that offers non-invasive techniques that used the sound and their elements to test, to diagnostic and to treat patients in a minimal state of conscious. This technique has the ultimate goal of rehabilitate the cognitive functions and enhance the alert levels, besides providing a reinforcement for the interdisciplinary approach.