Changes in music listening in post-concussion syndrome after mild traumatic brain injury.

Mild traumatic brain injury (MTBI) constitutes a public health problem with major socioeconomic consequences (Maas, Stocchetti, & Bullock, 2008). The notion of post-concussion syndrome (PCS) following MTBI is now a well-described (Borg et al., 2004) and extensively discussed concept (Rees, 2003; Wood, 2007). However, current standard imaging (mainly MRI) techniques rarely reveal abnormalities, and the consequences of diffuse axonal damage are difficult to document. For these reasons, PCS is often considered to be either psychogenic in origin (Whittaker, Kemp, & House, 2007)ora fallacious pretext for financial compensation. However, it is clear that new MR imaging methods such as MRI diffusion anisotropy (Belanger, Vanderploeg, Curtiss, & Warden, 2007; Maller et al., 2010) and magnetic resonance spectroscopy (MRS; Garnett et al., 2000; Govindaraju et al., 2004) can reveal structural and metabolic white matter abnormalities in connection with post-concussion symptoms, including depression (Maller et al., 2010). A significant proportion (5-7%) of patients with MTBI present a later cognitive decline (Hammond et al., 2004). Recent studies conducted on 2525 U.S. soldiers exposed to blasts and who suffered MTBI clearly reveal the neurological correlates of PCS and indicate that PCS is closely associated with loss of consciousness during the trauma (Hoge et al., 2008). The link between cognitive deficits related to PCS and impairment of brain connectivity, particularly in frontal regions, has been recently demonstrated (Sponheim et al., 2011). Apart from a few music-related pathologies (congenital amusia, musicogenic epileptic seizures), few studies have reported abnorCeline malities of listening to or producing music in neurological and psychiatric pathologies (Vion-Dury & Besson, 2010). However, throughout human history, billions of human beings have created and listened to sound patterns and sequences that do not carry any denotative meaning (Sacks, 2008). In this respect, Andrade and Bhattacharya (2003) proposed that the brain is tuned to music. Although many studies emphasize the value of music therapy in patients with various neurological and psychiatric diseases, the scientific literature exploring changes in the quality of music listening is sparse. Sacks presented many clinical examples related to this issue (Sacks, 2008), but only a few examples of any given pathology are available to the best of our knowledge.The current study stems from a clinical observation: during individual interviews prior to neurophysiological assessment of PCS following an MTBI, several patients reported an experience of time disruption, with alterations of their capacity to evaluate durations and the feeling of being disoriented in time. This led us to question them about changes in their music listening habits because music can be regarded as an "art of time" (Emery, 2000); thus, its appreciation requires precise processing of temporal structures at different time scales (Accaoui, 2001). Following the question "Has your way of listening to music changed since your brain trauma? ", patients remained silent for several seconds. Then, they reported being aware that their music listening habits had changed. However, they were unable to accurately describe this modification. This recurrent clinical observation gave rise to this study, the aim of which was to assess musicrelated changes in patients suffering from MTBI, by combining both objective and subjective data experienced in the "firstperson," according to the neurophenomenological approach (Vion-Dury, 2007; Vion-Dury et al., 2011) and by analyzing if these music-related changes are correlated to any abnormality in imaging, neuropsychological, or neurophysiologic evaluation.MethodSubjectsThis study took place during a global assessment of the PCS diagnosis in MTBI patients, as organized by the Groupe d'Etudes des Professionnels Alpes-Mediterranee sur les Traumatismes Crâniens (GREPAM-TC), from October 2008 to June 2009 (Soriat-Barriere, Tcherniack, & Vion-Dury, 2011). …