Using Azam software for the stimulation, rehabilitation and arousal of coma and brain injured patients
This page contains a general overview for use by members of the public and is not just for medical staff.
Under the Azam Disabilities Initiative (ADI) hospital intensive care wards qualify for free use of Azam software in the treatment of brain injured or comatose patients. Family members of the patient may also download Azam free of charge for this purpose but are advised to seek medical supervision as described within this article. Hospitals should email firstname.lastname@example.org to request free software keys. To save on administration, family members are advised to download Azam and create the recordings they wish to use within the 30 day free trial period. This can be extended indefinitely by sending a request to the above email address.
A brief synopsis relating to coma and how Azam software could help, will now be described.
Coma is: " ... the total absence of awareness of self and environment even when the subject is externally stimulated."
There have been many studies undertaken relating to coma recovery. Head injury is a major cause of death and permanent disability. In New South Wales, a report from the Government Insurance office indicated that road trauma accounts for 70 percent of cases of severe brain damage and that 50 percent of these occur in the 17 to 25 year age group. The report further indicates that approximately 1,000 people each year are left with a permanent deficit in brain function and that one third will be left seriously disabled for life. These people are often forgotten, seen as being beyond the help of rehabilitative care. However Ian Hunter, in an oral submission to the Parliamentary Social Development Committee inquiry into the options for dying with dignity stated: It cannot be proven that there is no potential for recovery following brain injury, even in the most severe cases, because there is no known diagnostic test that can scientifically demonstrate that recovery of function will not occur (therefore) every attempt should be made to tap this.
Through controversial coma arousal programmes it is being shown that even when in a coma a person may be reached through the use of external stimulation. Coma arousal is a planned series of activities aimed at "arousing" a person from a coma.
The basis of coma arousal therapy lies in the frequency, intensity and duration of environmental stimuli that the patient receives. Stimuli may be via the five sensory modalities (vision, hearing, touch, taste and smell) by which the brain receives information about the outside world and physical movement. Sensory stimuli are essential factors in stimulating the reticular activating system (consciousness control centre) to maintain consciousness.
Basically, any comatose patient in a stable medical condition is a suitable subject for a coma arousal programme. Coma mostly results from head trauma sustained in motor vehicle accidents and it is this category of patient most commonly found in coma arousal programmes. Patient assessment is essential prior to commencement of the programme. Dr Freeman (who undertook a coma arousal feasibility study at the Sydney College of Advanced Education) points out that though it is relatively easy to assess the physiological state, it is difficult to measure the degree of brain function. He believes that the Glasgow Coma Scale (GCS) enables a uniform approach to assessing severe brain injury but questions its value once the patient is scoring above 9; a score of 8 or less out of a total of 15 is usually considered to indicate coma. Due to possible GCS inaccuracy on scores of 9 or above, Freeman suggests that assessment of brain function should involve determining the patient's visual, auditory and tactile abilities on a continual basis.
Coma arousal therapy should commence as soon as possible after the development of coma and may start in the intensive care unit providing the person's medical condition is stable. Coma arousal programmes are very labour intensive and it has been suggested that the best therapists are those who are interested and caring - frequently relatives or significant others. In addition, those closest to the person are more likely to receive and see a response. As Freeman notes: "Often the relatives have indicated to us that the patient has an awareness which is much greater than we can detect. We listen carefully, because we find them to be right so often."
Some studies have shown stimulation programmes using music can arouse coma patients and provide examples of other stimulation programmes used in the past. The use of music in rehabilitation and the goals of music therapy are described by some doctors. Also studied are the reasons for using music as a stimulus, what kind of music and how it should be presented, and what kinds of non-musical stimuli you would want to include in the rehabilitation programme. One team has produced a video which also stresses the importance of conversation with the patient and the pairing of touch with the music during therapy, and family involvement. It includes charting examples, examples of responses, examples of musical stimuli, and examples for non-musical stimuli. Recent studies of the use of music therapy with coma patients are mentioned. (Please refer to the links below).
Here is a quote from a patient's daughter, Andrea "My father whom I love dearly suffered a cardiac arrest. It's been 1 1/2 years. I spend 6 hrs everyday with him. I do a lot of coma stimulation techniques. He smiles at me, when I ask sometimes or if I show him how, it's like he'll mimic me. I don't know though if he knows I am his daughter for 37 yrs." However research shows us that it doesn't take a miracle for patients to come out of a coma and do well.
The section above was prepared by obtaining information from the following websites:
Azam software can easily be used to record some of these stimulation techniques of musical and non-musical stimuli and repeatedly play them back to the patient. Azam can be used to mix the musical and non-musical messages. As stated in some of the recovery techniques it is often better to have several different types of messages and recordings. For example loud, soft, high pitch and in some cases slowed down or even speeded up.
This can be done using Azam voice filter functionality. Azam software is built with a set of unique morphing functions that far exceed the limits of most recording devices. Friends and relatives who know the patient's tastes can even monitor the patient's awareness, can create customized voice recordings and musical excerpts using Azam. These 'sound clips' can be filtered and recorded to perfection as a very simple exercise. As an example, let's assume one of the voice clips was emailed from the patient's grandmother. Using Azam, an ordinary 5 minute audio track could be produced, copied, morphed and merged into the final CD. Grandma's voice could then be heard normally, fast, slow, and/or with the other morphing effects such as with an echo or even backwards. By doing this, it could light a spark in the deepest subconscious of the patient. Please refer to the voice audio clip example we have produced on our website which can be played on most PCs that have MP3 or Wav capability.
We wish to emphasize that there is nothing stopping a family from producing a simple tape recording in a short space of time, using an ordinary tape recorder, nevertheless, it can be very cumbersome to collect and merge audio clips from several sources, some of whom may live some distance away from the hospital or the physical recording machine. Additionally, very few recording devices have the morphing capability of Azam software. Azam even allows voice clips to be recorded during a preplanned phone conversation directly onto a PC. Patients who are in a coma, brain injured, traumatized or unconscious can be given various forms of audio stimulation to help bring them out of their state. We are here to provide some innovative, state of the art technology that may assist. View specific screen shots
Diagram of voice and audio clips collected from different sources, emailed to a central Azam enabled PC that will create an MP3 CD to play back to the patient.
The recordings you will create as a family will probably contain memories that are very private and personal relating to the patient's life. It may even be improper to divulge such close family matters to certain participants of the final CD such as friends, teachers or workmates. Please respect the privacy of everyone concerned. If all goes well and a full recovery ensues, let the patient decide whether to allow external parties access to these special messages.
Example of a finished CD using basic Azam functionality (i.e. no morphing)
We have included a thought provoking poem relating to World Peace on this website for download, which can be used by anyone (religious, spiritual or atheist). Juan Carlos Calderon, the Spanish composer who has written songs for Ricky Martin, Louis Miguel and others, has very kindly agreed to allow the use of the music to his hit beautiful number one song 'Amarte es un placer' for use in the Azam coma initiative. The lyrics to 'The Ancient Song of the Human Race' were written by Andronicos as part of one of his other projects. It has been included here because it is not often easy to get legal copies of downloadable music from the internet. Download and play for coma patient use (WMA format). Alternative MP3 format. If the patient is religious, refer to track 7 below.
Example of a finished CD using all available Azam functionalityThe maximum time should not exceed the capacity of 1 CD (approx 77 mins).
Following recovery to full consciousness, some patients have short or medium term memory loss. Consider using Azam software to facilitate voice emails from friends and relatives who need to remind the patient of forgotten memories. Even face to face discussions and phone calls can be recorded using Azam so the patient can analyze what was said afterwards and hopefully prompt in the restoration of forgotten memories.
A form has been produced offering suggestions and to enable the study to take place. Please download the 2 page PDF from here.
Kindly note this whole section was written by Andronicos, inventor of Azam and Head of the Azam Disabilities Initiative. He is not a doctor. He would be very grateful for feedback, suggestions and results because it is imperative we know how you get on using Azam in this way so that other patients in similar positions can be helped. Please email email@example.com. This is a high priority email address only for use by medical professionals.
A couple of disclaimers follow: This is a live research project, which should only be attempted with the approval of a doctor. Strictly speaking, copying copyright music for use in the manner described above should be with the permission of the record company concerned. Azam Version 2 is required for voice morphing.
As described at the start of this page, under the Azam Disabilities Initiative (ADI) hospital intensive care wards qualify for free use of Azam software in the treatment of brain injured or comatose patients. Family members of the patient may also download a copy of Azam free of charge for this purpose but are advised to seek medical supervision as described within this article. Hospitals should email firstname.lastname@example.org to request free software keys. To save on administration, family members are advised to download Azam and create the recordings they wish to use within the 30 day free trial period. This can be extended indefinitely by sending a request to the above email address. If you wish to use Azam in this way, please email email@example.com and let us know how you get on.
Finally, if you are reading this section because a friend or relative is in a coma or is suffering from a brain injury, we recognize this must be a very difficult time for all concerned. The whole Azam team wishes the patient all the best for a speedy recovery.