Murattal Al-Quran Therapy and Changes of Patient's Consciousness: A Literature Review

A decreased level of consciousness is an emergency problem that can lead to brain function issues resulting in high morbidity and mortality rates. The number of patients with the complication of hemodynamics deterioration accompanied by decreased level of consciousness has been considered to be high. Therefore, the caring management in the form of Murattal al-Quran therapy could be used as an alternative intervention to respond to the particular problem. The purpose of this literature review is to determine the effect of Murattal therapy on changes in patients’ consciousness. The selected articles of this research were collected from various electronic sources such as google scholar, pubmed, and the Garuda portal. Specific keywords related to the topic such as the effect of murattal therapy, the decreased level of patients’ consciousness, and Glasgow Coma Scale (GCS) indicator were used to specify the search. The results of this research showed that Murattal alQuran therapy intervention had an effect on changes in the Glasgow Coma Scale and Vital Signs in patients with decreased consciousness.


Heading
Based on data obtained from the World Health Organization (WHO), it was recorded that patients with critical conditions in the Intensive Care Unit showed an increasing prevalence rate every year [1]. The morbidity percentage of patients with critical conditions is around 9.8-24.6% and is treated intensively in the Intensive Care Unit (ICU) per 100,000 population. Statistically, the percentage of mortality (death) rate due to chronic diseases in the world has increased. It was apparent that around 1.1-7.4 million people were in the hospital critical rooms which spread across 16 hospitals in Asian countries. Indonesia is a country with 1.285 sepsis patients with breathing aids (ventilators). The average length of treatment days using this tool is around 3-10 days with a mortality rate of about 575 patients [1]. The indicator in assessing the level of awareness of critical patients in the Intensive Care Unit (ICU) is the Glasgow Coma Scale (GCS). GCS is a precise and systematic indicator that is generally used when determining the patient's body response, patient prognosis, level of head trauma (mild, moderate, severe), and assessing the level of consciousness. GCS indicators are carried out quickly and require relatively short time. Some health workers use this indicator because it is considered to be easily used. However, GCS has limitations in assessing the verbal response of patients with the decreased level of consciousness who are attached to a breathing apparatus (ventilator) [2].
Nurses have the ability to conduct evaluations using consciousness assessment indicators. According to Avner, consciousness is a state of being aware of yourself and the environment. Consciousness has two aspects, namely wakefulness and awareness [3]. A compatible complementary therapy with spiritual support often used is Murattal therapy. This therapy uses the media of the Koran (either by listening or reading) to help increase specific changes in the  [4].
Murattal is recorded sound of the Qur'anic verses recited by the qori or the Qur'anic reader [5,6]. Reading the verses of the Al-Qur'an digitally has the advantage of being a constant and regular rhythm in which no sudden change could occur. The tempo of the Al-Qur'an verses is around 60-70/minute accompanied by a low tone frequency which has a relaxing effect that helps reduce patients' anxiety and stress [6,7].
Murattal comes from the word ratala which means basic "harmonious and beautiful". Murattal was also taken from the word "ritl" which means "white, strong, and neatly arranged teeth" described as beautiful and neat recitation [8]. In addition, the term tartil al-kalam is o used to describe clear and systematic speech. The opinion of Ibn 'Abbas and Qatadah emphasizes that reading tartile is reading clearly in terms of articulation and intonation [9]. Therefore, considering the Ibn Abbas opinion, the term of "Murattal" could be understood as reading verses of the Koran, either directly or recorded, in a slow and well articulated way. The reader should also follow the rules of recitation so that the listener can understand and appreciate the contents of the verses of the Koran. The way of Koran reading should be in accrodance with the demand of the Koran at QS. Al-Muzammil / 73: 4 "Or add to it, and recite the Qur'an with measured recitation." (QS. Al-Muzammil / 73: 4) Therefore, by listening to the holy and noble verses of the Qur'an, the vibrations of the neurons will return to stabil condition and even perform their principal functions properly.Based on the translation of the verse, sound at constant speed is useful for reducing chemical mediators that cause stress, activating endorphins, increasing feelings of relaxation to relaxing, distracting clients from fear, anxiety, and tension, improving the physiological system and chemical processes in the body so that It can reduce pressure blood, slow breathing, heart rate, pulse, and electrical wave activity in the brain [10,11].

Subheading
The results of several studies on murattal therapy in dealing with changes in GCS prove that murattal therapy has an effect on changes in the consciousness of patients. These results were based on the reference tracing and the analysis on 6 different articles related to the ropic. Specifically, the results of the search showed that the murattal therapy had an effect on changes in the patient's GCS with the case of decreased consciousness.
Zuhriana K. Yusuf (2019) describes the effects of murattal Al-quran therapy on GCS. According to her research, the murattal has a strong power to change GCS in patients who experience decreased consciousness. Some respondents who had been given this therapy experienced a change in GCS where on average, each respondent experienced an increase in the level of consciousness seen by the increased value on GCS from the motoric aspect [12]. Some patients also experienced improvement on their eyes when given a pain response. The patients were spontaneously opening their eyes, while some others were responding the sounds and commands even though they were not able to open their eyes.
The research results above are certainly in accordance with the research conducted by Widaryati (2016) which explains that Al-Qur'an murattal therapy has an effect on changes in the level of consciousness with the GCS indicator [13]. However, the study revealed that there was no effect of this therapy on blood pressure, respiratory rate, and pulse. This conclusion could be seen from the results of various tests with Wilcoxon which compared the differences before and after therapy on each variable. Blood pressure (systolic & diastolic), respiratory rate, and pulse rate showed no change after being given murattal Al-Qur'an intervention. This is because some of these variables are more systemic. It means that the Al-qur'anmurattal could affect changes in GCS merely which is localized in the brain. Safri (2015) in his research explained that Alquranmurattal could increase consciousness in which the increase was considered to be significant [14]. Physiologically, as the connection between the nervous system and the hormonal www.psychologyandeducation.net system occurs, this therapy (stimulation of music or sound waves) could stimulate the activation of dopamine, which physiologically plays an important role in signal transmission in the brain. The changes that occur in a person's body are none other than the help of Allah AllahSubhanahuWaTaála. It is coherent with what Allah SubhanahuWaTaála says in the Quran surah Al-Isra: 17 By listening to the holy verses of the Qur'an, the signal transmission and activity of neurons in the patient's body will return to stability and function properly. Reading the verses of the Al-Qur'an (Tahsin Al-Qur'an) using the correct tajwid knowledge will bring benefits in the form of peace of mind and heart for those who read and hear it. This activity will make both reader and listener to increase their love for Allah SWT, will find peaceful on their heart and mind, and will appreciate the meaning of the Koran. Besides, the koran could function as as a medicine for patients as stated in the QS. Al-Isra / 17: 82 "And we send down of the Qur'an that which is healing and mercy for the believers, but it does not increase the wrongdoers except in loss" (QS. Al-Isra`: 82).
The meaning of the verse implies that the sending down of the Qur'an becomes an antidote for the heart of ignorance, disbelief and doubt, and becomes a medicine for the body through a spiritual process (IlmuRuqyah). Al-Qur`ān is a blessing for believers who do good deeds with the creator of the universe. Al-Qur`ān becomes a medicine for the human heart so that it avoids envy, lies and turns away from the creator.
Gempitasari&Betriana (2019), with their case study research, explained that 30° head-up adjustment and murattal therapy showed significant results for stroke patients [15]. Moh al Khoif (2015) identified the results of the analysis using Mann Whitney which showed a significant value (p) = 0.001 indicating that there was a difference in the level of awareness between the treatment group that was given murattal therapy compared to the control group that was not given murattal therapy [16].Through this research, it could be seen that there is an effect of Alquranmurattal (Ar-rahman) therapy in the recovery process of patients with the average treatment group value of 9.3 higher than the control group value of 8.2.
This study is in line with research conducted by Naseri-Salahshour, et al. (2015) who proved that for the group with the intervention of the sound of the Koran, there was significant increase in patients' consciousness. In contrast, for the control group without the intervention, there was no significant increase in patients' consciousness. It means that the Koran can increase consciousness in comatose patients [17].
Based on the results of the literature review that has been carried out on murattal al-quran therapy on changes in GCS, it could be concluded that murottal therapy has an effect on changes on patients' consciousness. Based on the analysis on six articles related to murottal therapy, it is concluded that the murottaltheraphy is recommended to be used asalternative for nonpharmacological therapies.The theraphy is considered to use simple techniques, and it does not require a lot of tools and materials, nor doesit require special abilities in providing complementary interventions for critical patients.The theraphy is also considered to be the implementation of Quranic teachings.