A disorder of consciousness resulting from a brain injury can cause the loss or reduction of a wide spectrum of functions and abilities. Music therapy can provide significant information for a differential diagnosis between a minimally conscious state and a vegetative state in an interdisciplinary assessment. Through a specific approach and personalized interventions, the music therapist can facilitate a patient's purposeful responses. There is a diverse body of research on the links between music and brain function. The processing of musical elements and structures is considered a highly demanding task for the brain, as multiple brain functions occur simultaneously in a highly organized and coordinated process. The purpose of this article is to contribute to the existing literature on differential diagnosis between vegetative state and minimally conscious state through a case report and analysis of music therapy interventions based on clinical improvisation. The article aims to explore how music may be employed as part of a comprehensive, multimodal approach to differential diagnosis and how musical interventions may provide data to determine the potential for rehabilitation of patients with disorders of consciousness. © the American Music Therapy Association 2014. All rights reserved.