Sensory Stimulation for Children and Youth with Disorders of Consciousness: Recommendations from the developing evidence-base

Description:

Disorders of Consciousness (DOC) occur in children following acquired brain injury. Evidence-based interventions and assessments for this complex population are limited as a solid body of research with pediatric DOC is lacking. Drawing on the emerging research and current clinical practice, this panel will share and discuss sensory stimulation approaches that have been protocolized for intervention and research, and examine the current theoretical rationale underpinning these approaches. Through brief verbal presentations our speakers look at the effects of salient stimuli in sensory stimulation. Evidence from the adult literature will be presented regarding auditory stimulation. We will then address the evidence from the pediatric literature regarding auditory processing of musical stimulation and describe a clinical protocol using music for sensory stimulation with youth. Lastly, participants will discuss the implications of all of the evidence presented for delivering evidence-based protocols for children and youth with DOC.

Dr. Paasch will discuss a behavioral approach to identifying individualized and personally relevant stimuli for individuals with DOC across multiple sensory domains. A structured interview (Preference Assessment for Youth with Disorders of Consciousness (PAYDOC)) and methodology of a preference assessment will be described as tools to identify these salient stimuli. Identified preferred stimuli can be incorporated throughout rehabilitation, school, and daily life to individualize treatment, reinforce effort, and provide meaningful stimulation for youth with DOC. Dr. Paasch will use a case example to illustrate this approach to identifying and using preferred items across sensory domains to optimize care for youth with DOC. Dr. Magee will provide an overview of the evidence emerging from brain imaging and behavioral studies for using music as an auditory stimulus with DOC patients. Music’s role in promoting arousal and attention in particular will be examined, and the theoretical foundations underpinning these observed effects. Lastly, the potential use of music to optimize interdisciplinary rehabilitation and care of youth with DOC will be considered. Ms Bower will present the results of a recent systematic review exploring the neurophysiological processing of musical stimuli in typically developing children and expand upon this, exploring the foundational role of music for children presenting with a severe acquired brain injury. Further, referencing clinical cases she will explore the acute period following an ABI as a unique window of rehabilitative opportunity to utilize familiar music to stimulate early arousal and awareness. Dr. Pool will discuss the use of music in the assessment and treatment of children with DOC. Music can be particularly salient as a stimulus depending on the child or young person’s exposure to music. Methodological issues regarding stimulation and behavioural assessment will be briefly discussed. Evidence will be presented describing the use of music to improve responsiveness in children with DOC. Dr. Pool will describe the Music therapy Sensory Instrument for Cognition, Consciousness and Awareness (MuSICCA), adapted from a standardized adult protocol for use with children and youth. Clinical examples will be used to illustrate how music has been used for sensory stimulation and assessment with children and young people with DOC.

Learning Objectives:

  • Identify one way to behaviorally identify personally salient stimuli for youth with DOC.
  • Explain the current theory of music’s effect on behaviors indicating awareness.
  • Articulate a rationale for the use of music in acute pediatric DOC

 

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