Novel Approaches in the Evaluation and Treatment of Children with Disorders of Consciousness



Beth Slomine


Beth Slomine
Valerie Paasch
Jonathan Pool
Stacy Suskauer



Disorders of Consciousness (DOC) including coma, vegetative state, and minimally conscious state can occur following acquired brain injury.  The literature on pediatric DOC is sparse and there are no specific clinical guidelines for behavioral evaluation or treatment of children with DOC.  This symposium will focus on reviewing the existing literature and introducing novel approaches in evaluation and treatment of pediatric DOC.

Dr. Slomine will provide an overview of behavioral measures of DOC and outline challenges to behavioral assessment and intervention in pediatric DOC. Studies exploring the use of behavioral assessment tools in pediatric DOC are limited by the wide “pediatric” age range, including infants to young adults.  Assessment of DOC is particularly challenging in the youngest children due to their limited repertoire of behaviors and rapid development of skills.  Emerging tools, including the Coma Recovery Scale – Pediatric (for children ages 2 and older) and the Responsive Recovery Scale (for children ages 0 -2 and those with pre-existing developmental delay) will be described. 

Dr. Paasch will discuss modifications and application of systematic behavioral methods used to identify highly idiosyncratic and personally meaningful stimuli that can be incorporated in multiple ways throughout rehabilitation to individualize treatment programs for youth with DOC.  Observational data collection as well as a new structured interview,  the Preference Assessment for Youth with Disorders of Consciousness, will be described, and a case example will be provided to illustrate the use of this unique methodology to identify preferred items across sensory domains and optimize care.

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 patient’s exposure to music.  Recent guidelines for adults advise that evaluative stimulation used with patients with DOC should maximize stimuli that are familiar to the patient, highlighting the use of the patient’s favorite music.  Evidence will be presented describing the use of music as an individually tailored intervention to improve responsiveness in children with DOC. Dr. Pool will discuss emerging evidence supporting the use of music within the protocol of a diagnostic tool – the Music therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC). Additionally, Dr Pool will present the Music therapy Sensory Instrument for Cognition, Consciousness and Awareness (MuSICCA), which is a version of the MATADOC that has been adapted for use with children and youth.

Dr. Suskauer will provide an overview of the evidence-based for pharmacological interventions for children with DOC.  She will discuss a strategy of medication management that involves systematically weaning sedating medication and adding medications to promote arousal and responsiveness.  Case examples will be provided to highlight the use of behavioral assessment tools to inform medication management over time.   


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