Emergence to the Conscious State During Inpatient Rehabilitation After Traumatic Brain Injury in Children and Young Adults

Abstract

In this limited cohort, the majority of patients with disorders of consciousness after traumatic brain injury emerged to CS during acute inpatient rehabilitation, underscoring the presence of functional goals for inpatient rehabilitation in this population. Larger cohorts are needed to further explore clinical variables associated with emergence to CS.

Joint Neuropsychological Assessment through Coma/Near Coma and Level of Cognitive Functioning Assessment Scales Reduces Negative Findings in Pediatric Disorders of Consciousness

“…No specific scale adaptation was needed. CNCS was applicable to the youngest patients, in agreement with previous cases of effective employment in pediatrics [14,30,31]. LOCFAS was administered to all 54 children older than 48 months.…”

“…Novel assessment tools are generally designed for and calibrated on adult cohorts. Validation in children remains sporadic, sized on small samples and aimed to the 'wide' pediatric age [13,14]. A recent survey and the most updated guidelines have both highlighted a lack of appropriate tools and standards for pediatrics [1,15].…”

“…The Coma Recovery Scale-Revised [26] has emerged as the gold standard neurobehavioral measure for assessment of adult cases; nevertheless, it has only been adapted and tested on healthy children so far [27]. Albeit lacking wide validation in children, the Rappaport Coma/Near Coma Scale (CNCS) [28,29] has been successfully applied in a few pediatric cases and small cohorts [14,30,31]. Ease of administration, basic behavioral cognitive and motor requirements of items, and suitability for a wide spectrum of ages are the main reasons for its increasing application.…”

Feasibility of the music therapy assessment tool for awareness in disorders of consciousness (MATADOC) for use with pediatric populations

“…Despite the challenges associated with diagnosis of DOC in pediatric populations, there are important clinical reasons for achieving accurate diagnosis. Accurately assessing the presence or absence of a particular disorder of consciousness and understanding typical trajectories of recovery serve as prerequisites for formulating appropriate treatment goals and providing family support and advisement for appropriate expectations ( Ashwal, 2003 ; Pham et al, 2014 ). For example, in acute care and short-term rehabilitation settings, comprehensive interdisciplinary efforts can improve outcomes for children who experience a DOC as a result of an acquired TBI ( Ashwal, 2003 ; Pham et al, 2014 ).…”

International survey on diagnostic and prognostic procedures in pediatric disorders of consciousness

“…Recent studies have examined these methods in small cohorts of children with DoC,(25,26,39) exploring sub-tentorial diffusion tensor imaging measures as diagnostic biomarkers and electroencephalographic sleep/wake modulation as a prognostic biomarker.While advanced neuroimaging and neurophysiological techniques, such as event related potentials, visual evoked potentials and fMRI can supplement clinical evaluation, availability, methodological constraints and challenges in data interpretation might limit their use in clinical routine of patients with DoC (40). Outcome from DoC is difficult to predict in children and adults; however, similar to adults, levels of consciousness (MCS versus VS/UWS) have been associated with outcome (10,11,41). Consistent with this literature, most respondents indicated using levels of consciousness as a prognostic marker for older children.…”