Due to advances in healthcare, more children than ever are surviving brain injuries. Some, however, may remain in a coma or with a disorder of consciousness (DOC). This can cause diagnostic, ethical and clinical challenges, and misdiagnoses can lead to inadequate care, and insufficient access to treatment, rehab, and services…
For adults with DOC, clinicians can use the Music therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) to better understand the patient’s recovery, but until recently, there hasn’t been anything similar for children.Acquired brain injuries can lead to language impairment.
And for some children, their language may not have been fully developed before their injury. This renders language-based tests unsuitable for getting proper responses from children to gauge their needs and recovery.
A new addition to the neuro-rehab tool kit is helping to address this, however. The Music Therapy Sensory Instrument for Cognition, Consciousness and Awareness (MuSICCA) supports goal planning for children living DOC.
Its development in recent years has been led by Jonathan Pool, a clinician-researcher at The Children’s Trust; with the charity and the Cambridge Institute for Music Therapy Research now supporting a MuSICCA validation study.
Pool, who also works as a senior music therapist of Chroma, says music can be effective, as it doesn’t rely on language, and has been found to improve motivation in rehab.
It also increases arousal and cognition in adults with DOC, so it is plausible, he says, that the same can be said for children with DOC.
And, he adds, the numbers of children and adults surviving acquired brain injuries is rising due to improvements in healthcare, therefore, the number of children with disorders of consciousness is also likely to rise.
The development of the MuSICCA started after the music therapy team at The Children’s Trust were trained in the adult version, MATADOC, to support treatment planning and assist in diagnosis.
During the training, Pool discussed with Wendy Magee, associate professor of Music Therapy at Temple University, Philadelphia, US, the need for a detailed assessment of responses for children with DOC.
Since then, Pool has been collaborating with Magee about making adaptations to the MATADOC to create the MuSICCA, and consulting clinicians from around the world.
“The medical, education and therapy teams need to know how conscious a child is of his/her body and the environment, including the presence of their family,” Pool says.
“The families of these children are worried and expect the teams caring for their children to use the available knowledge to help their children. They want to know if their child can feel pain, hear their voice, feel their touch, see their face, and know if they are in the room with them.
“In rehabilitation, the families want to know what clinicians are working on and what progress clinicians hope to make with their children. If clinicians do not have valid and reliable tools to provide accurate and reliable knowledge about awareness, responses to stimuli and function, then, how can they plan treatments and goals effectively?”
The MuSICCA uses musical stimuli to maximise opportunities for responses during assessments. There are six tasks within the assessment, all of which involve the child listening to live or recorded music.
Non-stimulated observations are recorded before and after stimulation. The stimulation involves specific tasks and detailed observations made during these tasks.
“Not only are children listening but, where possible, vocalising and/or making sounds or choices of music to be played by the therapist,” Pool says.
Responses are rated across motor, visual, auditory, communication and arousal, showing how the child responds to stimuli.
Pool says there may be several reasons why a similar tool for children doesn’t already exist.
“One factor might be that the model of consciousness is based on adult experience and reflection about this phenomenon,” he tells NR Times.
“This means that the model of consciousness is based on the mature brain, rather than the developing one.
“Another factor is that there are more adults with disorders of consciousness than children. So the need to develop a tool may have emerged earlier for the adult population.
“We hope that the new tool will be able to be used in acute and post-acute hospital settings, rehabilitation units, community settings, specialist schools and homes,” Pool says.
