Rehabilitation in Children with Disorder of Consciousness

Yeh, Nancy; Slomine, Beth S.; Paasch, Valerie; McLean, Heather B.; Suskauer, Stacy J.

doi:10.1007/s40141-019-0214-4

Cited by 16 publications

(18 citation statements)

References 54 publications

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“…The clinician performing the CRS-R will not be blinded to stimulation conditions. The CRS-R is considered appropriate to use in children aged 5 to 17 years 1…”

Section: Methodsmentioning

confidence: 99%

“…Children with disorders of consciousness (DOC) after acquired brain injury (ABI) are frequently encountered in paediatric rehabilitation settings. DOC are conditions of severely altered arousal and responsiveness and include the minimally conscious state (MCS) and the vegetative state/unresponsiveness wakefulness syndrome (VS/UWS (VS)) 1. The MCS is characterised by minimal but persistent evidence of self or environmental awareness 1.…”

Section: Introductionmentioning

confidence: 99%

“…DOC are conditions of severely altered arousal and responsiveness and include the minimally conscious state (MCS) and the vegetative state/unresponsiveness wakefulness syndrome (VS/UWS (VS)) 1. The MCS is characterised by minimal but persistent evidence of self or environmental awareness 1. The VS is defined by the presence of arousal without any clear evidence of self and environmental awareness 1…”

Section: Introductionmentioning

confidence: 99%

“…The MCS is characterised by minimal but persistent evidence of self or environmental awareness 1. The VS is defined by the presence of arousal without any clear evidence of self and environmental awareness 1…”

Section: Introductionmentioning

confidence: 99%

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Single-arm, open-label, dose escalation phase I study to evaluate the safety and feasibility of transcranial direct current stimulation with electroencephalography biomarkers in paediatric disorders of consciousness: a study protocol

et al. 2019

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IntroductionChildren with disorders of consciousness (DOC) represent the highest end of the acquired brain injury (ABI) severity spectrum for survivors and experience a multitude of functional impairments. Current clinical management in DOC uses behavioural evaluation measures and interventions that fail to (1) describe the physiological consequences of ABI and (2) elicit functional gains. In paediatric DOC, there is a critical need to develop evidence-based interventions to promote recovery of basic responses to improve rehabilitation and aid decision-making for medical teams and caregivers. The purpose of this investigation is to examine the safety, tolerability and feasibility of transcranial direct current stimulation (tDCS) in children with DOC.Methods and analysisThis study is an open-label dose escalation trial evaluating the safety, tolerability and feasibility of tDCS in 10 children (5–17 years) receiving inpatient rehabilitation for DOC. This study will follow a modified rule-based design, allowing for intrapatient escalation, where a cohort of patients will be assigned to an initial tDCS current of 0.5 or 1 mA based on participant’s head circumference and according to the safety data available in other paediatric populations. The subsequent assignment of increased current (1 or 2 mA) according to the prespecified rules will be based on the clinical observation of adverse events in the patients. The study will include up to three, 20 min sessions of anodal tDCS (sham, 0.5 or 1 mA, 1 or 2 mA) applied over the dorsolateral prefrontal cortex. The primary outcomes are adverse events, pain associated with tDCS and intolerable disruption of inpatient care. Secondary outcomes are changes in electroencephalography (EEG) phase-locking and event-related potential components and the Coma Recovery Scale-Revised total score from prestimulation to poststimulation.Ethics and disseminationThe Johns Hopkins IRB (#IRB00174966) approved this study. Trial results will be disseminated through journals and conferences.Registration numberNCT03618849.

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“…The clinician performing the CRS-R will not be blinded to stimulation conditions. The CRS-R is considered appropriate to use in children aged 5 to 17 years 1…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Single-arm, open-label, dose escalation phase I study to evaluate the safety and feasibility of transcranial direct current stimulation with electroencephalography biomarkers in paediatric disorders of consciousness: a study protocol

et al. 2019

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“…Amantadine is a dopaminergic agonist that has improved rates of recovery in adults with disorders of consciousness after TBI, as well as irritability and abnormal behavior. 18…”

Section: Treatment Considerationsmentioning

confidence: 99%

Acquired Brain Injury in the Pediatric Intensive Care Unit: Special Considerations for Delirium Protocols

Tikkanen

Kudchadkar

Goldberg

et al. 2020

J Pediatr Intensive Care

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The goal of this article is to highlight the overlapping nature of symptoms of delirium and acquired brain injury (ABI) in children and similarities and differences in treatment, with a focus on literature supporting an adverse effect of antipsychotic medications on recovery from brain injury. An interdisciplinary approach to education regarding overlap between symptoms of delirium and ABI is important for pediatric intensive care settings, particularly at this time when standardized procedures for delirium screening and management are being increasingly employed. Development of treatment protocols specific to children with ABI that combine both nonpharmacologic and pharmacologic strategies will reduce the risk of reliance on treatment strategies that are less preferred and optimize care for this population.

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