Music in the Treatment of Children and Youth with Prolonged Disorders of Consciousness.

Children and youth with disorders of consciousness (DOC) are defined as those under 18 years of age who show wakefulness, but with absent or reduced awareness. This condition is considered to be prolonged when this state lasts for longer than four weeks. Hence, the term prolonged disorders of consciousness (PDOC) (Royal College of Physicians, 2013). Children and youth with DOC need care that can meet their highly complex needs. This care includes careful stimulation to elicit purposeful responses in assessment and evaluation, and managing an individualu0027s environment optimally to meet their sensory needs. Accuracy in determining awareness is paramount due to several factors. First, ethical issues surround the provision of appropriate care (Ashwal, 2013) regarding the design and use of the type of sensory stimulation and the intensity of the intervention. Second, admission to rehabilitation programmes is affected by accurate diagnosis (Eilander et al., 2005), as this would ensure that those who could benefit are not excluded from admission to these programmes. Third, end-of-life decisions are critically dependent upon correct diagnosis (Ashwal and Cranford, 2002), when clinicians, families, and the legal system consider continuation or withdrawal of intervention in the light of the patientsu0027 pain and suffering and their prognosis for recovery.Although guidance for working with adults with PDOC is available (Royal College of Physicians, 2013), there are no specific clinical guidelines for working with children and youth with PDOC. Recovery following brain injury in adults is better understood than in pediatric populations (Anderson and Yeates, 2010; Ponsford, 2013). This has resulted in theories about recovery of consciousness being based on adult brains, despite neurodevelopmental differences between child, and adult brains (Ashwal and Cranford, 2002; Perner and Dienes, 2003), particularly within the frontal lobes (Nicholas et al., 2014). This poses several problems for clinicians. Evaluation and treatment guidelines for rehabilitation with pediatric PDOC are adapted from those used with adults. However, guidance on adaptation is limited and dependent on cliniciansu0027 specialist knowledge, which is likely to be highly variable. The dearth of knowledge regarding neurological recovery from PDOC in childhood positions some theorists to argue that the immature brain is less susceptible to damage due to its plasticity, whereas others propose that the developing brain is more vulnerable to injury (Bower and Shoemark, 2012). Hence, more must be understood about recovery from brain injury in the pediatric population.