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

Claire M. Ghetti,Alvin Moyer,Wendy L. Magee

doi:10.3389/fpsyg.2015.00698

Claire M. Ghetti, Alvin Moyer + Show 1 more

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https://doi.org/10.3389/fpsyg.2015.00698

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Abstract

Measuring responsiveness to gain accurate diagnosis in populations with disorders of consciousness (DOC) is of central concern because these patients have such complex clinical presentations. Due to the uncertainty of accuracy for both behavioral and neurophysiological measures in DOC, combined assessment approaches are recommended. A number of standardized behavioral measures can be used with adults with DOC with minor to moderate reservations relating to the measures’ psychometric properties and clinical applicability. However, no measures have been standardized for use with pediatric DOC populations. When adapting adult measures for children, confounding factors include developmental considerations for language-based items included in all DOC measures. Given the lack of pediatric DOC measures, there is a pressing need for measures that are sensitive to the complex clinical presentations typical of DOC and that can accommodate the developmental levels of pediatric populations. The music therapy assessment tool for awareness in disorders of consciousness (MATADOC) is a music-based measure that has been standardized for adults with DOC. Given its emphasis on non-language based sensory stimuli, it is well-suited to pediatric populations spanning developmental stages. In a pre-pilot exploratory study, we examined the clinical utility of this measure and explored trends for test-retest and inter-rater agreement as well as its performance against external reference standards. In several cases, MATADOC items in the visual and auditory domains produced outcomes suggestive of higher level functioning when compared to outcomes provided by other DOC measures. Preliminary findings suggest that the MATADOC provides a useful protocol and measure for behavioral assessment and clinical treatment planning with pediatric DOC. Further research with a larger sample is warranted to test a version of the MATADOC that is refined to meet developmental needs of pediatric DOC populations.

Highlights

Disorders of consciousness (DOC) refer to a compromised level of awareness of self and the environment, which manifests as coma, vegetative state (VS), or minimally conscious state (MCS)
Assessor clinicians engaged in the current study anecdotally reported instances of children with Prolonged disorders of consciousness (PDOC) demonstrating increased alertness and responsiveness to vibroacoustic stimuli, delivered via deeply resonant wooden instruments
The MATADOC provides a sensitive measure of responsiveness to sensory stimuli and early indications suggest that it may contribute to differential diagnosis and enable ongoing evaluation of progress for children with PDOC

Summary

Introduction

Disorders of consciousness (DOC) refer to a compromised level of awareness of self and the environment, which manifests as coma, vegetative state (VS), or minimally conscious state (MCS). Consciousness is comprised of the dual dimensions of wakefulness and awareness (The Multi-Society Task Force on PVS, 1994), both of which are lacking in a coma state. Individuals who achieve wakefulness, but continue to lack awareness may be considered to be in a VS, “a clinical condition of complete unawareness of the self and the environment, accompanied by sleep–wake cycles with either complete or partial preservation of hypothalamic and brain-stem autonomic functions” Prolonged disorders of consciousness (PDOC) is a more recent term representing conditions of DOC that persist for more than 4 weeks following sudden acquired profound brain injury (Royal College of Physicians, 2013)

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