Clinical Features of Disorders of Consciousness in Young Children

Publication date: Available online 9 January 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Gabrielle Alvarez, Stacy J. Suskauer, Beth Slomine

Abstract

Objectives

To investigate behavioral and demographic features of levels of consciousness in young children with brain injury, including classifications of conscious (CS), minimally conscious (MCS), and vegetative states (VS), and to investigate the course of recovery in children with disorders of consciousness (DOC).

Design

Retrospective chart review and post-hoc analysis.

Setting

Pediatric inpatient rehabilitation unit.

Participants

Children aged 6 months to 5 years (n=54) admitted for inpatient rehabilitation directly from an acute care hospital following new neurologic injury from 2011 – 2016.

Interventions

N/A.

Main Outcome Measures

Clinically abstracted behavioral features of DOC and levels of consciousness at admission and discharge, based on established guidelines from the Aspen Neurobehavioral Conference Workgroup.

Results

Children in MCS were younger than children in CS. Commonly observed behaviors in children in VS were mouth movements or vocalizations, flexion withdrawal or motor posturing, visual or auditory startle, and localization to sound. Common features of MCS were contingent affect, visual fixation or pursuit, automatic motor behavior, and contingent communicative intent. No children in MCS showed command following or intelligible verbalizations. All children in CS showed functional object use, while functional communication was observed in a subset. By discharge, more than half of children in VS emerged to MCS, and a third emerged from MCS to CS. No child emerged from VS to CS.

Conclusions

Visual and motor skills may be most applicable, and language-based skills may be least applicable for the assessment of DOC in very young children. Accurate classifications of consciousness may have important prognostic implications, and additional research is needed to develop clear guidelines for assessment of DOC in this population.

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