Interventions to improve outcomes in children and young people with unresponsive wakefulness syndrome following acquired brain injury: A systematic review

Unresponsive wakefulness syndrome (UWS) is a disorder of consciousness (DoC) which describes a state of wakefulness without evidence of self or environmental awareness, or interaction. There is currently no universally accepted evidence-based intervention for the treatment of UWS. This systematic review aimed to identify interventions to improve functioning in children and young people (0-25 years) with UWS following acquired brain injury (ABI). A systematic review of electronic databases was conducted, consisting of CINAHL, EMBASE, Medline, PsycINFO, PubMed, Cochrane Library, Scopus and Google Scholar. Eight studies met inclusion criteria. In these studies, the outcomes of interventions which aimed to improve quality of life, functional outcomes and/or increases in level of consciousness of paediatric patients in UWS were reported. Retrieved studies presented some evidence for improved consciousness and functional outcomes, following multi-component neurorehabilitation programmes, sensory stimulation or pharmacological interventions. Quality appraisal, using a modified version of the Downs and Black (1998) checklist, revealed risk of bias in a number of sources, including insufficient control over confounding variables, the use of inadequately validated outcome measures and concerns regarding diagnostic accuracy. More robust research is needed to adequately determine which interventions are most valuable at improving outcomes in paediatric UWS and to provide an improved evidence base for clinicians to draw upon when selecting treatment for patients. (C) 2020 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.