The use of dopamine enhancing medications with children in low response states following brain injury

Abstract

Primary objective : The study examines the possible relationship between dopamine-enhancing medications and improvement of arousal and awareness in children during persistent low response states (Rancho Los Amigos Levels I, II and III). Research design : A retrospective review was conducted of 10 children enrolled in an existing clinical protocol. The Kluge Children's Rehabilitation Center (KCRC) low response protocol provides a double baseline serial measure (A, A, B, B, B) design. Scores on the Western NeuroSensory Stimulation Profile (WNSSP) are the dependent variable. Methods and procedures : Ten children, mean age of 13.7 years low response state (30 days or more) who were treated with dopamine agonists. Co-morbid or iatrogenic influences were addressed or ruled out. Seven children had traumatic brain injury, one cerebral vascular accident, one anoxia and one encephalitis. Experimental intervention : On average, dopamine medications were started 52.9 days post-event. Main outcomes and results : Paired t -test of WNSSP scores before medications and on medications were significant at p = 0.03 (paired t -test). Also, the distributions of the slopes (rates of change of WNSSP scores over time) were significantly different in the pre-medication and medication phases (Paired T -test, p = 0.02). Random coefficient model comparison of individuals during pre- and medication phase response variability on WNSSP yielded F -test at p = 0.02. Conclusions : These results suggest a promising relationship between acceleration of recovery for some children in a low response state and administration of dopamine-enhancing medications.