# The development and face validity of the music therapy sensory instrument for cognition, consciousness, and awareness (MuSICCA)

## TL;DR

The MuSICCA is a new music-based tool designed to assess consciousness in children and young people with severe brain injuries, and initial feedback suggests it is valid and useful.

## Contribution

The MuSICCA is a novel music-based behavioral assessment for evaluating consciousness in children and young people with disorders of consciousness.

## Key findings

- Participants showed substantial agreement that MuSICCA is an effective assessment of consciousness and awareness.
- MuSICCA was perceived as suitable for use with children and young people across a wide age range.
- Strengths include caregiver involvement, salient stimulation, and support for clinical teams.

## Abstract

Severe brain injuries in children and young people can result in disorders of consciousness. This can pose significant challenges for the brain injury survivor as they may struggle to show awareness; for their family, who want to help their child to recover consciousness; and for the team providing treatment and care for them, who need an assessment that will inform optimal treatment and care planning. Currently, there is a paucity of fully validated behavioral tools to assess consciousness in 2–18-year-olds. Assessing awareness across this age range is challenging and complex due to neurodevelopmental changes that occur during maturation. This study evaluated the face validity of a music-based behavioral assessment for children and young people with disorders of consciousness. This is known as the Music therapy Sensory Instrument for Cognition, Consciousness and Awareness (MuSICCA). The study recruited 20 participants to compose a mixed cohort of music therapists, non-music therapy healthcare professionals and family members with lived experience of caring for a child or young person with a disorder of consciousness. These participants reviewed the MuSICCA and evaluated its suitability as an assessment of consciousness for use with children and young people. They provided feedback by rating their level of agreement with two statements and they also described the perceived strengths and limitations of the MuSICCA. The results showed substantial agreement among raters that the MuSICCA appears to be an assessment of consciousness and awareness, and that the MuSICCA appears to be suitable for use with children and young people. Its strengths include being rigorous, comprehensive, providing guidance and opportunity for caregiver involvement, its use of salience in stimulation, and its utility in supporting the wider clinical and care teams. The findings suggest that the MuSICCA may be a valuable assessment tool in providing treatment and care for children and young people with disorders of consciousness and their families.