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Brain Injury Responsiveness Program
Kennedy Krieger Institute • 707 N. Broadway • Baltimore, MD, 21205
Stacy Suskauer, MD
Beth Slomine, PhD, ABPP
Adrianna Amari, PhD
About Our Program:
The Brain Injury Responsiveness Program at Kennedy Krieger Institute evaluates and treats children and adolescents with a history of injury to the brain who exhibit altered arousal and/or altered ability to interact with their environment. Our program includes detailed interdisciplinary evaluations and state-of-the-art treatment techniques. Patients are initially evaluated in our outpatient clinic by an interdisciplinary team of physicians and therapists. During this initial assessment period, the team will evaluate medical issues, including medication regimen and sleep, sensory and motor functioning, responsiveness, and motivational stimuli.
Following the evaluation, the interdisciplinary treatment team and the patient's family will work together to identify goals for participation in the program. Patients will either be admitted to our inpatient neurorehabiliation unit or receive intensive outpatient coordinated care. Subsequent evaluations and treatment are carried out by a specialized interdisciplinary team with expertise in disorders of consciousness that works together to address issues through direct interaction with patients and regular interdisciplinary discussions.
Primary Program Goals:
Our expert physicians and therapists make it possible for our program to address goals in patients with limited to no response to their surrounding environment. We currently admit two types of patients:
- Acute Rehabilitation Patients: Acute rehabilitation patients are children who are experiencing their first rehabilitation following a new injury or illness. For an acute rehabilitation patient, goals of the inpatient admission include optimizing the child's responsiveness and function, in addition to preparing the family to care for the child at home.
- Chronic Rehabilitation Patients: Chronic rehabilitation patients are children with chronic effects of injury or illness who have previously been discharged from an inpatient rehabilitation setting or never received acute inpatient rehabilitation. For a chronic rehabilitation patient, specific goals are identified prior to admission and are addressed in a time-limited manner that typically lasts two to four weeks. Common goals include optimization of medication management, strengthening of potential means of functional communication, maximizing positioning, and other goals to promote motor functioning.
Our interdisciplinary team has extensive experience evaluating and treating patients with disorders of consciousness from infancy through adolescence. Members of this team include:
- Physicians: Neurologists, physiatrists, and developmental pediatricians with specialized experience in managing sequelae of severe brain injury, including motor dysfunction, sleep dysregulation, and impaired arousal and awareness. Special attention is given to managing medications in an effort to reduce sedating medications, while considering medications to promote arousal such as amantadine, methylphenidate, and Ambien.
- Neuropsychologists: Neuropsychologists with expertise in the assessment of children who are minimally responsive provide systematic evaluation of arousal and responsiveness through the use of standardized clinical assessment techniques as well as individualized measurements designed to evaluate each child's particular responses. Information gathered by our neuropsychologists is used to evaluate the effectiveness of current medication and therapeutic interventions.
- Behavioral Psychologists: Behavioral psychologists with expertise in functional behavioral analysis collect and analyze data about the child's sleep to determine the need for medical and/or environmental recommendations to improve day time arousal and nighttime sleep. Our behavioral psychologists also obtain information from the child's family and therapists regarding the child's likes and dislikes. These preferences are systematically evaluated to ensure that preferred items are incorporated into daily therapy as motivators.
- Rehabilitation Therapists: Physical therapists, occupational therapists, and speech-language therapists with expertise in disorders of consciousness intensively work with children to address goals related to swallowing, functional mobility, optimal positioning, functional communication and responsiveness. Although these therapies are typically found in programs traditionally known as "coma stimulation" programs, in our program they are uniquely paired with additional intensive evaluation and treatment services from other specialists.
Several team members also hold faculty appointments at both Kennedy Krieger Institute and Johns Hopkins Hospital.
Publications & Presentations:
Slomine, B.S., Eikenberg, J., Salorio, C.F., Suskauer, S., Trovato, M., Christensen, J.R. Preliminary Evaluation of the Cognitive Linguistic Scale: A Measure to Assess Recovery in Inpatient Rehabilitation following Pediatric Brain Injury. Journal of Head Trauma Rehabilitation. 2008: 23, 286-293.
Suskauer SJ, Slomine BS, Inscore AB, Lewelt AJ, Kirk JW, Salorio CF. Injury severity variables as predictors of WeeFIM scores in Pediatric TBI: time to follow commands is best. Journal of Pediatric Rehabilitation Medicine. 2009: 2, 297-307.
Kramer, ME, Suskauer, SJ, Christensen, JR, DeMatt, EJ, Trovato, MK, Salorio, CF, Slomine, BS (in press). Examining acute rehabilitation outcomes for children with total functional dependence after traumatic brain injury: a pilot study. Journal of Head Trauma Rehabilitation.
Kramer, M., Suskauer, S., Christensen, J., DeMatt, E., Trovato, M., & Slomine, B. (2010). Predictors of recovery during inpatient rehabilitation following severe pediatric traumatic brain injury. [abstract]. The Clinical Neuropsychologist, 24(4), 627.
McCann, S, Suskauer, S., Amari, A., Pennington, H., Slomine, B.(2011, February) Use of Neurobehavioral Assessment to Detect Effects of Weaning Sedating Medications in a Minimally Conscious Child. Poster accepted for presentation at the annual meeting of the International Neuropsychological Society in Boston, MA.
Pennington, H, Suskauer, S, Amari, A., McCann, S., Slomine, B. (2011, February) Use of Methylphenidate Improved Responding in a Minimally Conscious Child 14 Months after Traumatic Brain Injury. Poster accepted for presentation at the annual meeting of the International Neuropsychological Society in Boston, MA.
Kramer M, Suskauer S, DeMatt E, Slomine B. Recovery Patterns of Children with Anoxic Brain Injury in an Inpatient Rehabilitation Setting. Annual Meeting of the International Neuropsychological Association, February 2011.
Amari A, Paasch V, Suskauer SJ, Slomine BS, Slifer K. Using Behavioral Assessment Methods to Identify Preferred Environmental Stimuli for Children with Disorders of Consciousness. Annual Meeting of the International Brain Injury Association, 2012.
Austin CA, Slomine BS, DeMatt EJ, Salorio CF, Suskauer SJ. Time to follow commands (TFC) remains the best predictor of WeeFIM scores in pediatric TBI one year after discharge. Annual Conference of the American Academy of Clinical Neuropsychology, 2012.
To make a referral or request an initial evaluation:
Contact our Care Management Office
Toll-Free Referral: (888) 554-2080
Local Referral: (443) 923-9400
TTY: (443) 923-2645 or Maryland Relay 711
For Health Care Professionals:
To make a referral, call our Physicians Referral Line at (443) 923-9403.