A study protocol for international consensus guidelines on music therapy for paediatric posterior fossa syndrome

Posterior fossa syndrome (PFS) is a common complication following surgical resection of paediatric posterior fossa tumours, characterised by mutism, ataxia, emotional disturbance, and cognitive impairment. Despite significant rehabilitation needs, there is limited evidence regarding effective therapeutic approaches, including the role of music therapy. Music therapy is uniquely positioned to address the multidimensional needs of children with PFS, yet the low incidence and clinical heterogeneity of the syndrome preclude traditional empirical research designs. International consensus guidelines are therefore needed to consolidate clinical knowledge and support consistent, high-quality practice. This protocol describes a two-phase study to develop international consensus guidelines for music therapy practice with children with PFS. Phase 1 involves a pre-Delphi consultation with three regional Advisory Panels (North America, Europe, Australia), each comprising family representatives, music therapists, allied health professionals, and medical practitioners. These panels will identify clinical priorities, family concerns, and interdisciplinary outcomes to inform the development of the survey instrument. Phase 2 uses an international Delphi process with a minimum of 30 experienced paediatric music therapists, proceeding through three to five iterative rounds of item generation, rating, and refinement. Consensus is defined a priori as ≥80% agreement. Quantitative analysis will be conducted in R; qualitative data will be analysed thematically. The study will be conducted and reported in line with DELPHISTAR recommendations. The resulting consensus guidelines will support developmentally responsive, family-centred music therapy assessment and intervention for children with PFS, while identifying priority areas for future research in paediatric neuro-oncology and neurorehabilitation.