Purpose: To examine relationships between functional outcomes after pediatric acquired brain injury (ABI) and measures of rehabilitation dose. Methods: An observational study of children receiving residential neurorehabilitation after severe ABI. Results: Basic total rehabilitation dose shows a paradoxical inverse relationship to global outcome. This is due to confounding by both initial injury severity and length of stay, and variation in treatment content for a given total rehabilitation dose. Content-aware rehabilitation dose measures show robust positive correlations between fractions of rehabilitation treatment received and plausibly related aspects of outcome: specifically, between rates of recovery of gross motor function and the fraction of rehabilitation effort directed to active practice and motor learning. This relationship was robust to adjustment for therapists' expectations of recovery. Conclusion: Content-aware measures of rehabilitation dose are robustly causally related to pertinent aspects of outcome. These findings are step toward a goal of comparative effectiveness research in pediatric neurorehabilitation.
Background Major trauma is a leading cause of death and disability in 16–18-year olds in the UK. Since the launch of major trauma centres (MTCs) in 2012 in UK, survival rates have improved on the whole. The aim of this study was to look at the pathways of 16–18-year olds through one MTC and patterns of rehabilitation provision. Material and methods A retrospective case notes review of all trauma patients aged between 16 and 18 years admitted to one MTC between October 2012 and May 2018. Results One hundred forty-seven young people were identified. 67.3% were male with a mean age of 17.1 years. Motor vehicle accidents were the most common cause of injury (59.2%). Thirty-nine percent had a Glasgow Coma Scale at scene >13. Sixty-three percent were admitted to an adult intensive care unit (ICU), 5.4% to paediatric ICU and 31.3% directly to a ward. Admissions to rehabilitation ward came through adult services with no commissioned equivalent in those admitted to paediatrics. Mean length of stay was 18.1 days. 75.5% of patients were discharged home from the MTC. Discussion The majority of young people were admitted on to adult wards and were able to access commissioned services. However, such services do not provide for the specialist needs of young people, with no access to schooling or parent’s accommodation. Those who were admitted to children’s services missed out on commissioned rehabilitation pathways. Conclusion Young people of transition age often fall between services. For the first time, we illustrate injury patterns and the fragmented services seen in this vulnerable patient group.
IntroductionAcquired brain injury (ABI) is a major cause of morbidity and mortality in childhood. Specialist rehabilitation services are often situated far from families and local services may be non-standardised and fragmented. A strategic level of understanding is needed to improve patient care and outcomes. Roadmapping techniques are commonly used in industry settings to discover and present a systematic understanding of structures; however, they are rarely used in the healthcare setting. With continuing pressures on healthcare systems worldwide, they provide an effective method for examining services.MethodsThe Institute for Manufacturing (IfM) strategic roadmapping method was used to identify areas of difficulty and opportunities in paediatric neurorehabilitation. Participants included stakeholders from a wide range of professions and sectors who have input with children after ABI.ResultsDelegates identified a range of ‘layers’ covering trends, drivers, current experience and unmet needs. From these layers, four priorities were identified and further expanded.These included: ‘access to medical and therapy expertise close(r) to home’, ‘shared understanding across family, school and health’, ‘family and professional awareness of resources and support’ and ‘establishing a centre for rehabilitation technology evaluation, advice and co-ordination of services and research’.ConclusionThe IfM strategic roadmapping method identified and developed key areas for development in the field of paediatric neurological rehabilitation. Healthcare professionals looking at strategic level difficulties should strongly consider the use of such systematic tools when evaluating areas of practice.
ObjectivesTo identify current ‘gaps’ in clinical practice or therapeutic knowledge of the care of neonatal neurointensive care patients and to determine the impact healthcare technologies can have on improving outcomes.DesignThe Cambridge Institute for Manufacturing’s (IfM) roadmapping methodology.SettingCambridge, UK.Participants16 delegates were selected through professional networks. They provided coverage of academia and clinical skills, as well as expertise in neonatology, engineering and technology development.Main outcome measuresA ‘strategic landscape’ has been developed with ‘landmarks’ identified as ‘trends or drivers’, ‘patient pathway experience and unmet needs’ and ‘enabling project or resources’. Priorities were voted on by delegates.Results26 strategic ‘landmarks’ were identified, and of these 8 were considered ‘trends or drivers’, 8 ‘patient pathway experience and unmet needs’ and 10 as ‘enabling project or resources’. Of these, five priorities for the future of neonatal neurocritical care were identified by a voting process: real-time video monitoring for parents; individualised management of preterm infants in neonatal neurocritical care based on real-time multimodal monitoring; continuous electroencephalogram monitoring for early seizure diagnosis; neuroprotection: understanding basic mechanisms; and sleep measurement.ConclusionsThrough the use of the IfM methodology, a list of priorities has been developed for future work into improving the experience and possible outcomes of newborn infants with brain injuries and their families. While not an exhaustive list, it provides the beginning for a national conversation on the topic.
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