Local and global challenges in pediatric traumatic brain injury outcome and rehabilitation assessment

Schrieff-Elson, Leigh E.; Steenkamp, Nina; Hendricks, M; Thomas, Kevin G. F.; Rohlwink, Ursula K.

doi:10.1007/s00381-017-3527-6

Cited by 16 publications

(6 citation statements)

References 117 publications

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“…Further, this study made use of parent self-report measures, which may be limited by response sets, social desirability bias, and sometimes unreliable recall from memory of past behaviors. The measures used have not been validated in the SA context—as is the case generally with neuropsychological measures (Schrieff-Elson et al, 2017 ). Nevertheless, informant measures were used in this study due to their psychometric properties and that they are commonly used assessment tools.…”

Section: Discussionmentioning

confidence: 99%

Academic and Behavioral Outcomes in School-Age South African Children Following Severe Traumatic Brain Injury

2017

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Background: Children who have sustained severe traumatic brain injuries (TBIs) demonstrate a range of post-injury neurocognitive and behavioral sequelae, which may have adverse effects on their academic and behavioral outcomes and interfere with school re-entry, educational progress, and quality of life. These post-TBI sequelae are exacerbated within the context of a resource-poor country like South Africa (SA) where the education system is in a somewhat precarious state especially for those from disadvantaged backgrounds.Objectives: To describe behavioral and academic outcomes of a group of school-aged SA children following severe TBI.Methods: The sample included 27 school-age children who were admitted to the Red Cross War Memorial Children's Hospital (RXH), SA, between 2006 and 2011 for closed severe TBI and who received intracranial monitoring. We collected behavioral data using the Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF) and academic information sourced from the BRIEF, CBCL, medical folders, and caregivers. Analyses include descriptive statistics and bivariate correlation matrices.Results: The descriptive results show that (1) more than half of the participants experienced clinically-significant behavioral problems across the CBCL scales, (2) the working memory BRIEF subscale appeared to be the most problematic subdomain, (3) two thirds of the sample were receiving some form of, or were in the process of being placed in, special needs education, (4) there was a three-fold increase in the use of special education services from pre- to post-injury, and (5) more than half (n = 16) of the sample repeated at least one grade after returning to school post-injury. Correlation analyses results suggest that children with increased externalizing behavioral problems and executive dysfunction are more likely to repeat a grade post-injury; and that children with executive dysfunction post-TBI are more likely to require some form of special educational services.Conclusion: While there is a vast amount of literature on pediatric TBI (pTBI) academic and behavioral outcomes, little literature exists on the pTBI population from the developing world and SA specifically. This is important to address given unique challenges that face the country and its educational system, and its implications for the management and care of children post-TBI.

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Section: Discussionmentioning

confidence: 99%

Academic and Behavioral Outcomes in School-Age South African Children Following Severe Traumatic Brain Injury

2017

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“…Second, the mechanisms and patterns of injury are different. Finally, assessment of outcome in children is made difficult by the lack of a stable baseline for comparison—children are in a developmentally accelerated phase ( 165 ). Unfortunately, various pharmacological therapies have shown promise in the laboratory but have failed to improve outcome after TBI, including most recently progesterone in the PROTECT III trial.…”

Section: Developmental Outcomesmentioning

confidence: 99%

Anatomical and Physiological Differences between Children and Adults Relevant to Traumatic Brain Injury and the Implications for Clinical Assessment and Care

Figaji

2017

Front. Neurol.

128

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General and central nervous system anatomy and physiology in children is different to that of adults and this is relevant to traumatic brain injury (TBI) and spinal cord injury. The controversies and uncertainties in adult neurotrauma are magnified by these differences, the lack of normative data for children, the scarcity of pediatric studies, and inappropriate generalization from adult studies. Cerebral metabolism develops rapidly in the early years, driven by cortical development, synaptogenesis, and rapid myelination, followed by equally dramatic changes in baseline and stimulated cerebral blood flow. Therefore, adult values for cerebral hemodynamics do not apply to children, and children cannot be easily approached as a homogenous group, especially given the marked changes between birth and age 8. Their cranial and spinal anatomy undergoes many changes, from the presence and disappearance of the fontanels, the presence and closure of cranial sutures, the thickness and pliability of the cranium, anatomy of the vertebra, and the maturity of the cervical ligaments and muscles. Moreover, their systemic anatomy changes over time. The head is relatively large in young children, the airway is easily compromised, the chest is poorly protected, the abdominal organs are large. Physiology changes—blood volume is small by comparison, hypothermia develops easily, intracranial pressure (ICP) is lower, and blood pressure normograms are considerably different at different ages, with potentially important implications for cerebral perfusion pressure (CPP) thresholds. Mechanisms and pathologies also differ—diffuse injuries are common in accidental injury, and growing fractures, non-accidental injury and spinal cord injury without radiographic abnormality are unique to the pediatric population. Despite these clear differences and the vulnerability of children, the amount of pediatric-specific data in TBI is surprisingly weak. There are no robust guidelines for even basics aspects of care in children, such as ICP and CPP management. This is particularly alarming given that TBI is a leading cause of death in children. To address this, there is an urgent need for pediatric-specific clinical research. If this goal is to be achieved, any clinician or researcher interested in pediatric neurotrauma must be familiar with its unique pathophysiological characteristics.

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“…Paediatric rehabilitation presents unique challenges, primarily due to a child's ongoing development. As a result, the consequences of an ABI may not be immediately apparent but may only emerge as the child moves through the developmental trajectory (DePompei & Blosser, 2019;Schrieff-Elson et al, 2017). Ardila (2019) reports that early damage to the brain may not result in the direct loss of ability but difficulty to develop that ability in the future.…”

Section: Introductionmentioning

confidence: 99%

Exploring clinicians’ experiences of engaging in collaborative music therapy and speech and language therapy for children with an acquired brain injury

Burns,

O’ Connor

2023

AIJMT

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Music therapy and speech and language therapy are extensively used in the rehabilitation of communication and social interaction skills following acquired brain injury (ABI). Increasing evidence suggests that collaboration between the two disciplines may yield positive outcomes for the paediatric population. However, little is known about clinicians’ experiences of engaging in collaborative music therapy and speech and language therapy within paediatric rehabilitation settings, and there is a need to further explore and understand collaborative therapy to identify strategies for improving client outcomes as well as clinicians’ experiences. This study aimed to explore music therapists’ and speech and language therapists’ experiences of working collaboratively to develop communication and social interaction skills in children with ABI. The study also intended to gain further insights into collaborative practices as well as strategies and interventions used in joint sessions. Semi-structured interviews were conducted with three clinicians (two music therapists and one speech and language therapist) who have previously engaged in collaborative practices with this population. The interviews were analysed using thematic analysis. Four themes emerged from the data: (a) benefits of a collaborative approach, (b) limitations of conjoint work (c) collaborative practices, and (d) need for further research. Key findings suggested that conjoint working between music therapy and speech and language therapy facilitates increased attention and motivation which enables the client to engage in interpersonal interactions and develop communication skills. Joint working is a crucial component of music therapy practice within paediatric ABI. Larger studies are warranted to further explore its complexities and to advocate for this valuable yet demanding approach.

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Local and global challenges in pediatric traumatic brain injury outcome and rehabilitation assessment

Cited by 16 publications

References 117 publications

Academic and Behavioral Outcomes in School-Age South African Children Following Severe Traumatic Brain Injury

Academic and Behavioral Outcomes in School-Age South African Children Following Severe Traumatic Brain Injury

Anatomical and Physiological Differences between Children and Adults Relevant to Traumatic Brain Injury and the Implications for Clinical Assessment and Care

Exploring clinicians’ experiences of engaging in collaborative music therapy and speech and language therapy for children with an acquired brain injury

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