Moderate-to-Severe Traumatic Brain Injury in Children: Complications and Rehabilitation Strategies

Abstract

Traumatic brain injury (TBI) is the leading cause of death in children in the United States. Each year 37,200 children sustain a severe TBI, with up to 1.3 million life-years potentially adversely affected. Severe pediatric TBI is associated with significant mortality and morbidity. Of the children who survive their injury, more than 50% experience unfavorable outcomes 6 months after the injury. Although TBI-associated death rates decreased between 1997–2007, disabilities for TBI survivors continue to have both a direct and indirect impact on the economic and human integrity of our society. The degree of disability varies with the severity and mechanism of the injury, but a realm of physical and emotional deficits may be evident for years after the injury occurs. This article describes the pathophysiology of moderate to severe TBI, its associated complications, and opportunities to improve patient outcomes through use of acute management and rehabilitation strategies. To address the many challenges for TBI survivors and their families, including significant financial and emotional burdens, a collaborative effort is necessary to help affected children transition seamlessly from acute care through long-term rehabilitation.

Pediatric Traumatic Brain Injury: Families and Healthcare Team Interaction Trajectories During Acute Hospitalization

“…In our sample, at day 5, patients began to stabilize and slowly recover; therefore, families began to become more engaged in decision making and in bedside caregiving. Family interactions include being taught new skills often associated with feeding, positioning for comfort, hygiene, and cognitive communication (Popernack, Gray, & Reuter-Rice, 2015). …”

Tissue regeneration using endothelial colony-forming cells: promising cells for vascular repair

“…Traumatic brain injury is a significant cause of morbidity and mortality in children (33). Zhang et al first performed transplantation of human CB-ECFCs intravenously to a mouse model of traumatic brain injury and revealed that donor ECFCs were detected in injured brain and increased the microvessel density resulting in significantly less neurologic disability (34).…”

Age-Dependent Responses Following Traumatic Brain Injury

“…It has become increasingly clear that the brain is extremely vulnerable during key developmental epochs. During these sensitive maturation-dependent time windows, childhood TBI may increase the risk of brain dysmaturation and atypical development depending on the severity and location of the injury [21][22][23]. For example, generalized (frontal/extrafrontal) or extrafrontal lesion severity but not frontal lesion alone was predictive of poor performance in children who sustained a moderate to severe TBI at ages 1-9 years of age [23].…”