Physiotherapy in children hospitalized with traumatic brain injury in a South African tertiary paediatric hospital

Abstract

Introduction: Physical impairments following traumatic brain injury (TBI) may limit participation in daily living. Physiotherapy could assist in managing these limitations, however, there is a paucity of literature on the physiotherapy management of children in the acute phase of TBI. Objectives: To describe the characteristics, course and outcome of children hospitalized with TBI, with specific reference to the role of physiotherapy. Methods: A retrospective folder review of all children (n = 130, median 5.37 years [IQR 1.88-7.88]) admitted in 2016 with a primary diagnosis of TBI was conducted at a tertiary paediatric hospital. Results: Most cases presented with mild TBI (66.2%). The most common cranial manifestation of the TBI was brain bleeds (80%) and most occurred as a result of road traffic accidents (50%, including both pedestrian and motor vehicle accidents). Physiotherapy was administered in 35 cases (26.9%), with functional interventions, such as mobilizations out of bed, the most common form of therapy (71.4%). Children involved in road traffic accidents, presenting with severe diffuse TBI, resulting in altered tone and coordination problems, admitted to intensive care, monitored with an intracranial pressure or Licox monitor, and receiving occupational therapy and/or been followed up by dieticians, were more likely to receive physiotherapy. The duration of hospitalization (median 4 days [IQR 2-9]) was associated with infections, severity of TBI, presence of an intracranial monitoring, and parietal lobe injury. Conclusion: This is the first study in South Africa investigating standard physiotherapy care in children admitted with TBI. Physiotherapy was provided in a small portion of children and appeared to be well tolerated. However, due to the limited information recorded in the physiotherapy notes, results of this study need to be confirmed in larger, more well-documented studies before generalizations can be made.

Early neuro-rehabilitation in traumatic brain injury: the need for an African perspective

“…However, the first and only study in South Africa that evaluated the effects of early neurorehabilitation (Physiotherapy) in the management of paediatric traumatic brain injury and concluded that children who received early physiotherapy services (airway clearance: vibrations, tracheal stimulation, positioning, manual cough assist, suctioning; functional treatment: mobilization in and out of bed, strengthening, get education, bed mobility, caregiver education) well tolerated it and had better outcomes. Also, most of the children who received early neurorehabilitation during hospitalization were not recommended for further treatment after discharge [ 28 ]. They, however recommended further studies with larger sample to draw adequate conclusions on the role of early neurorehabilitation in TBI outcome.…”