Rehabilitation after paediatric acquired brain injury: Longitudinal change in content and effect on recovery

Abstract

Aim To describe cross‐sectional and longitudinal variation in neurorehabilitation content provided to young people after severe paediatric acquired brain injury (pABI) and to relate this to observed functional recovery. Method This was an observational study in a cohort of admissions to a residential neurorehabilitation centre. Recovery was described using the Pediatric Evaluation of Disability – Computer Adaptive Testing instrument. Rehabilitation content was measured using the recently described Paediatric Rehabilitation Ingredients Measure (PRISM) and examined using multidimensional scaling. Results The PRISM reveals wide variation in rehabilitation content between and during admissions primarily reflecting proportions of child active practice, child emotional support, and other management of body structure and function. Rehabilitation content is predicted by pre‐admission recovery, suggesting therapist decisions in designing rehabilitation programmes are shaped by their initial expectations of recovery. However, significant correlations persist between plausibly‐related aspects of delivered therapy and observed post‐admission recovery after adjusting for such effects. Interpretation The PRISM approach to the analysis of rehabilitation content shows promise in that it demonstrates significant correlations between plausibly‐related aspects of delivered therapy and observed recovery that have been hard to identify with other approaches. However, rigorous, causal analysis will be required to truly understand the contributions of rehabilitation to recovery after pABI. What this paper adds Rehabilitation content varies widely between, and during, admissions for neurorehabilitation after paediatric acquire brain injury. Strong correlations are seen between plausibly‐related aspects of rehabilitation content and observed recovery, though careful interpretation is necessary.

Retrospective study on the correlation between serum MIF level and the condition and prognosis of patients with traumatic head injury

“…Some studies show that BDNF is more neurotrophic in the brain, providing significant protection to both central and peripheral nerve cells, promoting effective repair in case of damage and normal functioning ( Lindholm & Saarma, 2022 ). MBP, a specific protein of oligodendrocytes and other neural tissues found in the vertebrate central nervous system, is released in large quantities into cerebrospinal fluid and then, into the blood after nerve tissue cells and myelin sheath are damaged or involved due to traumatic brain injury, often leading to an increase in the serum MBP level ( Forsyth et al, 2022 ). Studies reveal that serum MBP concentration is linked to the severity of the myelin injury of the white matter oligodendrocyte and destruction of the blood-brain barrier ( DiTommaso et al, 2022 ).…”

Capturing the active ingredients of paediatric neurorehabilitation

“…The authors' results quantified a known clinical phenomenon: for lower functioning children (or earlier in recovery) the focus of treatment is on the parents' emotions and skills, and the child's body function. 4 The focus in higher functioning children will be on training of adaptive skills in the child. This introduces a conundrum: how much was the changing therapy focus responsible for the observed recovery and how much did the child's recovery drive the change in therapy focus?…”

“…3 In this respect, Jacoby et al have identified relevant predictors of QoL-related personal outcomes in children with IDD, such as sleep and community participation. 4 When variables such as these are included in logic models, the effect of interventions and policies can be better understood and, thereby, improved.…”

“…The authors' results quantified a known clinical phenomenon: for lower functioning children (or earlier in recovery) the focus of treatment is on the parents' emotions and skills, and the child's body function 4 . The focus in higher functioning children will be on training of adaptive skills in the child.…”

Strategies supporting parent‐delivered rehabilitation exercises to improve motor function after paediatric traumatic brain injury: A systematic review

“…16 Neuroplasticity is the ability of the brain to adapt and reorganize neural networks in response to environmental stimuli, experiences, and challenges; 17 work is ongoing to understand more about the doseresponse relationships within rehabilitation. 18,19…”