Rehabilitation in severe head injury in children: outcome and provision of care

Abstract

Functional outcome and provision of care to 82 children (males: females 2.7: 1; age range 0 to 16 years) with severe head injury were investigated. The children were admitted to the intensive care units of the Regional Neuroscience Units of the Greater Manchester and Lancashire districts of the North West Region of the UK between 1994 and 1996. A questionnaire was devised based on 12 areas of recovery and data were collected at discharge and 6 weeks, 6 months and 12 months from discharge. Data were collected during home visits and at joint assessment at 12 months with the district consultant community paediatrician (CCP). Early involvement of the CCP enhanced the provision of needs at discharge and 6 weeks after discharge, as did a period of stay in district‐level care before discharge home. CCPs received formal notification of the injured child in only 32% of cases by discharge, and 54% of cases by 6 months. Sixty‐five per cent of children required early educational support but structured help reached only 55% of these children by the end of the study. Integrated planning between health and education was achieved in about half of the study population. Good physical recovery was achieved by the majority of children but parents said they did not feel prepared for the degree of help which their child still required 12 months after discharge. Children who required anticonvulsants at 12 months’follow‐up scored significantly lower on cognitive potential. Psychosocial family functioning deteriorated in a substantial number of families according to parental perception. Prevalence of this perception did not diminish over the study period. Aspects of caregivers’understanding and the child's language deficits, self‐care skills, fine and gross motor performance, as well as family, social, and financial consequences were assessed. A dedicated and integrated approach to assessment and provision of care across the domains of hospital, education, and community is discussed.

Learning to cross boundaries: The integration of a health network to deliver seamless care

“…Better coordinated care, it is widely acknowledged, leads to more efficient and effective care [1][2][3][4]. Health care, however is characterised by an enormous high level of differentiation (between professionals, units and organisations) and a low level of integration.…”

A comprehensive model of care for rehabilitation of children with acquired brain injuries

“…As emphasized in the literature (Gregg & Appleton 1999;Tomlin et al 2002;Gillett 2004), we provide a multidisciplinary comprehensive model of care and long-term followup, which have been shown to be essential in management of paediatric ABI. All children with ABI are eligible to benefit from the system, and the whole system is publicly funded.…”

“…The results indicate that the majority of the patients were rated GOS 2 upon discharge. Of course, this includes the effect of spontaneous recovery, but it is well known that adequate rehabilitation, information and organization of a discharge plan are essential to prevent growing disabilities in the future (Gregg & Appleton 1999;Tomlin et al 2002) and strong evidence exists in adults, supporting post-acute multidisciplinary inpatient rehabilitation for patients with moderate to severe ABI (Prvu Bettger & Stineman, 2007). The majority of children were also rated GOS 2 when they were admitted in the outreach programme, which is conceived to take over the follow-up at this phase, when difficulties arise in the school or in the community.…”

“…Despite these recommendations, it has been shown that only a small proportion of children received specialized rehabilitation and adequate follow-up after TBI (Emanuelson & von Wendt 1997;Javouhey et al 2006;Falk et al 2007). Studies identified many unmet or unrecognized needs, and those were highest for cognitive services and for dysfunctional families (Greenspan & MacKenzie 2000;Tomlin et al 2002;Slomine et al 2006).…”

Severe outcome of children following trauma resulting from road accidents

“…The early identification of predictive factors of impairment would make it possible to distinguish children at a high risk of an adverse outcome [14,31,34]. These children should benefit from a specific rehabilitation programme or a specific therapy during the early phase of care [22,28,36].…”