Severe neurological impairment: a review of the definition

Abstract

PNSPeripheral nervous system SNI Severe neurological impairmentSevere neurological impairment (SNI) is a term commonly used in the medical literature, though there is no agreed definition. This limits opportunities for research into healthcare needs, treatment opportunities, resource planning, and outcome. We reviewed the literature to establish consistency of use of the term and to place it in the context of other commonly employed terms used to describe children with severe, complex medical needs. Forty-two articles were included for full-text analysis, with 23 including a definition of SNI. Motor impairment, intellectual disability, communication difficulties, and increased care needs were included in the definition in 80%, 70%, 30%, and 13% of papers respectively. Dependence on others for decision-making, chronicity, and distinction between disorders of the central nervous system and peripheral nervous system were less frequently included. There is wide variation in the use of the term SNI. A consensus-based definition of this term would be useful to facilitate future research.

Severe Neurological Impairment: A delphi consensus-based definition

“…In preparation for the Delphi process, we carried out a review of the literature, the details of which have been previously published [1]. We searched the databases of PubMed and Cochrane using the term "Severe Neurological Impairment".…”

“…Motor impairment, intellectual disability, communication difficulties and increased care needs were included in the definition in 80%, 70%, 30% and 13% of papers respectively. Dependence on others for decision-making, chronicity and distinction between disorders of the central nervous system and peripheral nervous system were less frequently included [1]. This established, with certainty, that there was no universally accepted definition of SNI.…”

“…Free-text responses were copied verbatim, key phrases were extracted and similar responses were grouped into themes by one of the authors (JA) and reviewed by another author (DMc). These themes, as well as the data that had been previously gathered from the literature review [1], were then used to inform the following rounds.…”

“…Severe Neurological Impairment (SNI) is a term that is commonly used in medical literature. However, there is no consistently used definition and, indeed, there is wide variation in the application of the term [1]. Fundamental details about the term SNI are not clear e.g.…”

Dog-Assisted Therapy in Neurorehabilitation of Children with Severe Neurological Impairment: An Explorative Study

“…5,6 Interactions with animals positively influence the human cardiovascular system, 7,8 attenuate anxiety, depression and behavioral problems, [9][10][11] and enhance communication and social skills, as well as motivation and self-esteem. [12][13][14] Animal-assisted therapy, especially dog-assisted therapy (DAT), is increasingly applied in rehabilitation of patients with severe neurological impairment 15 and provides promising potential to complement the treatment in neurorehabilitation facilities. 16 Research investigating animal-assisted therapy, mostly with dogs and horses, in neurorehabilitation for different populations documents positive outcomes in socioemotional functioning, motivation, mobility, and balance but mixed results regarding attention and concentration.…”