A review of family intervention guidelines for pediatric acquired brain injuries

Epidemiology of head injuries in pedestrian-motor vehicle accidents

Despite efforts of many countries to improve pedestrian safety, international reports show an upward trend in pedestrian-motor vehicle accidents. Although the most common cause of death of pedestrians is head injuries, there is a lack of knowledge on the epidemiology and characteristics of head injury in terms of the Glasgow Outcome Scale to be used for prevention. However, this study aimed to determine the epidemiology of pedestrian-motor vehicle accidents, the characteristics of head injury, and differences in the Glasgow Outcome Scale in terms of gender. In this retrospective analytical study, the data of 917 eligible injured pedestrians were obtained from the two databases of the Trauma System and the Hospital Information System. The data were analyzed using SPSS software (Version 21). The mean age of all 917 injured pedestrians was 47.55 ± 19.47 years. Most of the injured pedestrians (42.10%) were in the age range of 41-69 years and 81.31% were male. Moreover, 83.07% did not have any acute lesions on the CT scan. The most common brain lesion was brain contusion (n = 33, 3.60%), subarachnoid hemorrhage (n = 33, 3.60%), and skull fracture (n = 29, 3.16%). Among all concurrent injuries, lower extremity/pelvic injuries were observed in 216 patients (23.56%). Outpatient treatment (n = 782, 85.27%), airway control/endotracheal intubation (n = 57, 6.22%), and resuscitation (n = 35, 3.82%) were the most applied treatments respectively. There were significant differences in the Glasgow Outcome Scale between men and women (P- value = 0. 012). The high rate of mortalities, disability, head injuries, contusion, subarachnoid hemorrhage, and skull fractures in pedestrians involved in MVAs emphasizes the need for developing and implementing prevention strategies including appropriate management and risk reduction. Male pedestrians were at higher risk of motor vehicle accidents and worse Glasgow Outcome Scale. The presented data identified the main types of pedestrian injuries and suggested the importance of adopting appropriate preventive strategies to achieve the most effective interventions for creating a safer community.

Cognitive rehabilitation in paediatric acquired brain injury-A 2-year follow-up of a randomised controlled trial

Background

Goal management training (GMT), a metacognitive rehabilitation method that has been demonstrated to improve executive function (EF) in adults with acquired brain injury (ABI), could potentially be effective for children in the chronic phase of ABI. In a previously published randomised controlled trial (RCT), the efficacy of a paediatric adaptation of GMT (pGMT) compared to a psychoeducative control intervention (paediatric Brain Health Workshop, pBHW) was investigated. Comparable improvements in EF in both groups were found at 6-month follow-up. However, a specific effect of pGMT could not be conclusively proven. The present study reports 2-year follow-up data (T4; T1: baseline, T2: post-intervention, T3: 6-month follow-up, and T4: 2-year follow-up) from this original RCT.

Methods

A total of 38 children and adolescents and also their parents completed questionnaires tapping into daily life EF. Explorative analyses were conducted comparing the 2-year follow-up data (T4) with the baseline (T1) and 6-month follow-up data (T3) for T4-participants in the two intervention groups (pGMT; n = 21, pBHW; n = 17), and we also assessed T4-participants vs. non-responders (n = 38) in the RCT. Primary outcome measures were the Behavioural Regulation Index (BRI) and the Metacognition Index (MI) derived from the Behaviour Rating Inventory of Executive Function (BRIEF) parent report.

Results

No difference between intervention groups was found (BRI, F = 2.25, p = 0.143, MI, F = 1.6, p = 0.213), and no time^*group interaction (BRI, F = 0.07, p = 0.976, MI, F = 0.137, p = 0.937) could be seen at the 2-year follow-up. Nevertheless, both pGMT and the pBHW groups improved daily EF as measured by parental reports over time from the baseline to T4 (p = 0.034). T4 participants and non-responders shared similar baseline characteristics.

Conclusion

Our results extend the findings from the 6-month follow-up previously published. Both pGMT and pBHW groups sustained their improvements in daily life EFs from the baseline, but additional effectiveness of pGMT relative to pBHW was not found.

Family matters: A systematic review and meta-analysis on the efficacy of family-oriented interventions for children with acquired brain injuries

INTRODUCTION

Acquired brain injury (ABI) is a leading cause of disability among children. An increasing number of programs have emerged to involve family members as an integral component of post-ABI rehabilitation. This study aimed to conduct a systematic review and meta-analysis of such programs among children with ABI.

METHODS

Following PRISMA guidelines, search among six databases (PsycINFO, PsycARTICLES, Scopus, Web of Science, PubMed, Cochrane CENTRAL) was conducted, followed by abstract/full-text screening and data extraction. Hedge's g was computed for effect sizes. The risk of bias was assessed using Cochrane guidelines. Meta-regression analyses were conducted on six moderators.

RESULTS

A total of 32 studies (reported in 37 articles) were included in the qualitative analysis. Meta-analysis of 20 studies showed a positive small-to-medium effect of family-oriented interventions on child and parental outcomes but not on family functioning. Study design moderated the effect sizes of parent outcomes.

CONCLUSIONS

This study synthesized the latest empirical evidence of family-oriented rehabilitation programs for pediatric ABI across interventional strategies, study designs, and outcomes. The findings suggested an overall beneficial impact of such programs on both the pediatric patients and their caregivers.

The Effect of Napping on the Function of Problem Behavior for One Child With an Acquired Brain Injury

Many children experience sleep disruption in the form of difficulties falling asleep, staying asleep, or getting back to sleep. Children with acquired brain injuries (ABI) sometimes experience an exacerbation of these symptoms. Thus, researchers and practitioners alike need to identify creative assessment and treatment approaches to meet this population’s needs. The purpose of the current case study was to highlight one method for (a) determining a nap schedule and (b) evaluating the effect of fatigue on behavioral function for one child diagnosed with an ABI. We conducted a scatterplot analysis to identify periods in which problem behaviors occurred more or less often. These data informed when the child took naps. Afterward, the child participated in a functional analysis of problem behavior before a nap and again after a nap. Results showed both negative and positive reinforcement maintained problem behaviors before naps, while only positive reinforcement maintained problem behaviors after naps. Functional communication training (FCT) programs implemented to address escape, tangible, and attention functions before naps reduced problem behavior and increased communication. These data suggested that (a) motivating operations for problem behavior can differ depending on fatigue and (b) FCT is an effective intervention for problem behavior affected by fatigue. The current study provides an example of an assessment and treatment approach when biologic factors, like sleep, may influence problem behavior.

Terminology and descriptions of navigation and related practices for children with neurodisability and their families: a scoping review

BACKGROUND

Children with neurodisability (ND) represent a significant population with a demonstrated need for coordinated support. Patient navigation has a primary focus on: facilitating access to and connection amongst fragmented systems; as well as the provision of educational and emotional support. Given the distinct needs of children with ND and their families, programs built upon such core concepts could be of great benefit. The diversity of terminology encompassing navigation-related concepts and activities (e.g., care coordination, case management, family support), however, presents challenges to both practice and research. This scoping review examined the terminology and descriptions provided within published articles on navigation-type models for children with ND and their families.

METHODS

The scoping review was conducted according to the Joanna Briggs Institute methodology. A preliminary search was completed on PubMed (NCBI), MEDLINE (Ovid) and CINAHL (EBSCO) to identify initial search terms, upon which a full search strategy was developed and executed in MEDLINE (Ovid) and CINAHL (EBSCO). After screening records according to our inclusion and exclusion criteria, a full-text review of relevant articles was conducted and data extracted using a researcher-developed tool. Under close supervision by the research team, study selection was primarily performed by one author.

RESULTS

Of the 2597 papers identified, 33 were included in the final review. From the included papers, a total of 49 terms were extracted, 20 of which were unique. Across the diversity of terminology observed, articles provided detailed and rich descriptions characterized by four central domains, namely: (i) what navigation-related resources, supports and services aim to facilitate and (ii) provide; (iii) descriptions of their intended outcomes; as well as (iv) guiding principles.

CONCLUSIONS

This scoping review addresses a gap in our knowledge related to the specification of patient navigation and related supports as applied to the specific context of children with ND and their families. Given the particular needs of this population, we propose an empirically-informed integrative model that synthesizes the findings from this scoping review. We suggest that this framework can be used as a guide to the mindful characterization of how supports aiming to connect children and families to needed service are termed and described within future research and in practice.

Application of Mussell-derived biosorbent to remove NH4+ from aqueous solution: Equilibrium and Kinetics

Mussel shells are often considered an abundant waste with no use. This study shows that the employment of mussel shells as a biosorbent for ammonium from water environment is completely possible. By using batch experimental method, optimal conditions for the ammonium adsorption onto mussel shells were determined. Specifically, those include a pH level of 8, contact time of 90 min, an initial ammonium concentration of 40 mg/l and the adsorbent dose of 700 mg/25 ml. With such operating conditions, experiments in laboratory aqueous solutions resulted in a maximum adsorption capacity of 2.33 mg/g, corresponded by 46.575% of efficiency. Adsorption isotherms and kinetics were well described with the Freundlich isothermal model, suggesting a heterogeneous adsorption process occurring on multilayers and both the pseudo-first-order and the pseudo-second-order, implying that the operational fundament was based on chemisorption. Analyses regarding SEM, EDS and FTIR were also implemented to identify the morphology, composition and functional groups of the adsorbent.

Exploring participation after paediatric acquired brain injury

This study aimed to explore the levels of participation in a UK sample of children and young people (CYP) with an acquired brain injury (ABI) at home, school and in the community through a cross-sectional study. The Child and Family Follow-Up Survey was distributed to parents/carers of 134 CYP with ABI (CYP-ABI) who received neuro-rehabilitation from 2014 to 2016. Access and recruitment were problematic resulting in a low response rate (4%). Widespread restrictions in participation were reported by four of the five respondents with community-structured events/activities and educational activities being the most restricted. Factors impacting on participation were cognitive-based and movement skills, family stress and lack of support/encouragement in the community. Study results provide information pertaining to the feasibility of undertaking research with this population while also highlighting the restrictions to participation experienced by CYP-ABI more than two years after injury.

Pediatric traumatic brain injury and abusive head trauma

Childhood traumatic brain injury (TBI) commonly occurs during brain development and can have direct, immediately observable neurologic, cognitive, and behavioral consequences. However, it can also disrupt subsequent brain development, and long-term outcomes are a combination of preinjury development and abilities, consequences of brain injury, as well as delayed impaired development of skills that were immature at the time of injury. There is a growing number of studies on mild TBI/sport-related concussions, describing initial symptoms and their evolution over time and providing guidelines for effective management of symptoms and return to activity/school/sports. Mild TBI usually does not lead to long-term cognitive or academic consequences, despite reports of behavioral/psychologic issues postinjury. Regarding moderate to severe TBI, injury to the brain is more severe, with evidence of a number of detrimental consequences in various domains. Patients can display neurologic impairments (e.g., motor deficits, signs of cerebellar disorder, posttraumatic epilepsy), medical problems (e.g., endocrine pituitary deficits, sleep-wake abnormalities), or sensory deficits (e.g., visual, olfactory deficits). The most commonly reported deficits are in the cognitive-behavioral field, which tend to be significantly disabling in the long-term, impacting the development of autonomy, socialization and academic achievement, participation, quality of life, and later, independence and ability to enter the workforce (e.g., intellectual deficits, slow processing speed, attention, memory, executive functions deficits, impulsivity, intolerance to frustration). A number of factors influence outcomes following pediatric TBI, including preinjury stage of development and abilities, brain injury severity, age at injury (with younger age at injury most often associated with worse outcomes), and a number of family/environment factors (e.g., parental education and occupation, family functioning, parenting style, warmth and responsiveness, access to rehabilitation and care). Interventions should identify and target these specific factors, given their major role in postinjury outcomes. Abusive head trauma (AHT) occurs in very young children (most often <6 months) and is a form of severe TBI, usually associated with delay before appropriate care is sought. Outcomes are systematically worse following AHT than following accidental TBI, even when controlling for age at injury and injury severity. Children with moderate to severe TBI and AHT usually require specific, coordinated, multidisciplinary, and long-term rehabilitation interventions and school adaptations, until transition to adult services. Interventions should be patient- and family-centered, focusing on specific goals, comprising education about TBI, and promoting optimal parenting, communication, and collaborative problem-solving.

Supporting children and young people with an acquired brain injury (ABI) and their siblings: The experience of a camp for families with a child with an ABI

Paediatric acquired brain injury (ABI) is associated with long-term negative sequelae, and families must continually adapt to meet the needs of the child with ABI and family members. Condition-specific camps may support families in this process. This study explored the experience of camps for children with ABI and their families from the perspective of children and young people with ABI and their siblings. Semi-structured interviews were conducted with 10 people with ABI (M_age = 23.93, SD = 16.52 years) and 19 siblings of people with ABI (M_age = 14.53, SD = 5.73 years). Using reflexive thematic analysis, the central theme identified was "My safe space," supported by three further themes: "Having fun and relaxing," "Making friends," and "Enjoying choices." Camp was a space where the shared understanding and acceptance of ABI created a sense of safety. This was facilitated by enjoying activities, developing friendships with peers who shared the experience of ABI, and having a sense of control through choice availability. Thus, camps appear to offer opportunities to enjoy typical childhood experiences while restoring a sense of security, increasing understanding of ABI and validating attendees' experiences. Camps may, therefore, offer low-cost interventions to support children with ABI and their families.

Neuropsychological consequences of childhood medulloblastoma and possible interventions: A review

BACKGROUND

Children who have been treated for a medulloblastoma often suffer long-term cognitive impairments that often negatively affect their academic performance and quality of life. In this article, we will review the neuropsychological consequences of childhood medulloblastoma and discuss the risk factors known to influence the presence and severity of these cognitive impairments and possible interventions to improve their quality of life.

METHODS

This narrative review was based on electronic searches of PubMed to identify all relevant studies.

RESULTS

Although many types of cognitive impairments often emerge during a child's subsequent development, the core cognitive domains that are most often affected in children treated for a medulloblastoma are processing speed, attention and working memory. The emergence and magnitude of these deficits varies greatly among patients. They are influenced by demographic (age at diagnosis, parental education), medical and treatment-related factors (perioperative complications, including posterior fossa syndrome, radiation therapy dose, etc.), and the quality of interventions such as school adaptations provided to the child or rehabilitation programs that focus on cognitive skills, behavior and psychosocial functioning.

CONCLUSION

These patients require specialized and coordinated multidisciplinary rehabilitation follow-up that provides timely and adapted assessments and culminates in personalized intervention goals being set with the patient and the family. Follow-up should be continued until referral to adult services.

Does Stepping Stones Triple P plus Acceptance and Commitment Therapy improve parent, couple, and family adjustment following paediatric acquired brain injury? A randomised controlled trial

OBJECTIVE

To evaluate the efficacy of a behavioural family intervention, Stepping Stones Triple P (SSTP), combined with an Acceptance and Commitment Therapy (ACT) workshop in improving parent, family and couple outcomes following paediatric acquired brain injury (ABI).

PARTICIPANTS AND SETTING

Fifty-nine parents (90% mothers) of children (mean age 7 years; 35 males, 24 females) with ABI.

INTERVENTION

Participants were randomly assigned to a treatment (10-week group SSTP and ACT program) or a care-as-usual (CAU) control condition (10 weeks). Those in the CAU condition received the treatment after the waitlist period.

OUTCOMES

Self-report measures of parent psychological distress, parent psychological flexibility, parenting confidence, family functioning, and couple relationship, assessed at: pre-intervention, post-intervention, and 6-months post-intervention.

RESULTS

Post-intervention, the treatment group showed significant, small to medium improvements relative to the CAU group (at the p < .05 level) on parent psychological distress, parent psychological flexibility, parent confidence in managing behaviours, family adjustment,and number of disagreements between parents. Most improvements were maintained at 6-months.

CONCLUSIONS

Parent skills training and ACT may be efficacious in improving parent, family, and couple outcomes in families of children with an ABI.

Role of contextual factors in the rehabilitation of adolescent survivors of traumatic brain injury: emerging concepts identified through modified narrative review

BACKGROUND

Recently research in traumatic brain injury (TBI) intervention has identified the benefits of contextualized, embedded, functionally based approaches to maximize treatment outcomes. An essential component of contextualized intervention is the direct and purposeful consideration of the broader context, in which the person with TBI functions. However, systematic consideration of contextual factors remains limited both in research and clinical practice.

AIMS

The purposes of this modified narrative review were (1) to provide a succinct review of the available literature regarding the contextual factors that are specific to adolescent survivors of TBI, one of highest incidence groups for brain injury; (2) to connect these contextual factors to the direct long-term management of TBI and to identify their potential impact on outcome; and (3) to highlight areas that are open to research and clinical advances that could enhance positive outcomes for adolescent survivors of TBI. The framework of the World Health Organization's (WHO) International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY; 2007) was used as a foundation for this review.

METHODS & PROCEDURES

A systematic literature search was conducted using databases and hand searches. A total of 102 articles were originally identified. Twenty-five original research articles, eight review papers and four expert opinion papers met inclusion and exclusion criteria and were included in the final review.

MAIN CONTRIBUTION

The body of research specifically focused on contextual factors is an emerging area. Early findings indicate that a focus on the direct modification of contextual factors is promising for the facilitation of positive outcomes long into the chronic phase of management for adolescences who have survived a TBI. The contextual factors included in this review were the overall ability of the school to support a student post-TBI, family psychosocial risk (sibling/sibling relationships/stress/burden/support), coping style (TBI survivor and their caregivers), and socioeconomic status of the family. Given the promise of these findings, research and clinical application efforts should be focused on identifying well-prescribed rehabilitation paradigms that capitalize on the modification of contextual factors throughout the recovery process.

CONCLUSIONS & IMPLICATIONS

The results of this modified narrative review provide an initial summary of the available evidence for addressing contextual factors in the rehabilitation process for adolescents with TBI. This is an area that is wide open for both systematic research and clinical application and holds potential to improve long-term outcome for survivors of adolescent TBI.

Improving child and parenting outcomes following paediatric acquired brain injury: a randomised controlled trial of Stepping Stones Triple P plus Acceptance and Commitment Therapy

BACKGROUND

Persistent behavioural difficulties are common following paediatric acquired brain injury (ABI). Parents and families also experience heightened stress, psychological symptoms and burden, and there is evidence of a reciprocal relationship between parent and child functioning, which may be mediated by the adoption of maladaptive parenting practices. Despite this, there is currently a paucity of research in family interventions in this population. The aim of this study was to determine the efficacy of Stepping Stones Triple P: Positive Parenting Program (SSTP), with an Acceptance and Commitment Therapy (ACT) workshop, in improving child outcomes and parenting practices following paediatric ABI.

METHODS

Fifty-nine parents of children (mean age 7 years, SD 3 years, 1 month; 35 males, 24 females) with ABI (Traumatic injuries 58%, Tumour 17%, Encephalitis or meningitis 15%, Cardiovascular accident 7%, Hypoxia 3%) who were evidencing at least mild behaviour problems were randomly assigned to treatment or care-as-usual conditions over 10 weeks. Mixed-model repeated-measures linear regression analyses were conducted to compare conditions from pre- to postintervention on child behavioural and emotional functioning (Eyberg Child Behavior Inventory, Strengths and Difficulties Questionnaire) and dysfunctional parenting style (Parenting Scale). Assessment of maintenance of change was conducted at a 6-month follow-up. The trial was registered on Australian New Zealand Clinical Trials Registry (ID: ACTRN12610001051033, www.anzctr.org.au).

RESULTS

Significant time-by-condition interactions were identified on number and intensity of child behaviour problems, child emotional symptoms and parenting laxness and overreactivity, indicating significant improvements in the treatment condition, with medium-to-large effect sizes. Most improvements were maintained at 6 months.

CONCLUSIONS

Group parenting interventions incorporating Triple P and ACT may be efficacious in improving child and parenting outcomes following paediatric ABI.

A systematic review of parenting interventions for traumatic brain injury: child and parent outcomes

OBJECTIVE

To evaluate the efficacy of parenting interventions on child and parent behavioral and emotional outcomes for parents of children with traumatic brain injury (TBI).

METHODS

Systematic searches of 5 databases. Included studies were assessed for quality, and relevant data were extracted and collated.

RESULTS

Eight articles met inclusion criteria, reporting 6 trials of interventions involving parent training for parents of children with TBI. Only 1 pre-post study trialed a version of a traditional parenting intervention. The remaining studies involved a multicomponent family problem-solving intervention. Each trial found a statistically significant intervention effect for at least 1 outcome measure.

CONCLUSIONS

Interventions that train parents may be a useful approach to alleviate behavioral and emotional disturbances after pediatric TBI. Some evidence suggests that these interventions may help to improve parenting skill and adjustment. However, all identified studies included interventions with multiple treatment components, so the effects attributable to parent training alone remain undetermined. Further quality trials are needed to assess the unique effectiveness of parenting interventions in this population.

Efficacy of Stepping Stones Triple P Plus a Stress Management Adjunct for Parents of Children with an Acquired Brain Injury: The Protocol of a Randomised Controlled Trial

Paediatric acquired brain injury (ABI) is the most common cause of acquired disability in childhood. It frequently results in significant personality, cognitive, emotional and behavioural changes, and consequent impairment in independent functioning, education, employment and interpersonal relationships. Additionally, paediatric ABI impacts on the entire family system, with parents commonly reporting significant distress and adjustment difficulties. Despite this, there is currently limited research into effective programmes to support families following their child's ABI. This protocol describes a wait-list randomised controlled trial of a behavioural family intervention plus a parent stress management programme for paediatric ABI. Interventions will be conducted with parents in a group format, aiming to improve child outcomes by improving parenting behaviour and coping. Outcomes assessed will be: (i) child behaviour and emotional outcome as measured by parent and teacher reports; (ii) parental style and confidence; (iii) parental adjustment (stress, anxiety and depression symptoms); (iv) family functioning; (v) parent relationship; and (vi) parent psychological flexibility. Assessments will be via questionnaires conducted pre-, mid- and post- intervention, and at a 6-month follow-up. The theoretical basis, study hypotheses, methods and planned analyses are described.

Quality care in pediatric trauma

Infrastructure, processes of care and outcome measurements are the cornerstone of quality care for pediatric trauma. This review aims to evaluate current evidence on system organization and concentration of pediatric expertise in the delivery of pediatric trauma care. It discusses key quality indicators for all phases of care, from pre-hospital to post-discharge recovery. In particular, it highlights the importance of measuring quality of life and psychosocial recovery for the injured child.

Community integration following severe childhood traumatic brain injury

PURPOSE OF REVIEW

Severe childhood traumatic brain injury (TBI) is the leading cause of death and acquired disability in children, causing impairments in children's sensory-motor, cognitive and behavioural functioning, with devastating consequences on community integration. Community integration is the ultimate goal of rehabilitation; it is a complex outcome, with many variables contributing to it.

RECENT FINDINGS

Community integration and quality of life (QOL) are lower in children who sustained severe TBI at a younger age. Further, a wide range of injury-related, demographic and postinjury factors influence outcomes, and should serve as targets for specific interventions. An increasing number of interventions targeting cognitive, behavioural or family-related issues have been developed, with promising results.

SUMMARY

Children should benefit from early integrated patient and family-centred specific care, and receive long-term follow-up until early adulthood, with regular assessments, enabling detection and treatment of any emerging problem, and to ensure the acquisition of independent living skills and stable vocational outcome when this is possible. So far, few well conducted intervention studies are available, but their number is increasing with positive results on the trained skills. Well designed studies using large samples and looking at generalization of the skills in everyday life are needed.

A systematic review of psychological interventions to alleviate cognitive and psychosocial problems in children with acquired brain injury

AIM

It is now generally accepted that paediatric acquired brain injury (ABI) can have an impact on a child's cognitive, social, and behavioural functioning. However, the lack of guidelines on effective interventions for the affected children and their families, particularly beyond the acute recovery phase, can limit access to effective support. We provide a systematic review of the literature on the effectiveness of psychological interventions aimed at alleviating cognitive and psychosocial outcomes after paediatric ABI.

METHOD

The search used the Ovid MEDLINE, Embase, Web of Knowledge, and EBSCO databases and hand searches of key journals. Nine studies met inclusion criteria: five intervention studies of cognitive outcome and four of psychosocial outcome. Effect sizes and methodological quality ratings were calculated using specific criteria.

RESULTS

Only two of the nine studies were rated as high quality. There was limited evidence for effective interventions for cognitive outcomes (attention, memory, and learning difficulties). For psychosocial outcomes, there was evidence that interventions can alleviate internalizing symptoms.

INTERPRETATION

Although there are some encouraging findings, there is a need for further, more rigorously designed, and better controlled research in this important area. We discuss how future research may consider issues such as age-appropriate interventions, the delivery format, and optimum post-injury timing of interventions, as well as multicentre collaborations.

Practitioner review: beyond shaken baby syndrome: what influences the outcomes for infants following traumatic brain injury?

BACKGROUND

Traumatic brain injury (TBI) in infancy is relatively common, and is likely to lead to poorer outcomes than injuries sustained later in childhood. While the headlines have been grabbed by infant TBI caused by abuse, often known as shaken baby syndrome, the evidence base for how to support children following TBI in infancy is thin. These children are likely to benefit from ongoing assessment and intervention, because brain injuries sustained in the first year of life can influence development in different ways over many years.

METHODS

A literature search was conducted and drawn together into a review aimed at informing practitioners working with children who had a brain injury in infancy. As there are so few evidence-based studies specifically looking at children who have sustained a TBI in infancy, ideas are drawn from a range of studies, including different age ranges and difficulties other than traumatic brain injury.

RESULTS

This paper outlines the issues around measuring outcomes for children following TBI in the first year of life. An explanation of outcomes which are more likely for children following TBI in infancy is provided, in the areas of mortality; convulsions; endocrine problems; sensory and motor skills; cognitive processing; language; academic attainments; executive functions; and psychosocial difficulties. The key factors influencing these outcomes are then set out, including severity of injury; pre-morbid situation; genetics; family factors and interventions.

CONCLUSIONS

Practitioners need to take a long-term, developmental view when assessing, understanding and supporting children who have sustained a TBI in their first year of life. The literature suggests some interventions which may be useful in prevention, acute care and longer-term rehabilitation, and further research is needed to assess their effectiveness.

Health-related quality of life after pediatric trauma

PURPOSE OF REVIEW

Pediatric injury results in significant preventable morbidity and functional limitations, with long-term impact on the quality of life of children and their families. The purpose of this review is to outline recent research in health-related quality of life (HRQOL) in pediatric trauma, with an emphasis on identification of predictors of outcome that will impact interventions and allocation of resources to optimize recovery.

RECENT FINDINGS

Studies of HRQOL in pediatric trauma use a variety of generic measurement tools that have now been validated in this patient population. Most children experience rapid recovery of physical and psychological functioning after injury, but children with traumatic brain injury continue to demonstrate long-term impairments. Decrease in HRQOL of children after trauma contributes to increase in caregiver stress and family burden of injury. There is increasing recognition of post-traumatic stress disorder (PTSD) in pediatric trauma, correlating with and impacting HRQOL.

SUMMARY

Evaluation of HRQOL in children after trauma should become incorporated into standards of care, with development of family-centered interventions and evidence-based allocation of resources for high-risk children and families to optimize long-term outcomes.