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Assessing Children with Traumatic Brain Injuries

Children with Traumatic Brain Injuries (TBI) is one of the new funding categories created by the Individuals with Disabilities Education Act of 1990 (PL 101-476). Children with TBI require a different model of educational assessment than other disabling conditions because of the rapid cognitive, emotional, and physical changes that children with TBI undergo in the two years post-incident. To conduct appropriate educational assessment of children with TBI, the medical issues unique to this population must be understood and translated into educationally relevant data. The purpose of this paper is to give an overview of traumatic brain injuries and to provide a model of assessment that is educationally relevant to the unique needs of children with TBI.

Overview of traumatic brain injury patients at a tertiary trauma centre

OBJECTIVE

The goal of this study was to provide a general descriptive and cognitive portrait of a population with traumatic brain injury (TBI) at the time of their acute care stay.

MATERIAL AND METHODS

Three hundred and forty-eight TBI patients were assessed. The following data were collected for each patient: age, level of education, duration of post-traumatic amnesia, Galveston Orientation Amnesia Test score, Glasgow Coma Scale score, results of cerebral imaging, Neurobehavioral Rating Scale score, the Functional Independence Measure cognitive score and the Glasgow Outcome Scale score.

RESULTS

The clinical profile of the population revealed a mean age of 40.2 (+/-18.7) and a mean of 11.5 (+/-3.6) years of education. Most patients presented with frontal (57.6%) and temporal (40%) lesions. Sixty-two percent had post-traumatic amnesia of less than 24 hours. Seventy percent presented with mild TBI, 14% with moderate and 15% with severe TBI. The cognitive deficits most frequently observed on the Neurobehavioral Rating Scale were in the areas of attention, memory and mental flexibility as well as slowness and mental fatigability. Most patients had good cognitive outcome on the Functional Independence Measure and scores of 2 and 3 were frequent on the GOS. Forty-five percent of the patients returned home after discharge, 51.7% were referred to in or out patient rehabilitation and 3.2% were transferred to long-term care facilities.

CONCLUSION

Because of the specialized mandate of acute care institutions, the information provided here concerning characteristics of our TBI population is essential for more efficient decision-making and planning/programming with regards to care and service delivery.