Parental stress and paediatric acquired brain injury

Transactional processes matter: experiences between parents of children with acquired brain injury and health and education providers

PURPOSE

Little is known about how parents' transactions with health and educational professionals shape their experience of these systems, and impact on capacities to support their child with acquired brain injury (ABI). We explored experiences of specific transactions and perceptions of impact.

METHODS

A focus group and individual interviews were conducted with seven parents of children in the chronic phase of recovery following ABI. Thematic analysis was used to interpret the data.

RESULTS

Four superordinate themes were identified: "These Encounters Matter," "A Person not a Number-Interpersonal Skills that Count," "The Blind Leading the Blind," and "Becoming the Backbone." Findings highlighted that these transactions mattered to parents, promoting either distress or empowerment. Positive outcomes were characterized by transactions related to communication, empathy, trust, collaboration, and connection. However, there was a perception of the "blind leading the blind" and that ultimately parents needed to enter such transactions armed with knowledge and their own therapeutic goals.

CONCLUSIONS

Our findings unpack contextual and transactional elements of parents' experiences with health and education professionals which empower or distress. Understanding and improving these processes is important, given the central role families play in child outcomes following ABI. Implications for clinical practice are discussed.

Coping and wellbeing in families with a child with acquired brain injury compared with families in the community

PURPOSE

Paediatric acquired brain injury (ABI) negatively impacts parental wellbeing and family functioning. Adaptive coping, that is behaviours promoting emotional wellbeing and addressing distressing problems, may support wellbeing and family functioning. This study compared wellbeing, coping, and family functioning between parents of a child with ABI and parents in the community, and examined coping as a predictor of wellbeing and family functioning.

METHODS

Forty parents of a child with ABI and 40 parents in the community participated in this cross-sectional survey using the Personal Wellbeing Index, Coping Scale for Adults Short Form, McMaster Family Assessment Device (General Functioning Subscale).

RESULTS

The ABI group had statistically significantly lower wellbeing, t(68.70) = -4.01, p < 0.001, lower adaptive coping, t(73.95) = -3.27, p = 0.002, and poorer family functioning, t(77) = 4.26, p < 0.001. Family composition (single-parent/couple), having a child with ABI, adaptive coping, and non-productive coping predicted 47.7% of the variance in wellbeing, F(5, 70) = 12.75, p < 0.001. Parental education, having a child with ABI, and non-productive coping predicted 35.9% of the variance in family functioning, F(5, 69) = 7.71, p < 0.001.

CONCLUSIONS

Adaptive coping may contribute to better family outcomes in paediatric ABI.Implications for rehabilitationPaediatric ABI may have a significant impact on the child with ABI and the family, leading to poorer outcomes for some families.This study suggested that parents of a child with ABI use adaptive coping less than parents in the community but do not differ in the use of non-productive coping.Families need long-term targeted support to meet the challenges paediatric ABI presents and may benefit from interventions which actively seek to change parental coping strategies.

The importance of assessing parent stress in families with children with severe neuromotor and intellectual disability - a pilot study

Parent-related stress represents the level of dysfunction in the parent-child system related to the parents' functioning. The aim of this retrospective pilot study was to assess the degree of stress perceived by mothers and fathers, in the framework of a family-centred approach to rehabilitation.We considered 43 parents of 29 children with cerebral palsy, genetic disorders or brain injury admitted to a neurological rehabilitation center. Parenting stress was assessed with the Parenting Stress Index - Short Form (PSI-SF) self-report questionnaire and a semi-structured investigation of situational stress factors of the family. The cognitive and motor disability of the children were assessed with the Diagnostic and Statistical Manual of Mental Disorders 5(DSM-5) and the Gross Motor Function Classification System-(GMFCS), respectively.The results showed that parental stress is directly correlated with the level of cognitive and behavioral disability and not with motor disability. No significant difference was found in the level of stress perceived by mothers and fathers. The effect of a worsening occupational situation seemed to influence the perception of stress more than a change in the formal relationship of the couple, but neither was statistically significant.

Discharge nurse intervention on a pediatric rehabilitation unit: Retrospective chart review to evaluate the Does it impact on number of unmet needs during the transition home following neurological injury

PURPOSE

The purpose of this study is to describe the post-discharge needs of children and adolescents when transitioning home after an inpatient comprehensive rehabilitation stay following an acute neurological injury and to evaluate if trends in those needs changed with implementation of a discharge nurse intervention.

DESIGN

Retrospective medical record review was conducted 1-year prior (T1) and 1-year after (T2) a discharge nurse intervention.

METHODS

Medical charts of 80 pediatric patients with acute neurological injury (T1 = 39; T2 = 41) were reviewed. Post-discharge communication from the 8-week post-discharge period was reviewed to identify and categorize care coordination needs, using 18 pre-defined care coordination categories. T1 and T2 findings were compared using two sample proportion z-test.

FINDINGS

Patients discharged following inpatient rehabilitation for acute neurological injury have unmet care coordination needs. The proportion of unmet needs decreased significantly for 10/18 care coordination categories after implementation of the discharge nurse intervention.

CONCLUSIONS

Data from this study support proactive care coordination by inpatient rehabilitation nurses to reduce unmet post-discharge care coordination needs and provides preliminary evidence that the role of a discharge nurse may have a positive impact on the transition from inpatient rehabilitation to home.

Pediatric Minor Head Trauma: Factors Affecting the Anxiety of Parents

Managing the anxiety of the parents of pediatric patients with head trauma is challenging. This study aimed to examine the factors that affect anxiety levels of parents whose children were admitted to the emergency department with minor head trauma. In this prospective study, the parents of 663 consecutive pediatric patients were invited to answer a questionnaire. Parents of 600 children participated in the study. The parents who believed they were provided sufficient information and who were satisfied with the service received had significantly more improvement in anxiety-related questions. Cranial X-ray assessment had a significantly positive impact on the anxiety of the parents, whereas cranial computed tomography and neurosurgery consultation did not. In assessing pediatric minor head trauma, cranial computed tomography imaging and neurosurgery consultation should not be expected to relieve the anxiety of the parents. However, adequately informing them and providing satisfaction are the factors that could lead to improvement.

Understanding the relationship between family functioning and health-related quality of life in very young children with moderate-to-severe TBI

Objective: To investigate the relationship of pre-injury and concurrent family functioning with health-related quality of life (HR QoL) following traumatic brain injury (TBI) or orthopedic injury (OI) in very young children. Method: Prospective enrollment of children ages 0-4 years who presented to the emergency department after sustaining either acute TBI or OI. This is a sub-analysis of children who completed at least one post-injury follow-up visit. At time of study enrollment, parents rated pre-injury family functioning (Family Assessment Device-General Functioning Scale) and the child's HR QoL (Pediatric Quality of Life Inventory^TM). Family functioning and HR QoL were assessed at one and six months post-injury. Mixed models were used to examine family functioning as a moderator of a child's HR QoL following injury. Results: Data were analyzed for 42 children with TBI and 24 children with OI. For both groups, better pre-injury family functioning was significantly associated with better HR QoL over time. A triple interaction of injury type by time since injury by concurrent family functioning indicated that children with TBI and poor family functioning had significantly worse HR QoL at six months post-injury relative to other groups. Conclusion: Despite a small sample size, current results underscore the importance of family functioning to recovery following early childhood TBI and support the need for continued research and development of interventions to improve outcomes in this population.

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.

Paediatric traumatic brain injury

PURPOSE OF REVIEW

To provide a summary of recent developments in the field of paediatric traumatic brain injury (TBI).

RECENT FINDINGS

The epidemiology of paediatric TBI with falling rates of severe TBI, and increasing presentations of apparently minor TBI. There is growing interest in the pathophysiology and outcomes of concussion in children, and detection of 'significant' injury, arising from concern about risks of long-term chronic traumatic encephalopathy. The role of decompressive craniectomy in children is still clarifying.

SUMMARY

Paediatric TBI remains a major public health issue.