Further recommendations of the International Paediatric Brain Injury Society (IPBIS) for the post-acute rehabilitation of children with acquired brain injury.

BACKGROUND: Paediatric acquired brain injury is a life-long condition which impacts on all facets of the individual's lived experience. The existing evidence base continues to expand and new fields of enquiry are established as clinicians and researchers uncover the extent of these impacts. PRIMARY OBJECTIVE: To add to recommendations described in the International Paediatric Brain Injury Society's 2016 paper on post-acute care for children with acquired brain injury and highlight new areas of enquiry. REVIEW OF INFORMATION: Recommendations were made based on the opinions of a group of experienced international clinicians and researchers who are current or past members of the board of directors of the International Paediatric Brain Injury Society. The importance of each recommendation was agreed upon by means of group consensus. OUTCOMES: This update gives new consideration to areas of study including injuries which occur in pre-school children, young people in the military, medical referral, young offenders and the use of technology in rehabilitation.

Service provision for children and young people with acquired brain injury: Practice recommendations.

BACKGROUND: Providing appropriate rehabilitation services for Acquired Brain Injury (ABI) in childhood presents a number of challenges for caregivers, health and education professionals and the young person as they develop. PRIMARY OBJECTIVE: To record the challenges and possible creative solutions generated by an international group of professionals to address the needs of children with ABI. Review of information: Recommendations were generated from children's special interest group meetings of the International Brain Injury Association (Turin, Italy, 2001; Stockholm, Sweden, 2003; Melbourne, Australia, 2005; Lisbon, Portugal, 2008) and through meetings of the International Paediatric Brain Injury Society (IPBIS), formed in 2009. Delegates participating in the workshops were representative of nations from around the world and included The Netherlands, New Zealand, Australia, the UK, Finland, Germany, South Africa, the US, Canada, Sweden, Brazil and Italy. OUTCOMES: The information presented is based on a retrospective review of those meetings and the summaries of the topics considered.

Individual profiles of predictors and their relations to 10 years outcome after childhood traumatic brain injury.

BACKGROUND: Outcome after childhood traumatic brain injury (CTBI) is heterogeneous, with several predictors influencing long-term outcome. METHOD: This exploratory study used person-oriented cluster analysis to investigate individual profiles of medical, psychological and social predictors and their relation to longitudinal development in a sample of 127 participants with mild, moderate and severe CTBI. Outcome of cognitive, adaptive and academic function was measured at 30 months and 10 years post-injury. RESULTS: A nine-cluster solution, explaining 67% of the variance in the sample, resulted in two clusters with individuals with mostly mild injuries, five with mostly moderate injured individuals and two clusters with severely injured individuals. Best outcome at 10 years post-injury had a cluster with individuals with moderate injuries, young age at injury, average socioeconomic status (SES) and high pre-injury adaptive function. Worst outcome had a small cluster with severely injured individuals, young age at injury, average SES and average pre-injury adaptive function. CONCLUSIONS: The findings suggest that pre-injury adaptive function is an influential predictor of outcome following moderate CTBI. Age at injury in the severe group appears to have increased influence over time, with younger age at injury associated with reduced outcome at 10 years after severe CTBI.

Long-term cognitive outcome after neurosurgically treated childhood traumatic brain injury.

OBJECTIVE: To explore the cognitive long-term outcome of two cohorts of patients neurosurgically treated for childhood traumatic brain injury (CTBI), either in 1987-1991 according to an older concept or 1997-2001 with a stronger emphasis on volume targeted interventions. RESEARCH DESIGN AND METHODS: Participants in the two cohorts were subject to an extensive neuropsychological assessment, 13.2 and 6.1 years post-injury, respectively. In a between-group design, assessment results of the two cohorts, n = 18 and n = 23, were compared to each other and to controls. Data were analysed with multivariate analyses of variance. RESULTS: Long-term cognitive deficits for both groups of similar magnitude and character were observed in both groups. Abilities were especially low regarding executive and memory function and verbal IQ. The cognitive results are discussed in terms of vulnerability of verbal functions and decreased executive control over memory-functions. CONCLUSIONS: There is a definite need for long-term follow-up of cognitive deficits after neurosurgically treated CTBI, also with the newer neurosurgical concept. Verbal learning and the executive control over memory functions should be addressed with interventions aimed at restoration, coping and compensation.

Variability in quality of life 13 years after traumatic brain injury in childhood.

With the aim of describing variability in the long-term outcome of quality of life after neurosurgically treated pediatric traumatic brain injury, mostly self-reports of 21 individuals with mild or moderate/severe injury were gathered using Mayo-Portland Adaptability Inventory in telephone interviews 13 years aftyer injury. A majority of the participants reported brain injury-related problems. The median outcome on Mayo-Portland Adaptability Inventory was mild to moderate limitations. The variation within the moderate/severe group varied between relatively good outcome and moderate/severe limitations. Concentration, irritability, fatigue, and transportation were reported as the most problematic areas, whereas self-care was reported as well functioning. Societal participation appeared to be the best functional domain in this Swedish study. Examples of individual reports of the life-situation at various outcome levels were provided. Variability in outcome is large within severity groups, and research may gain by addressing both outcomes of the individuals and groups. Objective questions of outcome should be accompanied by questions of actual functioning in everyday life. To ensure long-term support for quality of life for those with remaining dysfunction after pediatric traumatic brain injury, healthcare systems should implement systematic routines for referral to rehabilitation and support.