Early Elementary School Outcome in Children With a History of Traumatic Brain Injury Before Age 6 Years.

OBJECTIVE: To describe elementary school outcomes for children who experienced a traumatic brain injury (TBI) before age 6 years compared with a control group of children with orthopedic injuries. PARTICIPANTS: Children ages 6 to 9 years recruited from community and trauma registries in a large southeastern state. DESIGN: Descriptive findings from the first year of a 3-year longitudinal study. MAIN MEASURES: Child assessment and parent report measures were administered to capture cognitive, language, reading, and behavior outcomes. Medical record review confirmed injuries and injury severity. RESULTS: The TBI group (n = 39) had a mean age of 7.55 years (standard deviation = 1.29) and was 5.15 (standard deviation = 1.56) years postinjury. The TBI group had primarily classified as mild complicated TBI (63%). On average, children in both groups performed within normal limits on most cognitive, language, and reading measures. Group differences were identified in verbal IQ, receptive language, and reading comprehension, with robust performance differences in pragmatic language, story retell and word fluency, and parent report of executive functions. CONCLUSIONS: Findings indicate the importance of in-depth follow-up specialist assessments (eg, neuropsychologist and speech and language pathologists) to identify potential nuanced difficulties in children with mild complicated TBI that may be missed by general evaluations.

Rehabilitation and school services following traumatic brain injury in young children.

BACKGROUND: Preschool children have the highest incidence of emergency department visits for traumatic brain injury (TBI) with the majority discharged home without a single point of entry into follow-up services. This paper describes families' experience with service access following TBI. OBJECTIVES: To describe parent reported service utilization following preschool TBI and examine predictors of service access. METHODS: Participants (N = 80) were drawn from the first visit of a longitudinal study examining elementary school outcomes following TBI. Parents were interviewed about their service history. Descriptive statistics analyzed sample demographics. Logistic regression examined associations between injury related factors and service utilization. RESULTS: TBI participants had mild injuries (83%) and were either discharged to home or spent less than a week in the hospital. No TBI participants received inpatient rehabilitation and only a portion of the sample (26%) received outpatient treatment. Length of hospital stay was a significant predictor of service access (Wald = 4.33, df = 1, p = 0.040). All children were enrolled in preschool without accommodations. CONCLUSION: Currently no systematic continuum of care exists for children with TBI injured prior to elementary school, despite availability of healthcare, education and state based resources. Healthcare professionals in contact with young children can help with follow-up by educating parents about TBI effects on learning.

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.

Practical applications for use of PDAs and smartphones with children and adolescents who have traumatic brain injury.

It is often recommended that individuals with memory and organizational problems after a traumatic brain injury (TBI) use some type of memory device such as a paper calendar. Recently the use of electronic devices has been suggested. This article outlines data obtained from in vivo trials using personal data assistants (PDAs) and follow up in depth studies with PDAs and smartphones. These trials were conducted with individuals who had memory and organizational problems as a result of cognitive disorders of traumatic brain injury (TBI) or intellectual disability (ID) Results indicate that the use of electronic devices can enhance independent behavior. Factors influencing success include: student motivation, audible beep of the device; support for programming and troubleshooting, alterations of functions; and selection of features to motivate. Based on the result of the studies, an intervention plan for use of PDAs was developed for use by clinicians.

Paediatric traumatic brain injury: a review of pertinent issues.

Children with traumatic brain injury (TBI), regardless of the severity of the injury, often face challenges when living in home, school and community. Their needs are often overlooked and recognition of the long-term consequences is not always central to the management of the child in the school or community. This article provides references to pertinent literature and suggestions for intervention from the clinical experiences of four individuals with extensive experience of the family stresses, educational, cognitive-communicative and behavioural challenges that occur after TBI in children. It provides information regarding these issues, particularly educational situations, and suggests methods that may be useful for service providers and family members.

The potential of electronic organizers as a tool in the cognitive rehabilitation of young people.

Youths who have traumatic brain injury (TBI) or mental retardation and other developmental disabilities often experience cognitive challenges in using memory and organization for learning, managing daily routines, or conducting social interactions. This article presents the results of a survey of 53 youth-parent-teacher triads probing their views regarding the youth's relationship with technology. Since the sample is small, results should be viewed with caution, yet keeping in mind the study presents some of the only data available on the use of generic technologies with youths who have disabilities. Primary findings indicate: 1) youths use a variety of technologies and are more likely to be exposed to computers than cell phones or personal data assistants respectively; 2) youths with finger, reading, and copying skills use more technologies; 3) youths value many varied features of technology, but rated most highly good technical support, simple learning requirements, capacity to store information, and long battery life. The data also indicated that the most common memory and organization strategy the youths used was "someone does it for me".

Reports of head injury and symptom knowledge among college athletes: implications for assessment and educational intervention.

OBJECTIVE: To identify the prevalence of head injuries and related symptoms among college athletes and examine knowledge of head injury consequences and behavioral tendencies of athletes in the presence of symptoms. DESIGN: Retrospective survey. PARTICIPANTS: A total of 461 male and female athletes beginning competitive play at the University of Akron (Akron, OH) during the years 1995 to 2001. MAIN OUTCOME MEASURES: Responses to survey questions were analyzed to determine the frequency of concussions and injury-related symptoms (eg, dizziness, headache, nausea or vomiting) in addition to behavioral responses in the presence of certain symptoms (eg, playing with headache, failure to report symptoms while playing). Written responses to queries regarding symptom knowledge were analyzed for thematic content and were used to identify deficiencies in signs and symptoms of concussion. RESULTS: Nearly 32% of all athletes had experienced a blow to the head causing dizziness, with over 1/4 confirming various somatic symptoms following a blow to the head (eg, seeing stars, nausea or vomiting, head pain). Continuing to play despite symptom presence was noted (eg, dizziness, 28.2%; headache, 30.4%), with 19.5% reporting a concussion diagnosis. Knowledge of head injury consequences was found to be deficient, with 56% indicating no knowledge of the possible consequences following a head injury. Of those providing responses, the majority reflected awareness of cognitive (eg, memory problems) and physical (eg, brain damage) consequences. CONCLUSIONS: A sizable number of athletes may enter collegiate play with a previous concussion diagnosis, and many more are likely to have experienced symptoms suggestive of a mild head injury. Of considerable concern is the tendency to play while symptomatic (eg, headache, dizziness) and the failure to report symptoms while playing--especially among football players (25.2%). The apparent deficiency in athlete knowledge of head injury consequences raises concern regarding athlete recognition of potentially problematic symptoms and represents an important area for educational intervention.