Met and unmet rehabilitative needs among pediatric patients with moderate to severe TBI.

OBJECTIVE: Estimate the probability of met and unmet post-acute rehabilitative needs among pediatric patients with moderate to severe traumatic brain injury (TBI). PARTICIPANTS: One hundred and thirty children who received acute and post-acute rehabilitative services at a hospital for children. METHODS: Prospective, observational study. Recommended service needs (1. Medical, 2. Psychological, 3. Cognitive/Educational, 4. Medically Based Therapies, 5. Community/Caregiver/Family Support) were collected at discharge and 1, 6, 12, and 18 months post-injury. Probabilities were estimated using nonlinear logistic regression models. The impact of age at discharge was also assessed. RESULTS: Over time, the estimated probability of need for Medical, Medically Based Therapies, and Cognitive/Educational services were consistently high. Whereas unmet need for Medical and Medically Based Therapies were low, unmet need for Cognitive/Educational services were relatively high. Need for Psychological and Community/Caregiver/Family Support services increased in the months post-discharge, as did the probability of unmet need. Older age at discharge was associated with need for Psychological and Community/Caregiver Family Support services. CONCLUSIONS: Findings support the long-term monitoring of need for Psychological and Community/Caregiver/Family Support services among children with moderate to severe TBI. Future research to explore the etiology of unmet needs is warranted.

The Natural History of Postconcussion Recovery Among High School Athletes.

OBJECTIVE: Evaluate postconcussive symptom reporting and recovery. SETTING: Public high school. PARTICIPANTS: Unmatched controls (n = 760); students who sustained a sports-related concussion (n = 77); matched controls (gender, grade, sport) (n = 77). DESIGN: Prospective longitudinal cohort study. OUTCOME MEASURE: Immediate Postconcussion Assessment and Cognitive Testing. RESULTS: At baseline, athletes who went on to sustain concussions were more likely than unmatched controls to be younger (P = .02), male (P = .001), and participate in different sports (P < .0001) such as football (concussed = 52%, unmatched controls = 20%). Differences were also noted regarding a previous history of concussion (P = .045; concussed athletes = 26%; unmatched control athletes = 16%) and lifetime number of concussions (P = .05). At baseline, those whose sustained concussions during the study period were more likely than matched controls to report numbness (P = .01) and concentration problems (P = .01) and more likely than unmatched controls to report dizziness (P = .02), sensitivity to light (P = .01), sensitivity to noise (P = .002), and numbness (P = .02). However, when data were reanalyzed and those with a previous history of concussion were removed, differences between those who sustained concussions during the study period and matched controls were no longer significant; when compared to unmatched controls, sensitivity to light (P = .01) and vision problems (P = .04) remained significant. Among those who sustained concussions, median time to recovery was 6 days (95% confidence interval: 4-9), and 71 out of 77 (92%) recovered by the fourth postinjury evaluation (median: 20 days postinjury). CONCLUSIONS: Course and time frame of recovery were variable. Data also suggest that a previous history of concussion may be contributing to baseline symptom reporting and highlight the potential enduring impact of history of concussion on sensorimotor function. However, further research as to whether preinjury measures of sensorimotor function may increase understanding regarding concussion risk is warranted.

BrainSTARS: pilot data on a team-based intervention program for students who have acquired brain injury.

UNLABELLED: To conduct and evaluate an educational/consultation program for parents and teachers of children who have acquired brain injury (ABI). PARTICIPANTS: Parents, regular and special educators, and related school personnel of 30 students who had ABI and serious school problems. INTERVENTION: BrainSTARS (Brain Injury: Strategies for Teams and Re-education for Students), an individualized consultation program that includes a comprehensive manual on pediatric ABI. The intervention included 3 meetings in the school of the child identified with ABI. DESIGN: A pre/post single group design assessed the impact of BrainSTARS on ABI-related competencies in the adult participants as well as on measures of child behaviors. RESULTS: Significant improvement was shown in the participants' self-rated proficiency in working with children who have ABI as well as on their ratings of student performance in targeted neurodevelopmental areas. There was no significant change on standardized measures of child behavior (the Behavior Rating Inventory of Executive Functions and the Behavior Assessment System for Children). CONCLUSIONS: BrainSTARS appears to increase the competencies of parents and educators related to students who have ABI; further study of BrainSTARS' impact on student performance and capacity to produce long-standing results is called for.

The long-term impact and rehabilitation of pediatric traumatic brain injury: a 50-year follow-up case study.

Despite significant advances in the understanding of pediatric traumatic brain injury (TBI)-related sequelae, members of the medical community working with adult survivors often do not appreciate the impact of "latent" effects of these injuries. To assess deficits and facilitate intervention, the interactions among the nature of the TBI, the individual's developmental course, and the history of community response must be understood. This case study discusses the lifelong challenges faced by a 56-year-old individual who sustained a TBI at age 5. His case highlights the importance of developmental stage consideration, remote evaluation/intervention, and collaboration with mental health professionals.