NeuroRehabilitation

Traumatic brain injury (TBI) is common during childhood. However, most of the extant literature about outcomes following childhood TBI is based on children who were functioning “normally” prior to the injury event. But, with the increasing community integration of children with Intellectual Disability (ID) there is an urgent need for specific information regarding problems following TBI for this group.

Using a case study, this paper presents an overview of problems faced by these children who subsequently experience a TBI event, and examines questions pertinent to this dual diagnosis.

In the case study presented, despite supposedly having access to an internationally acclaimed comprehensive no fault accident compensation and rehabilitation system, a lack of assessment, intervention and support was evident for both the child and the family following a severe TBI because he had pre-existing ID.

This case study highlights the need for clinicians to consider the impact of TBI for children with ID, to avoid incorrectly attributing TBI symptoms to pre-existing problems. Children with ID are at increased risk; appropriate treatment plans are vital to maximize quality of life for them and their caregivers.

Our objective was to ascertain the feasibility and consumer satisfaction ratings of families who received an adapted pediatric acquired brain injury (ABI) ‘Signposts for Building Better Behavior’ program [25] in either group- or telephone-support delivery formats.

Forty-eight families of children aged between 3 and 12 years with mild, moderate, and severe ABI completed Signposts in group (n = 23) or telephone-support (n = 25) format consisting of nine information booklets, a DVD, and Workbook.

All parents approved of the skills taught and a majority felt the materials were helpful in both managing challenging behavior associated with brain injury, and teaching new skills to their brain injured child. All parents rated a high level of feasibility for all of the Signposts materials.

The current research has provided preliminary evidence for the feasibility and satisfaction of a family-centered parent-based behavioral intervention program called Signposts to be used with a pediatric ABI population. It also provides evidence for a less costly option of intervention delivery via telephone-support.

The aim of this randomized clinical trial study was to evaluate the efficacy of an intervention program based on social mediation, cooperative learning and metacognition (Metacognitive Dimension) in preadolescents with acquired brain injury (ABI).

Participants were 29 ABI preadolescents: 14 in the experimental group and 15 in the control group (average age, 10.4 y.o.; average time of lesion, 5.3 years). Evaluations were conducted 3 months after the start of the intervention, using the Evaluation Scale of Elementary School Learning Strategies (ESESLS) to assess metacognitive strategies, Self-Concept Scale for Children (SCSC) and Behavioral Rating Inventory of Executive Functions (BRIEF).

The experimental group had superior outcomes to the control. The results of metacognitive strategies (ESESLS) and self-concept (SCSC) were better in the experimental than in the control group (p < 0.05). BRIEF did not reveal any significant differences between the groups, although we observed better results in the experimental group for 5 sub items of the scale, in the broader index and global executive composite score.

Three months of an intervention based on cooperative learning helped preadolescents with acquired brain injury develop metacognitive strategies and improve self-concept, thereby helping empower the preadolescents in their social relationships.

Pediatric traumatic brain injury accounts for approximately 37,000 hospitalizations and 2,685 deaths in the United State annually. The 2003 guidelines consolidated and summarized the body of literature on this subject. Among the material covered was the role of surgical management of elevated intracranial pressure. Here we review the guideline recommendations, recent literature on the topic, and important recent results in the adult population.

A Medline literature review was performed to identify studies published since 2000 addressing decompressive craniectomy in the pediatric and adult populations. Important articles included in the 2003 guidelines were also reviewed. All references were reviewed to identify additional relevant studies.

There is little new data that addresses the key issues for investigation proposed in the 2003 pediatric guidelines. The only randomized trial in the pediatric population remains a 2001 study, which demonstrated a benefit of decompressive craniectomy. One recent randomized trial in adults demonstrated no benefit of the procedure and an additional randomized trial in adults is underway. No pediatric randomized trial is planned. Smaller, non-randomized series appear to support the practice.

Based on the only randomized trial in children and the abundance of smaller studies, it is our belief that decompressive craniectomy does provide a benefit in terms of the management of intracranial hypertension and overall outcome in children.

Meta analysis of studies was carried out to examine the effectiveness of functional task training with mental practice on functional performance following stroke.

An exhaustive search was conducted using computerized databases such as MEDLINE, PubMed, Cochrane, PsycINFO, and EBSCO (CINAHL).

The search was performed using the following keywords: stroke, functional task, mental practice, randomized controlled trial.

Two reviewers independently retrieved appropriate RCTs, extracted data, and assessed the methodological quality of each study. Selected studies needed to report the statistical values necessary for calculating the effect size, which was estimated using the standardized difference of the mean. Statistical heterogeneity and publication bias were also investigated.

The five studies included 146 participants. The overall effect size was moderate (0.51, p < 0.001). The 95% confidence interval was from 0.27 to 0.75. Significant heterogeneity and publications bias were not founded.

The present study is the first meta-analysis conducted on the effectiveness of functional task training with mental practice in stroke. The results indicate the clinical effectiveness of functional task training with mental practice provided by occupational and physical therapists in stroke rehabilitation.

The goal of this prospective study was to evaluate gender differences in rehabilitation outcome in patients after the first-ever unilateral stroke.

A total of eighty right-handed patients were prospectively enrolled, 35 (44%) women, and 45 (56%) men. A degree of neurological deficit was quantified by the National Institutes of Health Stroke Scale. Functional outcome was assessed by the Motor Status Scale, Chedoke Arm and Hand Activity Inventory, Rivermead Mobility Index and Barthel Index.

At the time of hospital admission there was no significant gender difference in clinical stroke severity. At discharge, we registered significantly better motor and functional recovery in men compared to women. Further, we found significantly better rehabilitation outcome in women with stroke in dominant left hemisphere (LH) than in women with stroke in subdominant right hemisphere (RH). Conversely, men with stroke in subdominant RH had significantly better rehabilitation outcome than men with stroke in dominant LH. Using a multivariate analysis we have found that men with stroke in RH had significantly higher probability to reach not only high response in mobility, but also more autonomy in ADL. The frequency of stroke in LH was significantly higher in both genders aged less than 51 years, as well as in women, while the frequency of stroke in RH was significantly higher in men.

This paper places particular emphasis on substantial gender-based differences in functional recovery of patients with their first-ever unilateral stroke.