NeuroRehabilitation

The provision of rehabilitation and long-term services to children and adolescents with traumatic brain injury is a challenge, in part related to the issues of growth and development. The needs of and the demands on the child change over time with different stages of development. This can be further complicated by the emergence of new deficits which often become apparent during transitions requiring more independent functioning. Additionally, changing models of care delivery and the need to improve efficiency and effectiveness of services present challenges for the systems providing services to these children and adolescents and their families. Communication and cooperation between and within these systems (medical and educational) must be optimal, to encourage appropriate, effective services and timely transitions.

This article highlights the role that Emergency Medical Services for Children (EMSC) can play in the continuum of care for children with traumatic brain injuries. Through national efforts by the EMSC, several initiatives and recommendations are proposed regarding the development of a coordinated system of care for children with special healthcare needs that includes children with traumatic brain injuries. In particular, EMSC is addressing the need for expanded emergency and trauma care services for children and methods of improving continuity among emergency, acute, rehabilitation, and community services to enhance better long-term outcomes for these children and their families. Other identified needs include: training and education of providers; resolving differences in language and philosophy that exist across disciplines; developing standards for family-centered care; and improving communication and service coordination for children with special healthcare needs.

The growth of managed care, in particular, has made statements regarding the potential progress of children with traumatic brain injuries more and more necessary prior to admission. In addition, institutions and programs have been held responsible for documenting positive progress in a more systematic fashion than previously. Typically, clinical pathways are documented timetables describing progress and outcome in medical settings. This article will present rationale for the need to develop clinical pathways, what components and rehabilitation areas should be included, and how to implement such pathways. Specific aspects of pathways can be formulated to meet the needs and reflect the characteristics of children with traumatic brain injuries. Incorporating clinical pathways into school, community re-entry, and program evaluation will also be discussed. Pathways can be valuable tools in communicating with families, funders, and clinical staff, as well as tools for program evaluation.

Educators today face the challenge of providing appropriate programs for students with a wide variety of needs. Students with acquired brain injuries may sustain permanent physical, cognitive, and psycho-social sequelae which can significantly impact their ability to function at home, in school, and in the community. After discharge from a rehabilitation facility, the educational system becomes critical in facilitating the student's ongoing progress. Addressing the long-term needs of students with brain injuries requires that educational personnel become knowledgeable about appropriate learning strategies and program modifications. This article describes the educational outcomes of students with acquired brain injuries, discusses critical features of effective programs, and suggests interventions for consideration in instructional planning.

Until recently, information about childhood brain injury was rarely geared toward families or educators. Yet information is critical, according to our survey of 89 experts. We asked about the type of information needed, groups needing information, and issues of timing. Respondents were most concerned about brain injury information gaps for parents, educators, and community physicians. Basic information about brain injury among children, methods of coping, and advocacy strategies were deemed most important. Good multi-media materials are needed, so people can quickly learn the basics, find where to learn more, and make contacts in the brain injury community. New Internet discussion groups, mailing lists, and websites appear almost daily. As more user-friendly information on brain injury gets placed on the Internet, more needs to be done to make this information accessible to all citizens.

This article focuses on the impact of brain injury on families of children and adolescents. It involves an unscientific study of nine families whose youngsters sustained brain injuries ranging from 3.5 to 17 years of age at the time of injury. Eight of the nine injuries were in a severe impairment range while one was a mild brain injury with loss of consciousness of less than 10 min. The individuals with brain injuries in this study are currently 15–32 years of age. The injuries resulted from motor vehicle crashes, biking, falls, and organized sports programs. Eight of the nine participants were living in two parent homes at the time of injury, the ninth parent was a widow. Currently two additional mothers are widowed. This article supports the need for increased dialogue and more productive communication between parents and those providing services, and greater access to community support systems over the life span of individuals with brain injuries.

Violence is one of the most important and preventable causes of head injury in children. This review discusses the epidemiology of youth violence from previously published reports and from new information obtained from the National Pediatric Trauma Registry. Violence prevention is considered in two categories: primary prevention aimed at the general population, and secondary prevention strategies focused on injured children and adolescents. Rehabilitation professionals have substantial roles to play in both primary and secondary prevention of youth violence.