Home > Diagnoses & Conditions > Traumatic Brain Injury > Ongoing Assessment
Traumatic Brain Injury - Ongoing Assessment
Overview
The child's need for intervention (physical, emotional, cognitive, educational) should be reassessed periodically as he/she recovers from the initial traumatic brain injury (TBI). This may include cognitive and physical recovery from the TBI, as well as from other post-injury problems, such as headache and attention deficits. While not available in all locations, comprehensive multi-disciplinary care by a pediatric rehabilitation team is preferred; [Max: 1998] if not available the Medical Home will need to make referrals as necessary.Screening
Continued screening for deficits in learning, problem solving, and general functioning that might not be readily apparent may be helpful. Screening for depression and other mental health disorders is also appropriate, as they occur more frequently in this population.Pearls And Alerts
Depression after traumatic brain injury occurs in approximately 1/3 of individuals experiencing a TBI. [Jorge: 2004] The frequency varies with age at head injury and the degree of injury. Depression following TBI may appear as a deterioration in ability over time, and should be considered in follow-up visits by the Medical Home. [Fleminger: 2008]
History And Examination
Interim History
Assess changes in functioning over time and ask about attention and memory problems, learning problems, continued headaches and other problems that may arise. Are associated injuries (e.g., fractures) healing well? Is pain or spasticity an issue? Is the patient growing appropriately? How does he/she eat, orally or by G-tube? Progress in rehabilitation goals?Developmental and Educational Progress
The Medical Home should monitor developmental and educational progress. In addition to asking the family, obtaining reports from school and therapists may be helpful. Does the child have enough energy to participate in school for the length of time they are attending? Are adaptive physical education needs being met?Social and Family Functioning
The Medical Home should monitor how the child functions in the community and how the family is coping with the problems caused by the brain injury. Children may have problems with their behavior after a TBI and act-out. They may have a high anxiety level and or post-traumatic stress disorder. Sometimes a child who is functioning well at first presents with behavior or adjustment problems at a later date. Does the family have adequate financial resources?Physical Exam
General
Asess mental status, including awakefulness, alertness, interaction, ability to follow commands in an age-appropriate manner, attention span for age, memory. Assess speech and language: Are expressions of wants and needs and response to circumstances age appropriate?Testing
Subspecialist Collaborations and Other Resources
Pediatric Physical Medicine & Rehab (see Services below for relevant providers)
often helpful in monitoring physical, emotional, behavioral issues, spasticity and generally key to devising and implementing a rehabilitation plan
Pediatric Neurology (see Services below for relevant providers)
as needed for the treatment of seizures, may also follow patients with traumatic brain injury, depending on local expertise
Pediatric Orthopedics (see Services below for relevant providers)
as needed for orthopedic issues relating to spasticity or injuries
Pediatric Gastroenterology (see Services below for relevant providers)
as needed for problems related to feeding
Speech/Language Therapy (see Services below for relevant providers)
to evaluate language, content, memory, speech, and feeding-related functions
Occupational Therapy (see Services below for relevant providers)
to evaluate visual perception and processing, hand writing, upper extremity strength and coordination, activities of daily living and fine motor skills.
Physical Therapy (see Services below for relevant providers)
to evaluate gross motor function, balance, lower extremity strength and coordination
Educational Advocacy (see Services below for relevant providers)
to assess learning disabilities and develop a plan for re-integration into school
Neuropsychology (see Services below for relevant providers)
to assess cognitive abilities. Sometimes available during initial hospitalization, often not done until 3 to 6 months post traumatic injury and repeated every 2 to 3 years as needed
Resources
Information & Support
For Professionals
Traumatic Brain Injury (CDC)
Overview, information, and links about TBI and its prevention, from the Centers for Disease Control and Prevention.
National Resource Center for Traumatic Brain Injury
Offering assessment tools, training program, publications, etc. for professionals and consumers. From the Virginia Commonwealth
University Health System.
For Parents and Patients
Support
Brain Injury Association of Utah
A non-profit organization dedicated to education and support for the prevention and recovery of brain injury. The site lists
services (support groups, helpline, community education, conferences, legislative liaisons) and offers family education (simple
definitions, a map of the brain with explanations of function, consequences of injury and more).
Brain Injury Association of America
National Organization whose site provides information, links to resources, publications, and information about policy/legislation
and state chapters.
General
Traumatic Brain Injury (MedlinePlus)
from the National Library of Medicine and National Institutes of Health; offers an overview and an extensive compilation of
links to reliable web sites and organizations related to TBI.
Traumatic Brain Injury (NINDS)
from the National Institute of Neurological Disorders and Stroke, provides an overview and links to publications and relevant
organizations; not pediatric-specific.
Traumatic Brain Injury (NICHCY)
From the National Dissemination Center for Children with Disabilities; parent-focused page about TBI, includes information
about education.
Services
Educational Advocacy
Children's Education Services,
more info...
100 N Mario Capecchi Drive
Salt Lake City, UT 84113
Phone: 801-662-4914
http://intermountainhealthcare.org/xp/public/documents/pcmc/school.pdf
See all Educational Advocacy services providers (25) in our database.
Pediatric Gastroenterology
See all Pediatric Gastroenterology services providers (2) in our database.
Pediatric Physical Medicine & Rehab
See all Pediatric Physical Medicine & Rehab services providers (6) in our database.
For other services related to this condition, browse our Services categories or search our database.
Studies
Brain Injuries in Children (clinicaltrials.gov)
A listing of clinical trials related to brain injuries in children, from ClinicalTrials.gov.
Helpful Articles
PubMed search on traumatic brain injury: articles over the past 2 years
Orliaguet GA, Meyer PG, Baugnon T.
Management of critically ill children with traumatic brain injury.
Paediatr Anaesth.
2008;18(6):455-61.
PubMed abstract
Martin C, Falcone RA Jr.
Pediatric traumatic brain injury: an update of research to understand and improve outcomes.
Curr Opin Pediatr.
2008;20(3):294-9.
PubMed abstract
Atabaki SM.
Pediatric head injury.
Pediatr Rev.
2007;28(6):215-24.
PubMed abstract
Giza CC, Mink RB, Madikians A.
Pediatric traumatic brain injury: not just little adults.
Curr Opin Crit Care.
2007;13(2):143-52.
PubMed abstract
Page Bibliography
Fleminger S.
Long-term psychiatric disorders after traumatic brain injury.
Eur J Anaesthesiol Suppl.
2008;42:123-30.
PubMed abstract
Jorge RE, Robinson RG, Moser D, Tateno A, Crespo-Facorro B, Arndt S.
Major depression following traumatic brain injury.
Arch Gen Psychiatry.
2004;61(1):42-50.
PubMed abstract
Max JE, Robin DA, Lindgren SD, Smith WL Jr, Sato Y, Mattheis PJ, Stierwalt JA, Castillo CS.
Traumatic brain injury in children and adolescents: psychiatric disorders at one year.
J Neuropsychiatry Clin Neurosci.
1998;10(3):290-7.
PubMed abstract