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Traumatic Brain Injury - Treatment & Management

Overview

The focus of care for children following a Traumatic Brain Injury (TBI) is to restore independence in mobility, communication, and self-care (feeding, grooming, toileting) through rehabilitation. See Rehabilitation for TBI in Children and Adolescents (US Dept HHS). A rehabilitation consult should be involved early (even while the patient is in the intensive care unit) to begin planning care based on the extent of injury, the family situation, and available resources. The Medical Home should become familiar with the child's treatment and progress during inpatient rehabilitation and with the discharge plan created by the rehabilitation team.

Primary Care Roles

Important roles of the Medical Home include:
  • assuring continuity of care by evaluating the needs of the patient and the family before and after discharge from the rehabilitation facility
  • educating the patient and the family about all aspects of care and explaining options
  • referring patients and family to appropriate specialists after discharge. Because patients often have suffered multiple injuries, they may be seeing a variety of specialists (physiatrist, neurosurgeon, ENT specialist, plastic surgeon, orthopedist, etc). Through frequent communication and coordination of care, the primary clinician can prevent duplication of tests and unnecessary treatments. Specialty care will usually involve follow-up from the facility where they received inpatient rehab.
  • providing prescriptions for medications and therapies. Instruct patients/parents to avoid all medications other than those prescribed by you or a referring physician and to make certain all providers have an up-to-date list of current medications, including over-the-counter and other substances (e.g. herbal remedies). Initially, after consultation with the patient's rehab specialist, determine therapy prescription needs. Immediately after discharge, patients often require two or three sessions per week of physical, occupational, and/or speech therapy. Primary care clinicians generally renew prescriptions for therapy based on the recommendations of the therapists, who should report patient progress and alert the physician to problems.
  • helping the family identify local, state and national resources
  • providing documentation necessary for obtaining resources and referrals
  • listening to parents and helping them cope with problems as they arise

Pearls And Alerts

For children with concussion or mild TBI in the emergency room, the focus is primarily ruling out more serious injuries. Having found none, children and families may be discharged without education regarding consequences of mild TBI, which may include changes in mood, concentration, and learning for months afterward, and can lead to headaches and sleep problems. Families should be given follow-up instructions with a physiatrist or neurologist, depending on local expertise. See [Kamerling: 2003], [Lovell: 2008], [Lee: 2007], and [Kirkwood: 2006] and the Mild Traumatic Brain Injury (TBI) and the Post-concussive Syndrome issue page for more information.

Practice Guidelines

There are no published guidelines for Medical Home management following discharge from the initial hospitalization for TBI. The guideline below is for acute care of the TBI in the pediatric population.

Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, Carson S, Chesnut RM, Ghajar J, Goldstein B, Grant GA, Kissoon N, Peterson K, Selden NR, Tasker RC, Tong KA, Vavilala MS, Wainwright MS, Warden CR.
Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition.
Pediatr Crit Care Med. 2012;13 Suppl 1(Jan):S1-82. PubMed abstract

Systems

Neurology

Establish Post-TBI Restrictions:
  • Restrict activities to those that have 'two feet on the ground' until the first post-hospitalization evaluation
  • Advise patients to get plenty of rest; they may need to begin school later in the day and/or attend for shorter periods;
  • For teenagers who drive, recommend driving evaluation through the outpatient occupational therapy department
  • Discuss safety and judgement issues to minimize risk of further injury
Address residual health problems:
  • Headaches: common following a head injury
  • Vision: refer to an ophthalmologist for decreased visual acuity, diplopia, strabismus, visual field deficits
  • Hearing: refer to an audiologist if patient has conductive hearing loss or sensorineural hearing loss
  • Spasticity: patients may have varying degrees of spasticity from damage to the motor areas of the brain or descending white matter tracts. Treatment, generally directed by a physiatrist, may include: range of motion exercises, casting, assistive devices and muscle relaxant medications. The primary care physician has an important role in monitoring progress and coordinating with the family and physiatrist.
  • Seizures: Anticonvulsants are generally discontinued upon discharge except in patients who are at high risk for seizures due to a penetrating injury.

Subspecialist Collaborations and Other Resources

Pediatric Physical Medicine & Rehab (see Services below for relevant providers)

Children with TBI should be followed by physiatry, and associated therapies, as well as their Medical Home to optimize recovery and treat complications.

Pediatric Neurology (see Services below for relevant providers)

Consider a referral to pediatric neurology for seizures or intractable headaches.

Pediatric Ophthalmology (see Services below for relevant providers)

Refer to ophthalmology for visual problems.

Audiology (see Services below for relevant providers)

Refer to audiology for hearing deficits.

Physical Therapy (see Services below for relevant providers)

Physical therapy is an important part of the rehabilitation process.

Occupational Therapy (see Services below for relevant providers)

Occupational therapy will help the child relearn activities of daily living following TBI.

Speech/Language Therapy (see Services below for relevant providers)

Children should be referred to speech/language therapy after TBI if they have problems with aphasia, attention, etc.

Musculoskeletal

Spasticity and movement treatment: Children with spasticity due to TBI may develop contractures. The management of spasticity includes both surgical and non-surgical interventions. If spasticity is severe, it may interfere with the child's functional abilities, make hygiene difficult, and cause discomfort. These may result from the spasticity itself or from secondary contractures and pressure sores. Spasticity may worsen when the patient is ill or upset. Oral medications, in combination with other modalities (e.g., physical therapy), may be very helpful. A team approach, including physiatry, therapies, and orthopedics, and realistic expectations are key to successful therapy.

Non-surgical interventions may include:
  • therapies - physical and occupational
  • positioning aids (used to help the child sit, lie, or stand) - if the child isn't sitting by him/herself, a corner chair, tumble form, wheelchair, or other positioning aids are used to allow the child to be in a seated position for feeding and for optimal hand use during play and activities of daily living.
  • braces and splints - used to prevent deformity and to provide support or protection. May be used during the day or night to provide stretch and optimal positioning across joints.
  • wheelchairs - either manual or power, may be needed for mobility.
  • standers/walkers - additional equipment to allow standing (weight bearing may help prevent osteoporosis, allow full lung expansion, stretches hamstrings, and allow children to be on-level with peers) and supported walking (for children requiring help with balance and support for walking).
  • medications:
    • oral: although oral antispasmodic agents may cause excessive sleepiness, they are often tried because they are non-invasive. Examples are diazepam (Valium), baclofen (Lioresal), and clonazepam (Klonopin). Valium given before sleep is helpful in some patients and may not cause daytime drowsiness. [Mathew: 2005] There is not as much experience in pediatrics with modafinil (Provigil) [Murphy: 2008] and tizanidine (Zanaflex), but these medications may improve function of children with spasticity. Doses should be titrated to avoid weakness and extensive hypotonia.
    • injections: botulinum toxin A (Botox) and B (Myobloc) and phenol injections are used to treat and prevent contractures that lead to tight ankles (difficulty walking) and hygiene problems (hip adduction contractures). These injections are usually combined with physical therapy, splinting, or casting to optimize impact. [Desloovere: 2007]
Surgical interventions may be used to manage the complications of spasticity or to decrease spasticity and/or dystonia:
  • orthopedic surgery to manage scoliosis, hip dislocations, muscle contractures, and ankle, foot and hand deformities
  • spasticity management:
    • baclofen pump - in some patients with severe spasticity, a small programmable pump is placed in the abdomen with a catheter going to the intrathecal space to deliver baclofen. Complications include infection, catheter breakage, and a possible increase in scoliosis. Pumps may be implanted in children as young as three years of age. Use of a baclofen pump in treating dystonia, though less well understood, may be of benefit. In the individual patient, a trial is performed by intrathecal injection of baclofen. The individual child's response is then assessed over the subsequent 8 hour period. See baclofen pump information for more information.

Subspecialist Collaborations and Other Resources

Pediatric Orthopedics (see Services below for relevant providers)

Children with spasticity after TBI should be referred to orthopedics for management of spasticity and related orthopedic complications.

Pediatric Physical Medicine & Rehab (see Services below for relevant providers)

Physiatry will manage the different treatment options available for spasticity after TBI, including initial evaluation and management of a baclofen pump.

Pediatric Neurosurgery (see Services below for relevant providers)

Neurosurgery, in conjunction with PM&R, will perform a baclofen trial and the pump insertion surgery.

Nose/Throat/Mouth/Swallowing

Swallowing dysfunction: Children discharged from the hospital after a TBI may have swallowing dysfunction and may already have a gastrostomy tube in place. The Medical Home should monitor changes in swallowing function, referring for evaluation if a child is experiencing problems or is showing improvement and may be able to switch to oral feeding.

Swallowing dysfunction might manifest as drooling, salivary pooling (with resultant malodorous breath and increased risk of dental caries), malnutrition, a high risk of choking, and/or frequent pneumonias. Generally, children with swallowing problems should receive therapy from a speech therapist (or, in some locations, an occupational therapist) who can evaluate swallowing function and safety, determine if interventions (e.g., oral therapy, special feeding techniques, improved feeding position) might lead to improvements in function, and determine the safest and most efficient textures for eating. If dysphagia is a problem, diets using pureed foods and thickened liquids may be necessary to prevent aspiration. See Power Packing (general) and Thickening Liquids and Pureeing Foods (general). Also see Aspiration/Chronic Lung Disease (general).

Drooling Many parents will choose not to treat drooling, due to concerns about the side effects of medication and surgery. Drooling in the older, socially-aware child can be very embarrassing and create barriers to important social interactions. See Drooling (general) and [Potulska: 2005] for resources and information about specific treatments.

Subspecialist Collaborations and Other Resources

Speech/Language Therapy (see Services below for relevant providers)

Usually the therapists most involved with swallowing and feeding issues

Occupational Therapy (see Services below for relevant providers)

In some locales, OTs may have the most expertise in swallowing and feeding issues

Pediatric Gastroenterology (see Services below for relevant providers)

Often helpful in evaluating and managing children with brain injurey-related swallowing and feeding problems

Pediatric Otolaryngology (see Services below for relevant providers)

Key to assessing anatomic and some functional disturbances in swallowing; may perform surgical treatments for excessive drooling

Mental Health/Behavior

Children with a TBI will have evolving problems with behavior and mental health. Behavioral problems are often the greatest concern for parents and the most difficult problems to address. These may include difficulty in controlling behavior and anger, and displays of emotion not consistent with the triggering stimulus. These may lead to social difficulties, particularly in the school setting. See Returning to school after a traumatic brain injury. Behavior problems are exacerbated by fatigue, stress, frustration, and elevated external stimuli such as bright lights and loud noises. For more information, see Traumatic Brain Injury Survival Guide and Behavioral changes following a brain injury.

Evaluation and treatment by physiatrists, neuropsychologists, psychiatrists, or psychologists with experience with TBI can be very helpful. Ask parents, the patient (if appropriate), teachers, care providers, therapists to complete the Behavioral Checklist for Patients with TBI(PDF Document 50 KB) to identify specific problems. When working with the families of children with TBI, the Medical Home should identify the priority issues upon which to focus.

Patients may be discharged on stimulant medications for attention and memory problems; their efficacy is still unclear, but may be helpful in selected patients, particularly if they had ADHD before the injury. [Jin: 2004] [Whyte: 2004] Other psychotropic drugs may be prescribed to address problems with behavior, attention, and learning. See Behavioral medication information. Behavior Modification has also been used to address the personality and behavioral effects of TBI, but is time intensive. 1998 Consensus Statement - Rehabilitation after TBI (NIH Conference)(PDF Document 920 KB)

Depression is common after TBI and should be watched for by familes and considered at Medical Home visits. See Depression Tool Kit (MacArthur Foundation Initiative on Depression and Primary Care) and Prescribing SSRIs for depressed children and adolescents.

Subspecialist Collaborations and Other Resources

Child Psychiatry (see Services below for relevant providers)

For the treatment of behavioral problems and mood disorders following TBI.

Neuropsychology (see Services below for relevant providers)

For behavioral evaluation and management, including cognitive problems after TBI.

Sleep

Lack of sleep interferes with the healing process, affects memory, causes irritability, and generally makes head injury symptoms worse. It can also contribute to depression and anxiety. The child may:
  • go to sleep easily but wake up often
  • suffer from fatigue during the day
  • be awakened easily by minimal stimuli, such as soft noises
Treatment generally includes both pharmacological and behavioral interventions. To assist your evaluation, ask the parents to complete a Sleep History Questionnaire(PDF Document 20 KB).

Ensure that families are following good sleep hygiene measures, including having the child:
  • go to bed at the same time every night even on weekends
  • avoid caffeine and chocolate, especially in the evening
  • avoid exercise or stimulating activity late in the evening
  • keep the bedroom at an even, moderate temperature and dark and quiet
  • avoid napping during the day
If necessary, medications for short- or long-term may be helpful. See Medications for sleep.

Subspecialist Collaborations and Other Resources

Pediatric Sleep Medicine (see Services below for relevant providers)

Very helpful in the assessment and management of sleep problems following TBI.

Gastro-Intestinal & Bowel Function

Constipation is a frequent problem, especially for children who are immobile. Symptoms include unexplained irritability, vague abdominal pain, and loss of appetite. Diet should be optimized for high-fiber and water content; if the child receives feedings via G-tube, consider prescribing a formula with added fiber. For medical management of constipation, see Bowel Management Algorithm(PDF Document 47 KB), Bowel Management (general)(PDF Document 74 KB), Constipation Evaluation Tool(PDF Document 84 KB), and Bowel Management Parent Information.

Subspecialist Collaborations and Other Resources

Pediatric Gastroenterology (see Services below for relevant providers)

Helpful for patients with intestinal motility problems or constipation that do not respond to typical measures implemented in the Medical Home

Learning/Education/Schools

The Medical Home should assist the family in planning and negotiating for educational needs following TBI. The child may have attended school while hospitalized and records from the hospital school will be helpful in planning reentry into the public school system. A neuropsychological evaluation, often used to plan an educational program, may also be available from the hospitalization. The Medical Home should advocate for early involvement of the school that includes the development of a comprehensive plan and an IEP. For some children, a shortened school day may be necessary and might require a letter requesting this from the Medical Home. See Traumatic Brain Injury: A Guidebook for Educators (University of the State of New York) for more information.

Subspecialist Collaborations and Other Resources

Brain Injury Clinics (see Services below for relevant providers)

For children with concussion, a visit to the Concussion Program may be helpful to assess potential learning problems and design a strategy for management.

Family

It is important to understand what parents face when their child is discharged. Despite discharge planning, the realities can be overwhelming. Families often must:
  • seek insurance coverage, community resources, and financial assistance
  • arrange for and pay for assistants and caretakers
  • obtain special equipment and/or transportation
  • educate themselves about medications, feeding, and monitoring
  • increase their time commitment to care for the child and meet appointments for follow-up care, sometimes giving up or decreasing work
  • change the physical set-up in the home possibly including reconstruction (bathroom, entranceway ramp, etc.)
  • coordinate with the school for modifications in the classroom, teacher's aide, and IEPs
  • make changes in lifestyle, work routine, and leisure activities for the entire family
  • relinquish committments made to other family members, friends, volunteer organizations, community
  • grieve for and accept the losses (physical, mental, emotional) that their child has suffered
The Medical Home should help the family by suggesting financial resources, support groups, and counseling and/or psychotherapy for the patient and/or family around depression, self-esteem issues, parenting challenges, and altered academic aspirations.

Subspecialist Collaborations and Other Resources

Child Psychology (see Services below for relevant providers)

May help with family and child adjustment, devising and implementing behavioral management programs, and counseling individuals

Family Support, Mental Health (see Services below for relevant providers)

Can assist with the myriad needs of families in managing the consequences of TBI

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
The mission of the National Resource Center for Traumatic Brain Injury (NRCTBI) is to provide relevant, practical information for professionals, persons with brain injury, and family members. The NRCTBI is housed at Virginia Commonwealth University’s Medical College of Virginia Campus.

Brain Trauma Foundation
The BTF is dedicated to disseminating information and education to healthcare professionals and first responders who treat brain injury in the U.S. They have developed guidelines for pre-hospital management, surgical management, and acute medical management of severe TBI in infants, children and adolescents.

The Rehabilitation Research Center for TBI and Spinal Cord Injury
The Rehabilitation Research Center (RRC) for Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI) at Santa Clara Valley Medical Center is a federally-funded "Model System of Care" and conducts research to better understand and improve outcomes after TBI and SCI. This site offers multiple downloadable files (some in Spanish) for patients and family and opportunities to participate in ongoing research projects.

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.

Center for Outcome Measurement in Brain Injury (COMBI)
COMBI is part of the TBI Model Systems Project of the National Institute on Disability and Rehabilitation Research (NIDRR) coordinated through Santa Clara Valley Medical Center. This site provides information about measurement scales that are currently being developed and tested (e.g. Agitated Behavioral Scale (ABS),Disability Rating Scale (DRS), Family Needs Questionnaire (FNQ), etc.)

Traumatic Brain Injury Model Systems National Data Center
The Traumatic Brain Injury National Data Center (TBINDC) at Kessler Medical Rehabilitation Research and Education Center is the coordinating center for the research and dissemination efforts of the Traumatic Brain Injury Model Systems (TBIMS) program funded by the National Institute on Disability and Rehabilitation Research (NIDRR).

Traumatic Brain Injury in the U.S.:Assessing Outcomes in Children
A summary of the existing measures for assessing outcomes with a description of their applicability to studies of TBI from the Centers for Disease Control and Prevention.

Project BRAIN: Effects of TBI on Students
Project BRAIN is a resource and training network for educators, families, and health care professionals who support students in Tennessee with traumatic brain injury. This webpage focuses on physical, cognitive and psychosocial/behavioral functioning.

TBI Resources for Educators (Utah)
On the Utah State Office of Education website, these presentations, reports, and guides are designed for educators to provide strategies in working with students with traumatic brain injury. Materials include those developed by the Brain Injury Association of Utah (BIAU).

For Parents and Patients

Support

Brain Injury Association of America
National Organization whose site provides information, links to resources, publications, and information about policy/legislation and state chapters.

Brain Injury Alliance 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).

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.

TBI Resource Guide (CSN)
From the Children's Safety Network, a comprehensive list of national , informational, educational, and organizational resources related to traumatic brain injury.

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.

Types of Memory(PDF Document 59 KB)
A handout developed by Dr. Glen Johnson, Clinical Neuropsychologist, that describes the types of memory, things that affect memory, and tips for improving memory.

Fatigue(PDF Document 41 KB)
Courtesy of Dr. Glen Johnson, Clinical Neuropsychologist, this handout describes fatigue and ways to adjust to the fatigue factor. Originally written for adults.

Traumatic Brain Injury, Susan's Story(PDF Document)
An explanation for parents about traumatic brain injury from the National Dissemination Center for Children with Disabilities (NICHCY)with a clear description of TBI and tips for parents and teachers and a listing of resources and organizations.

The Road to Rehabilitation Series(PDF Document 758 KB)
A compilation of 8 articles (total 80 pages) from the Brain Injury Association of America (www.biasusa.org) for TBI patients and families about dealing with pain, headaches, cognition and memory, behavior changes, speech and language, drug therapy, spasticity, and concussion/mild brain injury.

National Resource Center for TBI
This site, hosted by the Department of Physical and Rehabilitation Medicine at Virginia Commonwealth University, answers basic questions for parents and teachers, provides lists of links that address a multitude of topics such as medication, education, family support, legal issues, rehab resources and more.

Pediatric Neuropsychology: A Guide for Parents(PDF Document 456 KB)
Describes pediatric neuropsychology, how it differs from a school psychological assessment, reasons for referral, what is assesed and what it will tell you about your child. Also discusses preparation for the test.

Easter Seals National Home Page
Nonprofit organization offering services for individuals with disabilities and their families. Primary services include medical rehabilitation, early intervention, physical and occupational therapy, speech and hearing therapy, child care, recreation, and transition.

Family Functioning Following Pediatric Traumatic Brain Injury(Word Document 80 KB)
Of the more than 100,000 children each year who are hospitalized with traumatic brain injury (TBI), many experience subsequent long-term physical, intellectual and behavioral deficits. From the Brain Injury Association of Washington website (www.braininjurywa.org).

When Your Child Is In The Hospital
A Children’s Hospital Boston Resource Guide for parents. Although it has information specific to the Boston area, there are some great tools/resources for families in any state.

Pressure Ulcer Resource Guide
PressureUlcer.net was created to act as a reliable resource for members of the public wishing to educate themselves about pressure ulcers, their types, causes, treatment, prevention, and the remedies available to those suffering.

Practice Guidelines

The following guideline is for acute care of pediatric traumatic brain injury; it does not address care by the Medical Home after discharge from the initial hospitalization.

Kamerling SN, Lutz N, Posner JC, Vanore M.
Mild traumatic brain injury in children: practice guidelines for emergency department and hospitalized patients. The Trauma Program, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine.
Pediatr Emerg Care. 2003;19(6):431-40. PubMed abstract

Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, Carson S, Chesnut RM, Ghajar J, Goldstein B, Grant GA, Kissoon N, Peterson K, Selden NR, Tasker RC, Tong KA, Vavilala MS, Wainwright MS, Warden CR.
Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition.
Pediatr Crit Care Med. 2012;13 Suppl 1(Jan):S1-82. PubMed abstract

Society of Critical Care Medicine.
Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents.
Crit Care Med. 2003;31(6 Suppl):S407-91. PubMed abstract

Tools

Behavioral Checklist for Patients with TBI(PDF Document 50 KB)
The Behavioral Checklist is a questionnaire for parents, patient, teachers, and care providers. It was created by the Primary Children's Rehabilitation Program to assist the physician in identifying key behavioral problems and narrowing the focus of treatment.

Form for Evaluation and Service Recommendations(PDF Document 40 KB)
A form to facilitate communication between health care providers and school professionals relating to health concerns that impact a student's education.

Glascow Coma Scale(PDF Document 93 KB)

Information Release Form (Schools)(PDF Document 51 KB)
When signed by the parent/guardian, this form will authorize communication between the physician and school officials regarding your patient.

Rancho Los Amigos Cognitive Recovery Scale(PDF Document 41 KB)

Sleep History Questionnaire(PDF Document 20 KB)

Services

Adaptive Recreation

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Assistive Technology

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Audiology

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Brain Injury Clinics

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Child Psychiatry

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Child Psychology

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College Disability Centers

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Counseling

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Crisis Intervention, Mental Health

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Disability Employment

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Disability Transportation

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Disability/Diagnosis-Specific Advocacy

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Early Intervention Programs

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Family Support, Mental Health

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Financial Counseling

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Financial Support, Other

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Independent Living

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Local Support Groups, Disability/Diag

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Medicaid

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Neuropsychology

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Occupational Therapy

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Pediatric Gastroenterology

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Pediatric Neurology

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Pediatric Neurosurgery

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Pediatric Ophthalmology

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Pediatric Orthopedics

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Pediatric Otolaryngology

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Pediatric Physical Medicine & Rehab

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Pediatric Sleep Medicine

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Physical Therapy

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Residential Services, Disability

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Services for People with Disabilities

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Speech/Language Therapy

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State Disability Agencies

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State Financial Agencies

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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

Schoenbrodt, Lisa , Associate professor and Chair of the Department of Speech Pathology/Audiology at Loyola College in Maryland.
Children with Traumatic Brain Injury; A Parents' Guide.
Woodbine House; 2001. 0-933149-99-9
A comprehensive reference that provides parents with support and information in coping with traumatic brain injury and the complex process of readjustment to the changes in a once healthy child. This book won the 2001 Parents' Choice Award and was selected as a Library Journal "Best Consumer Health Book of 2001. It will also be helpful for professionals.

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

Walker S and Wicks B.
The Education of Children with Acquired Brain Injury.
Great Britain: David Fulton Publishers; 2005.

Wade SL, Cassedy A, Walz NC, Taylor HG, Stancin T, Yeates KO.
The relationship of parental warm responsiveness and negativity to emerging behavior problems following traumatic brain injury in young children.
Dev Psychol. 2011;47(1):119-33. PubMed abstract
Parenting behaviors play a critical role in the child's behavioral development. This study examined the relationship of parental warm responsiveness and negativity to changes in behavior following traumatic brain injury (TBI) in young children relative to an age-matched cohort of children with orthopedic injuries (OI).

Ganesalingam K, Yeates KO, Taylor HG, Walz NC, Stancin T, Wade S.
Executive functions and social competence in young children 6 months following traumatic brain injury.
Neuropsychology. 2011;25(4):466-76. PubMed abstract / Full Text
This study examined the impact of traumatic brain injury (TBI) in young children on executive functions and social competence, and particularly on the role of executive functions as a predictor of social competence.

Berry JG, Bloom S, Foley S, Palfrey JS.
Health inequity in children and youth with chronic health conditions.
Pediatrics. 2010;126 Suppl 3:S111-9. PubMed abstract

Taylor HG, Yeates KO, Wade SL, Drotar D, Stancin T, Minich N.
A prospective study of short- and long-term outcomes after traumatic brain injury in children: behavior and achievement.
Neuropsychology. 2002;16(1):15-27. PubMed abstract
Longitudinal neuropsychological outcomes of traumatic brain injury (TBI) were investigated. Further recovery was uncommon after the first year postinjury. Family factors did not moderate neuropsychological outcomes, despite their demonstrated influence on behavior and academic achievement after childhood TBI.

Authors

Authors: Teresa Such-Neibar, DO - 6/2009
Elaine Pollock - 6/2009
Content Last Updated: 7/2011

Page Bibliography

Desloovere K, Molenaers G, De Cat J, Pauwels P, Van Campenhout A, Ortibus E, Fabry G, De Cock P.
Motor function following multilevel botulinum toxin type A treatment in children with cerebral palsy.
Dev Med Child Neurol. 2007;49(1):56-61. PubMed abstract

Jin C, Schachar R.
Methylphenidate treatment of attention-deficit/hyperactivity disorder secondary to traumatic brain injury: a critical appraisal of treatment studies.
CNS Spectr. 2004;9(3):217-26. PubMed abstract

Kamerling SN, Lutz N, Posner JC, Vanore M.
Mild traumatic brain injury in children: practice guidelines for emergency department and hospitalized patients. The Trauma Program, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine.
Pediatr Emerg Care. 2003;19(6):431-40. PubMed abstract

Kirkwood MW, Yeates KO, Wilson PE.
Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population.
Pediatrics. 2006;117(4):1359-71. PubMed abstract

Lee LK.
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