NeuroRehabilitation

Preschool children have the highest incidence of emergency department visits for traumatic brain injury (TBI) with the majority discharged home without a single point of entry into follow-up services. This paper describes families’ experience with service access following TBI.

To describe parent reported service utilization following preschool TBI and examine predictors of service access.

Participants (N = 80) were drawn from the first visit of a longitudinal study examining elementary school outcomes following TBI. Parents were interviewed about their service history. Descriptive statistics analyzed sample demographics. Logistic regression examined associations between injury related factors and service utilization.

TBI participants had mild injuries (83%) and were either discharged to home or spent less than a week in the hospital. No TBI participants received inpatient rehabilitation and only a portion of the sample (26%) received outpatient treatment. Length of hospital stay was a significant predictor of service access (Wald = 4.33, df = 1, p = 0.040). All children were enrolled in preschool without accommodations.

Currently no systematic continuum of care exists for children with TBI injured prior to elementary school, despite availability of healthcare, education and state based resources. Healthcare professionals in contact with young children can help with follow-up by educating parents about TBI effects on learning.

The transition from hospital to school is regarded by researchers as a key factor in the educational success of students with traumatic brain injury (TBI).

The objective of this study is to look closely at what transition services consist of, how they are delivered, and how they are received by educators.

Parents and educators of 21 students with TBI participated in a qualitative study of the delivery of transition services and implementation of hospital recommendations.

This paper presents two themes that emerged from interview and observational data collected over a 7-year period: 1) provision of hospital-school transition services is inconsistent and 2) teachers lack sufficient awareness of and training in TBI to implement hospital transition recommendations. Regardless of the type and quality of transition support, most educators in the students’ schools remained unaware of the students’ needs and how to meet them.

Recommendations include more consistent and specific communication between hospital and school for all students with TBI, long-term tracking of the injury in student files, and increased training of educators in how to meet the needs of students with TBI.

The educational identification (ED-ID) of students with traumatic brain injury (TBI) has been legislated in numerous states, and TBI has become its own special education category. Questions abound as to whether these changes will lead to more readily identifying these students to provide appropriate special education supports.

Elucidate one state’s response to legislative changes around ED-ID of TBI.

This is a phenomenological case study of nine school districts in one state. Researchers conducted focus groups as well as individual interviews with various special education staff. On-going analysis of the focus group and interview data occurred, until themes were finalized.

Reactions of staff comprised two opposing viewpoints: those supporting and carrying out ED-ID (“Toward ED-ID”) and those describing processes and attitudes that stand in the way (“Barriers”). Themes that were supportive of ED-ID include Credible History, Personnel, Targeted Intervention, Effective Communication, and Education. Themes aligned with the barrier viewpoint include Concussion Protocols, Medical Nature, Misidentification, Stigma, and Communication Breakdown.

While many districts reported success with ED-ID for TBI, responses to the ED-ID legislation and TBI category were mixed, with enough barriers identified to cause concern over whether the legislative and policy changes have been overall beneficial.

It is vital to engage in systematic screening to identify and serve children who may have sustained an acquired brain injury (ABI) - either traumatic or non-traumatic, so they can be successfully transitioned between environments and life stages. This is particularly important for children and adolescents given the impact an ABI can have on learning and social functioning over the course of the neurodevelopmental process. A pattern of repeated, undiagnosed mild brain injuries may lead to mood or behavior disorders, learning problems. Despite increasing awareness of brain injury as a public health issue, there has not been implementation of systematic screening practices in schools or other public health settings similar to other conditions (e.g., vision disorders, Autism Spectrum Disorders).

What is needed to address this lack of systematic screening for ABI is a rationale for systematic screening for ABI in children and adolescents, including examining successful models of screening for other disorders and conditions.

A review was conducted of available ABI screening methods, including a description of the available screening tools for pediatric ABI, along with supporting research findings.

A comparison was made of these pediatric ABI screening tools, looking at the purpose of the tool, the populations and settings in which the tool can be used, the time and cost for administering the tool, the evidence basis in the literature supporting the tool, and the types of outcomes that can be attained from using the tool.

Recommendations are made for procedures for systematically implementing ABI screening in pediatric settings including schools, primary care providers, mental health, and juvenile justice systems to improve the access to brain injury services and affording more successful transition of adolescents into the adult roles.

Educators lack understanding of traumatic brain injury (TBI), which can lead to a lack of appropriate assessment and intervention methods for these students.

This qualitative study explored what experienced teachers perceive, believe, and know about pediatric TBI.

Following development of a standardized interview protocol, 46 teachers from Australia, New Zealand, Northern Ireland, and the United States took part in semi-structured interviews. Topics included understanding of the effects of TBI on school performance, supporting a child with TBI in the classroom, and challenges and teaching efficacy in working with students with TBI.

The themes we identified were: personal experience with TBI, lack of content knowledge, non-TBI-specific adaptations, collaboration with experts, need for specific training, confidence in working with students with TBI, and knowledge of students’ rights to service provision. Our findings show that although teachers had little knowledge of TBI, many felt they would be able to adequately support a child with appropriate input from specialists.

Teachers fill their knowledge gaps about TBI with their own personal experiences and prior information about working with students with disabilities. These findings support important implications for changes in how we educate and support teachers.

Children with brain injuries face significant challenges in their recovery. One of the greatest is transitioning from hospital/home to school where they face issues such as reintegration, lack of understanding and catching up with missed work. Many children struggle with their altered circumstances and require additional supports to meet the academic demands of systems which are ill equipped to teach them.

To summarise the best available evidence for the use of educational interventions to improve academic attainment in childhood survivors of acquired brain injury (ABI).

Six electronic databases (Cinahl, Embase, Medline, PsycINFO, Pubmed, & Web of Science) were systematically searched for randomised controlled trials published between 1980 and 2017. Two authors independently reviewed these studies and extracted data on type of intervention, characteristics of participants, outcome measures, findings and recommendations. The Cochrane Collaboration’s Risk of Bias tool was used to assess systematic error in the included studies.

Four studies met the inclusion criteria (n = 296 children and adolescents). Three studies (n = 287) were included in meta-analysis for the primary outcome which showed no statistically significant difference between the intervention and control conditions on academic attainment (SMD 1.31, 95% CI –0.06 to 2.68, p = 0.06). No statistically significant differences were found which favoured the intervention for the secondary outcomes of attention, internalising or externalising behavior. All effect sizes were considered as small.

This review suggests that no currently effective educational interventions exist for children with ABI. Greater efforts are required to produce effective and rigorously tested interventions to improve outcomes for these children.

The purpose of this article is to familiarize healthcare providers and parents with educational language, laws, and processes as they relate to a comprehensive ascending level of academic supports as it pertains to promoting a smooth and supported transition to school following a concussion.

Returning to learn (RTL) following a concussion is of parallel importance to returning to sport (RTS). A successful RTL is a critical part of concussion management. Many RTL articles advise healthcare providers and parents to request formalized educational supports, also known as Tier 2 or Tier 3 services, for children with concussion as they return to school.

Premature requests for formal (Tier 2 or 3) educational services, rather than allowing for immediate informal educational supports (known as Tier 1), can actually delay academic supports and have the potential to cause adversarial relationships between parents and schools. Additionally, this practice contradicts current research demonstrating the need for fast, flexible, temporary academic supports within the first month post-injury.

Allowing school districts to direct the application of existing ascending levels of educational support for students with concussion as they return to school can promote robust and positive outcomes.

Social communication is a persistent area of need after pediatric traumatic brain injury; however, it continues to be misunderstood, under-recognized, and under-treated. Clinicians must have a working understanding of current evidence and practice recommendations to support practice.

1) To analyze recent evidence in social communication published in the last ten years, which is specific to pediatric TBI and 2) To translate these findings for clinicians.

A systematic literature review was conducted. Ninety-five articles met criteria for full analysis. For analysis, articles were grouped according five themes: 1) Theoretical/Review; 2) Etiology/Characteristics; 3) Recovery/Outcome; 4) Assessment; or 5) Intervention. Article findings were then extracted, translated, and summarized.

The majority of articles focused on describing characteristics of social communication deficits after pediatric TBI, documenting recovery, and identifying factors that contribute to outcome. Research on the relationship of development, age at injury, injury severity, and environmental factors with social communication outcomes requires additional attention. Research in assessment and treatment is critically sparse.

The results of this review highlight both the progress that has been made in understanding the phenomena of social communication deficits in pediatric TBI and the critical need for basic and translational research in assessment and intervention.

Chronic impairment following childhood traumatic brain injury has the potential to increase risk of negative outcomes. This highlights potential value in community-based rehabilitation programs.

To identify research studies examining existing intervention programmes available in community-based rehabilitation to adolescents following TBI to assist with the transition back into the community.

A systematic review of community-based interventions was conducted across different national contexts. All included studies involved a clinical population with TBI, aged 11 to 25 years inclusive. Risk of bias was rated for each included study.

Seventeen studies were identified for inclusion in the review, of these eleven distinct interventions were found. The quality of evidence was largely weak and highly variable.

The results suggest some improvement in adolescent outcomes following community-based interventions, however higher quality evidence is needed to support specific interventions.

Students with TBI enter college with strategies that they have used prior to being injured yet often without knowing which ones will be effective in helping them to be successful. The purpose here is to describe how semi-structured interviews were used to identify self-regulated learning strategies, to demonstrate the utility and reliability of coding self-regulated learning strategies, and to provide examples of student-centered goals derived from survey and interview responses.

College students completed the College Survey for Students with Brain Injury (CSS-BI) and were interviewed before and after coaching support that focused on teaching self-regulated learning. Responses to interview questions about strategies were coded using a modified version of Zimmerman and Martinez-Pons’s (1986) schema. Coders also rated strategies for specificity.

Strategies were reliably coded into 16 categories of self-regulation. Inter and intra-reliability were strong. Four of the five students reported using a larger variety of self-regulation strategies and strategies that were more specific after coaching support.

It is possible to reliably code self-regulation learning strategies reported by college students with TBI. These measures have potential as functional ‘outcomes’ for students who are transitioning to college. Interview responses can be used to collaboratively create student-centered goals.