19 June 2012

Extent of Damage for Children With Brain Injury Difficult To Predict and Highly Variable

The Centers For Disease Control and Prevention (CDC) defines a Traumatic Brain Injury (TBI) as "a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain". Not all blows or jolts to the head are considered a TBI.

TBI may range from mild to severe. A mild case of TBI would result in a brief change in mental status or consciousness and a severe case would result in an extended period of unconsciousness or amnesia after the injury. The majority of TBIs that occur each year are concussions or other forms of mild TBI.

While the symptoms of a brain injury in children and adults are the same, the resulting condition may be different. The brain of a child is different, it still is developing. Although it is assumed that because the brain connections (neurons) change and grow (plasticity), children would recover better, this is not true. A brain injury actually has a more devastating impact on a child than an injury of the same severity has on a mature adult.

Results of a brain injury can manifest in months for an adult. But with a child, it may take years after the injury before the extent of the damage can be detected.

Outcomes for children after brain injury difficult to predict and highly variable

Outcomes for children with brain injury acquired during childhood are difficult to predict and vary significantly, states an analysis of evidence on the topic published in CMAJ (Canadian Medical Association Journal).

"There is no single best approach to describing outcome after acquired brain injury during childhood, and the one chosen must be appropriate to the purpose at hand (e.g., identifying individual, population, global or domain-specific outcomes)," writes Dr. Rob Forsyth, Institute of Neuroscience, Newcastle University and Great North Children's Hospital, Newcastle-upon-Tyne, UK, with coauthors.

Video: Children with Brain Injuries

Brain injury, acquired after a period of normal development, is the leading cause of death and disability in children after infancy. Survival in the past was uncommon, but advances in medical care, especially in the pediatric intensive care unit have increased survival rates for injured children.

However, there is a lack of high-quality evidence to help physicians and families make decisions about care and the possible withdrawal of care. Although there is ample literature regarding adults, much of it cannot be extrapolated to children. Researchers from the UK analyzed the English-language literature from 1966 to the present to provide an overview of factors and challenges for physicians to consider.

The cause of injury is a strong predictor of outcome. For example, recovery from traumatic brain injuries is more likely than that from injuries caused by a lack of oxygen to the brain (from drowning or suffocation), although good recovery of motor skills can mask later psychological and psychiatric issues arising from the injury.

Symptoms in a pediatric brain injury. Any or all of the above impairments may occur to different degrees. The nature of the injury and its consequences can range from mild to severe, and the course of recovery is very difficult to predict for any given child.
Credit: Brain Injury Association of America

Recovery is also challenged by the age at which injury occurs, since a child's brain is developing and growing and must at the same time recover. "The very young brain can appear remarkably resilient to focal injury, although this view has been challenged," state the authors.

"What is clear, however, is that widespread views that young brains make better recoveries are naive," they write. "Early injury alters the entire developmental trajectory (the challenge of making 'a year's progress every year' with an injured brain), and effects can compound through childhood. This is particularly clear in the literature surrounding pediatric brain injury, where sometimes impressive early motor recoveries obscure the characteristic emergence of cognitive and psychological morbidity in subsequent years."

Sophisticated imaging tests can help determine severity of injury and predict outcome in adults, but many of these techniques have not been studied for use with children.

The authors conclude that it is challenging to improve outcomes for children with acquired brain injuries because of the complexity and unpredictability of recovery in children. They emphasize that prevention of injury, especially from accidents or infections, should be a key focus and that other approaches need to be tailored.


Canadian Medical Association Journal
Institute of Neuroscience - Newcastle University
Newcastle Hospitals - The Great North Children's Hospital
Injury Prevention & Control: Traumatic Brain Injury
Pediatric Brain Injury
Diffusion Tensor Imaging (DTI) With An MRI Gives Insight On How Concussions Differ From Person to Person
Behavioral Problems In Children May Be A Sign Of Mental Health Problems
When Head Injury or Trauma In Sports Leads To Memory Loss and Chronic Traumatic Encephalopathy (CTE)
Walking Again After Spinal Cord Injury Through Neuroprosthetics and Robotics
Impairments in Brain Involved in Post Stroke Depression (PSD)
Research Into Facial Perception Reveals Brain Processes Information At A Deeper Level
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Parents and Child Upbringing Major Psychological Factors In Teen Violence
Reaserch Suggests Hearing Disability May Be Linked To Dyslexia