About Physiatry

Pediatric Traumatic Brain Injury
(Moderate to Severe)

Condition: Traumatic brain injury (or TBI) results from head trauma that causes brain injury. This condition may affect daily tasks, such as communication, feeding, cognition, walking, and behavior.

Background: Brain injury can be caused from direct physical blows to the head or indirectly from brain swelling, seizures, or blood in the brain. In babies, the most common cause of brain injury is assault, while in toddlers, it is falls. In older children, the most common causes are bicycle accidents, motor vehicle collisions, and sports, and in adolescents, the most common cause is motor vehicle accidents.

Risk Factors: Children with attention deficit hyperactivity disorder (ADHD) are at greater risk, and more males than females experience brain injury.

History and Symptoms: Brain injury may be accompanied by changes in mood, sleep patterns, and vision and may also cause extremity weakness, headaches, dizziness, and balance problems. Additional secondary problems, such as brain swelling, seizures, and brain bleeding, can occur. More long-term complications, such as fluid build-up, difficulty swallowing, hearing loss, joint or muscle rigidity, scoliosis, speech impairment, and urinary and/or bowel incontinence, can also develop.

Physical Exam: Physicians will record a detailed history of the event as well as perform a physical examination, including a neurological exam and assessment of alertness, ability to smell, muscle strength and tone, reflexes, and motion. If abuse is suspected, the child should be assessed for additional injuries due to abuse.

Diagnostic Process: A computed tomography (CT) scan is commonly performed acutely to evaluate bleeding or swelling in the brain. Magnetic resonance imaging (MRI) may be used to further assess brain injuries that may not be visible on the CT scan. X-rays may be used to rule out additional injuries to the neck or extremities. An electroencephalogram (EEG) may be used for detection of seizures, and specific assessments of hearing, vision, and swallowing may be necessary. Neuropsychological testing can fully elucidate cognitive and emotional issues a child may have after injury.

Rehab Management: An interdisciplinary approach to inpatient rehabilitation is essential. Following stabilization and prevention of secondary complications, patients may receive physical therapy, occupational therapy, speech therapy, and neuropsychological testing. Rehabilitation will include teaching of strategies to compensate for impaired or lost functions and for optimization of the use of abilities as they return. Partnering with a child’s school is paramount to making sure the child receives the services needed to achieve academically in a safe and appropriate manner. With respect to concussions, recommendations about return to school/play after a concussion and assessment tools are currently being developed.

Other Resources for Patients and Families: Following brain injury, patient and family education and support are important, and community support groups may be available.

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