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Many U.S. kids with brain injuries not getting needed rehab
By Lisa Rapaport
(Reuters Health) - Many children hospitalized in the U.S. for brain injuries don't receive all the rehabilitation services needed for them to potentially make a full recovery, a new study suggests.
Researchers interviewed parents and children four times over two years after kids had a head injury. Overall, children with moderate to severe traumatic brain injuries had greater functional impairments and required more rehab services than kids with mild injuries.
But severely injured kids were also more likely to get the help they needed, while more than one in four children with mild brain injuries failed to receive necessary services like educational support, mental health care and treatment from physiatrists – doctors who specialize in addressing brain and spinal cord conditions.
"Mild brain injuries are more common than moderate to severe brain injuries, so there are a greater number of children who may be at risk of having unmet health care needs after being hospitalized for a mild brain injury," said study leader Dr. Molly Fuentes of the University of Washington School of Medicine and Seattle Children's Research Institute, Center for Child Health, Behavior, and Development.
"If children are waiting for services to help them recover or learn how to adapt to their new impairments, not only are their long term functional outcomes at risk of being poorer, they are also missing time in school (making it harder to catch back up) and other activities that are an important part of their development," Fuentes said by email.
There's a big difference between brain injuries in adults and children, Fuentes added.
While adults recovering from a head injury must strive to get back to where they were before they got hurt, children and teens get hurt while their brains are still developing, and so they need to work on both recovery and continuing to develop into mature adults mentally and physically.
Previous studies have found that less than half of kids hospitalized for brain injuries get rehab during their hospitalization, and very few kids get sent to outpatient rehab facilities when they leave the hospital, researchers report in Pediatrics.
Fuentes' team interviewed parents and kids one month after the children left the hospital, and again at six, 12 and 24 months.
The analysis included 123 children hospitalized with mild traumatic brain injuries and 47 kids with moderate to severe head injuries. Car crashes were the most common cause of the brain injuries, although many of the milder cases were caused by falls.
After moderate to severe brain injuries, the most common problems were physical, cognitive and academic challenges, with more than half of parents reporting these issues during each follow-up interview.
Among children with milder injuries, academics, mental health problems and cognitive challenges were the most common problems, reported by one third of parents.
As time passed, the need for educational support increased and a growing number of kids had unmet needs for academic help and for treatment from specialists in recovery from brain injuries, the study found.
Younger children in the study, ranging in age from 8 to 11, were more likely to receive all of the necessary rehab services than older kids.
Children with pre-existing brain conditions were also more likely to receive all of the necessary services after their injuries than kids who didn't have these health problems before they got hurt.
The study wasn't designed to prove whether or how the receipt of rehab services might directly impact recovery for children who have traumatic brain injuries.
Another limitation is that researchers relied on children and parents to accurately recall and report on kids' abilities before they got hurt, and those perceptions might not always be accurate, researchers note.
Even so, the results add to growing evidence suggesting that many children don't get the long-term help necessary to fully recover from brain injuries, said Dr. Jack Tsao, a researcher at the University of Tennessee Health Science Center and the Memphis Veterans Affairs Medical Center.
"It matters as children have inherent neuroplasticity and intensive therapy can improve cognitive outcomes, so not getting the rehab needed could adversely affect clinical outcomes and child development," Tsao, who wasn't involved in the study, said by email.
SOURCE: https://bit.ly/2HNSjZs Pediatrics, online April 19, 2018.
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