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Rehabilitation of brain-injured children
A Laurent-Vannier1, D G Brugel, M De Agostini
1Service de Rééducation des Pathologies Neurologiques Acquises de l'Enfant, Hôpital National de Saint Maurice, 14 Rue du Val d'Osne, 94415 Saint Maurice, France. a.laurentvannier@hopital-saint-maurice.fr
Insights
Pediatric neurosurgical emergencies in Paris are managed by a new care network. Contrary to the Kennard principle, diffuse brain injuries in children do not always show better recovery than in adults, with prognosis depending on learning ability.
Area of Science:
- Pediatric neurosurgery
- Neuroscience
- Child neurology
Background:
- A specialized care network for pediatric neurosurgical emergencies has been established in the Paris area.
- This network facilitates research into brain-injured children.
- The traditional "Kennard principle" suggested better recovery in children than adults after similar brain lesions.
Purpose of the Study:
- To investigate the recovery patterns of brain-injured children.
- To challenge the universal applicability of the "Kennard principle" in pediatric traumatic brain injury.
- To understand factors influencing prognosis in pediatric brain injury.
Main Methods:
- Establishment of a dedicated care network for pediatric neurosurgical emergencies.
- Research into outcomes of brain-injured children within this network.
- Analysis of recovery based on lesion type and age.
Main Results:
- Recovery from diffuse brain injuries in children is not consistently better than in adults.
- Prognosis is significantly influenced by the remaining ability to learn new skills.
- Normal IQ does not preclude cognitive deficits, such as visuo-spatial neglect, which are common.
Conclusions:
- The "Kennard principle" may not apply to diffuse pediatric brain injuries.
- Cognitive deficits in children with traumatic brain injury can mirror those in adults.
- Long-term follow-up is crucial for assessing outcomes after childhood traumatic brain injury.
Abstract:
A care network has been created in the Paris area according to two criteria--the continuity and the specificity of the care, with a single place to manage pediatric neurosurgical emergencies. This network makes possible research about brain-injured children. Until recently, the "Kennard principle", that is, the assumption that recovery after similar lesions is greater in children than in adults has been supposed to be always true. In fact, if the lesions are diffuse, recovery is not greater in children compared with adults, or in younger children compared with older ones: the prognosis depends on the remaining ability to learn new practices. Normal IQ does not mean absence of sequelae. The cognitive deficits are very similar to those found in adults at the acute phase. For instance, visuo-spatial neglect appears as rather frequent when systematically looked for. The final assessment of outcome after childhood traumatic brain-injury should be done only after several years.