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Upper-limb function in Australian children with traumatic brain injury: A controlled, prospective study
M A Wallen1, S Mackay, S M Duff
1Occupational Therapy and Rehabilitation Departments, The New Children's Hospital, Westmead, Australia. margarw@nch.edu.au
Insights
Children with severe traumatic brain injury (TBI) show persistent upper-limb functional deficits. Both quantitative and qualitative assessments are crucial for understanding these challenges in pediatric TBI research.
Area of Science:
- Pediatric neurology
- Neurorehabilitation
- Developmental pediatrics
Background:
- Traumatic brain injury (TBI) significantly impacts children's development.
- Upper-limb function is critical for daily activities and long-term outcomes in pediatric populations.
- Understanding functional deficits post-TBI is essential for effective intervention.
Purpose of the Study:
- To characterize upper-limb motor function in children with mild versus severe TBI.
- To compare quantitative and qualitative measures of upper-limb function after pediatric TBI.
- To identify persistent functional challenges in children following TBI.
Main Methods:
- Prospective cohort study involving 51 children with TBI (mild n=26, severe n=25) and 30 controls.
- Assessments conducted at baseline, 6 months, and 2 years post-injury.
- Utilized standardized motor tests (BOTMP, PDMS) and adapted qualitative measures (Brunnstrom stages, muscle tone, grasp, writing, bilateral activity, splint use).
Main Results:
- Standardized motor assessments showed minimal differences between mild and severe TBI groups when tests were completable.
- Qualitative measures revealed significant, persistent difficulties in gross arm control, hand control, and overall hand function in the severe TBI group.
- Severe TBI was associated with more pronounced upper-limb functional impairments.
Conclusions:
- Children with severe TBI experience more significant and enduring upper-limb functional deficits.
- Integrating both quantitative and qualitative assessment methods provides a more comprehensive understanding of TBI-related functional impairments.
- This research underscores the need for tailored rehabilitation strategies addressing specific upper-limb challenges in pediatric TBI survivors.
Objective:
To describe upper-limb function in children with mild and severe traumatic brain injury (TBI), by using both quantitative and qualitative measures.
Design:
Controlled, prospective cohort study with assessment points initially, at 6 months, and at 2 years after TBI.
Setting:
A tertiary pediatric trauma center in Australia.
Patients:
Fifty-one children, ranging in age up to 14 years, who were consecutive admissions with TBI. On the basis of initial and persisting abnormal coma score and persistence of posttraumatic amnesia, they were assigned to either a mild (n = 26) or a severely injured (n = 25) group. Thirty children admitted with non-TBI trauma were recruited as a control group.
Main Outcome Measures:
Quantitative measures included Bruininks-Oseretsky Test of Motor Proficiency and Peabody Developmental Motor Scales. Qualitative measures included Brunnstrom Recovery Stages (adapted), categoric scales of muscle tone, grasp used when handwriting, quality of writing product, bilateral activity, and splint use.
Results:
There was little difference between the groups on the standardized assessments for subjects who could complete the tests. Qualitative measures showed the severe TBI group to have more difficulties with gross arm control, hand control, and hand function.
Conclusion:
Children with severe TBI experience more and persisting difficulties with upper-limb function. It is essential to include both quantitative and qualitative measures in this type of research.