Rehabilitation and outcome after severe head injury
R Scott-Jupp1, N Marlow, N Seddon
1Child Development Centre, Royal Liverpool Children's Hospital.
Insights
Severe pediatric head injuries often lead to lasting cognitive and behavioral issues, impacting education. Many children require special educational support and interventions for neurological impairment and psychiatric disorders post-injury.
Area of Science:
- Pediatric Neurorehabilitation
- Child Psychology
- Educational Psychology
Background:
- Severe head injuries in children frequently result in persistent cognitive and behavioral deficits, even after physical recovery.
- These deficits can lead to significant educational challenges, impacting academic performance and classroom integration.
- Multidisciplinary head injury rehabilitation teams play a crucial role in assessing and managing these complex post-injury sequelae.
Purpose of the Study:
- To evaluate the long-term cognitive, behavioral, and educational outcomes in children following severe head injury.
- To assess the prevalence of neurological impairment, psychiatric morbidity, and the need for special educational support.
- To compare the perceptions of parents and teachers regarding the behavioral and academic functioning of head-injured children versus controls.
Main Methods:
- A cohort of 43 children referred to a regional multidisciplinary head injury rehabilitation team was studied.
- Clinical outcomes, including neurological impairment and educational needs, were assessed at a median of 13 months post-injury.
- Psychiatric morbidity, cognitive function, and classroom performance were evaluated using Rutter behavioral questionnaires administered to parents and teachers, with matched classmate controls.
Main Results:
- 42% of children exhibited persistent neurological impairment, and 35% required special educational support.
- Parents reported significantly worse 'health' and 'habits' in head-injured children, with a higher incidence of psychiatric disorders.
- Teachers identified significant disadvantages in classroom skills and performance for head-injured children, though less decisively than parents.
Conclusions:
- Severe head injury in children has a substantial impact on cognitive, behavioral, and educational functioning, necessitating ongoing support.
- Parental and teacher assessments highlight significant challenges, underscoring the need for tailored interventions and educational strategies.
- There is a clear need for enhanced support and training for educators working with head-injured children to address their specific learning and behavioral needs.
Abstract:
After severe head injury, many children continue to experience major cognitive and behavioural problems and consequent educational difficulties, even after good physical recovery. Forty three children referred to the regional multidisciplinary head injury rehabilitation team are described. The clinical outcome at a median interval of 13 months after injury showed that 18 (42%) had persistent neurological impairment and 15 (35%) had an identified need for special educational support. Thirty seven children were further assessed for psychiatric morbidity, cognitive impairment, and classroom performance. Rutter behavioural questionnaires were sent to parents and teachers of head injured index cases and classmate controls matched for age and sex. Index parents scored their children significantly worse in both 'health' and 'habits' and more cases than controls had scores suggesting a psychiatric disorder. Teachers scored index cases significantly worse for five of the traits questioned, but discriminated cases from controls less decisively than parents. Index cases were significantly disadvantaged on teachers' assessments of classroom skills and performance. A need for improved support and training of staff who teach head injured children was identified.
