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Rehabilitation for children with chronic acquired brain injury in the Child in Context Intervention (CICI) study:
Nina Rohrer-Baumgartner1, Ingvil Laberg Holthe2,3, Edel Jannecke Svendsen2,4,5
1Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway. uxronb@sunnaas.no.
Insights
This study evaluated the Child In Context Intervention (CICI) for children with chronic pediatric acquired brain injury (pABI), showing potential for improved everyday functioning and family well-being through goal-oriented rehabilitation.
Area of Science:
- Neuroscience
- Pediatric Rehabilitation
- Clinical Psychology
Background:
- Pediatric acquired brain injury (pABI) leads to lasting cognitive, behavioral, and emotional challenges impacting quality of life and family functioning.
- Children with chronic pABI often lack access to evidence-based, community-centered rehabilitation programs.
- The Child In Context Intervention (CICI) study addresses this gap by evaluating a novel rehabilitation approach.
Purpose of the Study:
- To assess the effectiveness of the CICI, an individualized, goal-oriented intervention for children with chronic pABI.
- To improve everyday functioning and quality of life for children and their families affected by pABI.
- To develop evidence-based rehabilitation strategies for a currently underrepresented patient group.
Main Methods:
- A pragmatic randomized controlled trial (RCT) involving 70 families of children aged 6-16 years with chronic pABI.
- Intervention includes family sessions, a parent seminar, and school sessions over 6 months, focusing on SMART goals.
- Primary outcomes measured at 9 months are parent-reported child brain injury symptoms and parenting self-efficacy.
Main Results:
- Data collection is ongoing; primary outcome results are pending.
- The study employs goal attainment scaling (GAS) to measure progress towards individualized goals.
- Secondary outcomes include child-reported symptoms, quality of life, executive functioning, and family functioning.
Conclusions:
- The CICI study offers an innovative rehabilitation approach for children in the chronic phase of ABI.
- This complex intervention has the potential to enhance evidence-based rehabilitation for a significant patient population.
- The study may foster improved collaboration between rehabilitation facilities, schools, and local healthcare services.
Background:
Pediatric acquired brain injury (pABI) is associated with long-term cognitive, behavioral, social, and emotional problems, which may affect the quality of life, school, and family functioning. Yet, there is a lack of evidence-based community-centered rehabilitation programs for chronic pABI and these children do not systematically receive comprehensive rehabilitation. The Child In Context Intervention (CICI) study is a pragmatic randomized controlled trial (RCT) for children with chronic pABI, which aims to evaluate the effectiveness of an individualized and goal-oriented intervention targeting everyday functioning of the child and family.
Methods:
Children aged 6-16 years with MRI/CT-verified intracranial abnormalities will be included in the CICI study if they have persistent self- or parent-reported cognitive, emotional, and/or behavioral challenges 1 year or more after insult and attend school regularly. A total of 70 families will be randomized 1:1 to an intervention or a control group. The intervention consists of seven family sessions, one parent seminar, and four school sessions delivered over approximately 6 months. The parent seminar will be held in person, and the other sessions will mainly be video based. The children's and families' self-reported major challenges in everyday life will be targeted using SMART goals. Evidence-based strategies, when available, will be applied to achieve the goals, combined with psychoeducation. Goal attainment scaling (GAS) will be used to evaluate goal attainment. Data is collected at baseline and after approximately 6 and 9 months. External assessors are blinded to group allocation. Primary outcomes are parent-reported brain injury symptoms in children and parenting self-efficacy at 9 months of follow-up. Secondary outcomes include child-reported brain injury symptoms, quality of life, executive functioning in daily life, parent emotional symptoms, family functioning, and unmet family health care needs. A process evaluation will be conducted.
Discussion:
The current study provides an innovative approach to rehabilitation for children in the chronic phase of ABI and their families. This complex intervention may contribute to the development of evidence-based, high-quality rehabilitation for a large patient group, which is underrepresented in clinical research. It may also improve collaboration between specialized rehabilitation facilities, schools, and local health care services. Inclusion for the trial started in April 2021.
Trial Registration:
ClinicalTrials.gov NCT04798859 . Registered on March 15, 2021.
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