Long-term Participation and Functional Status in Children Who Experience Traumatic Brain Injury
Linda Ewing-Cobbs1, Amy Clark, Heather Keenan
1Department of Pediatrics and Children's Learning Institute, McGovern Medical School, University of Texas Health Science Center at Houston (Dr Ewing-Cobbs); and Division of Critical Care, Department of Pediatrics, University of Utah (Ms Clark and Dr Keenan).
Insights
Children with severe traumatic brain injury (TBI) face significantly higher risks of reduced participation. Factors like functional skills and family environment also impact long-term participation outcomes after TBI.
Area of Science:
- Pediatric rehabilitation
- Neuroscience
- Child psychology
Background:
- Traumatic brain injury (TBI) in children can lead to long-term participation challenges.
- Understanding factors influencing participation is crucial for effective intervention.
Purpose of the Study:
- To evaluate the impact of child and family factors on children's participation outcomes 2-3 years post-TBI.
- To identify predictors of reduced participation in children with TBI.
Main Methods:
- Prospective cohort study at two pediatric trauma centers.
- Children aged 0-15 years with TBI or orthopedic injuries were included.
- Caregiver-reported participation (CASP) and functional outcomes (PIFOS, BRIEF) were assessed.
Main Results:
- Severe TBI was associated with a nearly 3-fold increased risk of reduced participation compared to orthopedic injuries.
- Lower functional skills and less favorable family function predicted reduced participation.
- 78% of children with pre-injury data completed participation assessments at follow-up.
Conclusions:
- Child and family factors significantly influence participation in home, school, and community activities post-TBI.
- Participation-focused interventions are necessary to address barriers and improve outcomes for children with TBI.
Objective:
To evaluate the effect of child and family factors on children's participation outcomes 2 to 3 years following traumatic brain injury (TBI).
Setting:
Two level 1 pediatric trauma centers.
Participants:
Children aged 0 to 15 years with TBI at all severity levels or an orthopedic injury.
Design:
Prospective cohort.
Main Measures:
Caregivers completed the Child and Adolescent Scale of Participation (CASP) at 2- and 3-year follow-ups. The CASP was categorized as more than 90 or 90 or less on a 100-point scale, with 90 or less representing the 10th percentile and below in this sample. Modified Poisson regression models were used to describe relative risk of the CASP at 90 or less at 2 to 3 years postinjury, adjusting for preinjury family environment variables and injury group. A secondary analysis only included children who were 31 months or older at injury ( n = 441) to determine whether changes in functional outcome (Pediatric Injury Functional Outcome Scale, PIFOS) and executive functions (Behavior Rating Inventory of Executive Function, BRIEF) from preinjury to 1 year after injury predicted CASP scores at the 2- or 3-year follow-up.
Results:
Seventy-eight percent (596/769) of children who had a completed preinjury survey had a completed CASP. In the adjusted model, children with severe TBI had a nearly 3 times higher risk (RR = 2.90; 95% CI, 1.43-5.87) of reduced participation than children with an orthopedic injury. In the secondary analysis, lower functional skills (5-point increase in 1-year postinjury PIFOS score) (RR = 1.36; 95% CI, 1.18-1.57) and less favorable family function (RR = 1.46; 95% CI, 1.02-2.10) were associated with reduced participation in both girls and boys.
Conclusion:
Participation in home, school, and community activities after TBI is related to multiple biopsychosocial factors. Participation-focused interventions are needed to reduce barriers to involvement and assist children and families to close the participation gap across settings.
