2.2 Pediatric TBI.pdf

RS3330 Clinical Sciences for Medical & Neurological Conditions Traumatic Brain Injury in children and adolescent How is TBI in adults different (or the Same) from those Injured as children…? More optimistic due to better neuroplasticity...

RS3330 Clinical Sciences for Medical & Neurological Conditions Traumatic Brain Injury in children and adolescent How is TBI in adults different (or the Same) from those Injured as children…? More optimistic due to better neuroplasticity One of the common causes is child abuse Dr Hoe Lee 1  Objectives 1. To describe the distinctive characteristics of peadiatric TBI that differ from adults 2. To understand the long-term impacts of TBI on occupational performance of children 3  Factors contributing to distinctive characteristics peadiatric TBI More serious consequences comparing with adults with same force bcz structurally different and bones not calcified (not rigid skeleton to protect the cerebral cortex) age-related anatomical and physiological differences mechanism of injuries based on physical ability of the child difficulty in neurological evaluation ---- advances in diagnostic tools (MRI) improve prognosis recently 4  Injury characteristics in age & development Newborns The surface of baby’s skull is full of vein Eg forceps or suction -> pressure on skull -> damage the veins Delivery head injury Intracranial hemorrhages Head Cephalic hematoma Subgaleal hematoma & b/w skin & skull Vein rupture -> leakage of blood in that space -> circulation of baby becomes unhealthy-> fatal *  Infants Accidental head injury Abusive Head Trauma Toddlers and School children Accidental head injury Adolescents Bicycle and motorcycle related accidents Sports- related head injuries  Management of peadiatric TBI Primary TBI – skull fracture – growing skull fracture into suture cranial bones – epidural hematoma, subdural hematoma, subarachnoid hemorrhage, diffuse axonal injury and intracerebral hematoma Secondary TBI – diffuse cerebral swelling  Prognosis and recovery Glasgow outcome – Good recovery (GR) – Moderate disability (MD) – severe disability (SD) – persistent vegetative state (PVS) – Death (D) Related to – Glasgow Coma Scale (3/12 to be coma) – Length of amnesia for the events surrounding the accident – Altered mental status 9 Effect of TBI during childhood or adolescence : Labelled as naught, hard to manage student in the skl Delayed cognitive abilities development of the stage Reduce rate of mental processing speed Diminished organizational abilities Mental inflexibility Difficulty self-monitoring and regulating emotional experiences As the consequence, produce – Patchy memory, inconsistent acquisition of new information – Mental fatigue – Stress and anxious – Poor frustration tolerance – Confusion, anger 10 Paediatric TBI Neuropsychiatric I Impairment/syndrome Attentional Impairment following Paediatric TBI Memory Impairment following Paediatric TBI Language Impairment following Paediatric TBI Intellectual Impairment following Paediatric TBI Executive Function Impairment following Paediatric TBI  Sequelae of TBI in children Neurological : Sleep disturbances Fatigue Headaches Sensory and motor: Loss of coordination, balance and motor planning abilities Difficulty perceiving sensation from fingers Difficulty maintaining awareness of body positions Blurred or double vision Hypersensitivity to sounds, tastes, smells or loss of smells Visual-perceptual distortions (affect child’s energy and availability for higher order cognitive activity) 12 Cognitive and emotional functioning: Often less obvious than the physical symptoms in younger age Likely to be more individualized Types and severity of problems depends on – Severity of injury – stage of development at the time of injury Previously learned and knowledge recovers quickly But emotional and social impact of TBI increases with age Adolescents be most prone to serious depression during recovery 13  TBI under the age of 10 Most reported problems are behavioral: Temper tantrums Unpredictable swings of emotion and display of emotion Non-compliance Resistance to change Impulsive, aggressive, and/or dangerous behavior 14  TBI during adolescence Symptoms are more subtle By adolescence, behavioral control should be well established and they have a solid foundation of academic, personal and social competencies Older child can draw on his/her previously learned information in school, while teacher may not recognize the impact of TBI on the ability to learn new material Slow rate of mental processing and difficulty organizing and managing complex information (N.B. very difficult to function in the quick-paced and complex world of the school classroom) 15  Post-injury return to school and social activity can be very confusing, agitating and disappointing – Activities that once were routine now require thought, planning and assistance – Feels overwhelmed by the pace of material being presented in class and feels discouraged by inability to keep up with the demands to process multiple sources of information simultaneously – Typical adolescent social life is spontaneous, with fewer rules and little predictability – easily overwhelmed by social areas, afraid of making a mistake (call attention to their problems), often withdraw and loss the support of peer groups – Injury may prevent or diminish their involvement in activities, like sports, physical activities, further increase stress and their loss of social support 16 Effects on family and the support system Disruption of family life Undue anxiety on parents for the future Feelings of isolation and abandonment by the system Excessive financial and legal demands High levels of stress in day-to-day routine Stress on friendships, relationships and support system 17  Trends affecting OT practice context Greater number of children survive TBI More children survive very serious TBI Spend less time in hospital rehabilitation program Return home, schools, community at an early stage to TBI recovery Responsibility for ongoing care (rehabilitation), often falls primarily on family, pediatrician and school personnel in the community 18