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Children with Traumatic Brain Injuries
Ronald C. Savage, Ed.D.
The number of children and adolescents in this country sustaining traumatic brain injuries is staggering. Each year one million youngsters are taken into emergency rooms with brain injuries resulting from motor vehicle accidents, falls, sports, and abuse (National Head Injury Foundation, Inc., 1992). Approximately 165,000 of these children will be hospitalized, with 20,000 suffering moderate to severe symptoms.
Unfortunately, many of these children are not seen in rehabilitation programs. The National Pediatric Trauma Registry Report found that out of 18,000 pediatric head traumas recorded in the registry from over 50 trauma centers only 2% of these admissions were discharged to rehabilitation services despite the recognition of noted cognitive, behavioral, and/or motor deficits in 3 or more areas. While there are services in this country for adults with brain injuries, very few facilities exist for children. Hence, even for those children who are referred, many end up in "watered down" adult rehabilitation programs working with therapists who have no training in pediatrics.
Yet, we know children have brains that are still developing. When a child's brain is injured it can have longterm devastating effects on the child and his/her family. Too often children who sustain a brain injury early in life look "well" at that moment in time, but as the child gets older and their brain matures more serious cognitive and behavioral problems emerge. Pediatric brain injury is like throwing a pebble into a pool of water, except the ripples become more pronounced over time instead of fading into oblivion.
Children need a very specialized environment in order to recover from their injury, to develop compensatory strategies, and to coordinate services between hospital, home, and school. A rehabilitation facility for children needs to focus on three very important components in a child's life: family, school, and recreation. The rehabilitation facility should look like the child's world with schoollike therapy rooms, colorful surroundings, patient rooms that the parent can decorate like the child's own bedroom, toys, toys and more toys. In addition, the interdisciplinary team of therapists who work with children need to have specialized training in pediatrics. Quite simply, the rehabilitative environment needs to represent the "world of the child," not a sterile medical environment that often frightens and inhibits children.
Most importantly, any rehabilitation program working with children needs to understand the extraordinary needs of the child's family. Mothers, fathers, siblings and other family members need help understanding the potential longterm needs. Family members need to be with their child as much as they can and to work sidebyside with their child's therapists. All family members need support Mom, Dad, brothers and sisters, grandparents, and the child's peers.
Lastly, as soon as the child is admitted to a rehabilitation facility, the home school needs to be contacted. The child's teacher(s) need to receive information on traumatic brain injury and the resulting cognitive, behavioral, and physical problems. The teacher or special educator needs to see the child in the rehabilitation facility and to plan with the therapists for the child's return to school. This will insure that upon discharge the teachers know how best to work with this child and when to call the rehabilitation therapists for help.
Children are not just "little adults waiting to grow up." Children have their own very special needs that have to be taken into consideration in order to provide the best rehabilitation possible.
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