Advances in postacute rehabilitation after childhood-acquired brain injury: a focus on cognitive, behavioral, and social domains

Abstract

Despite traditional views, children do not necessarily recover well from brain injury. Residual functional impairments are commonly documented in physical, cognitive, educational, behavioral, and social domains and result in a significant, ongoing social and economic burden for the child's family and for the broader community. More recent acknowledgment of the serious, and often permanent, consequences of acquired brain injury in childhood has been paralleled by rapid advances in evidence-based, acute medical care and diagnostic technology. In contrast, child-based postacute rehabilitation and long-term interventions are less well developed. To date, child services have borrowed substantially from adult models, combining both direct therapies and interdisciplinary approaches. Despite their proliferation, and strong clinical support, such services are rarely the subject of rigorous evaluation and have given little acknowledgment to the important developmental factors that need to be considered when working with children. Using a developmental framework, this review aims to consider the nature of functional impairments that result from childhood traumatic brain injury, the recovery process postinjury, and the scope and role of child-based rehabilitation. In addition, the relatively scarce body of literature describing the evaluation of child rehabilitation models are reviewed with an emphasis on identifying approaches that provide evidence of enhanced function in the child's everyday life and, in particular, in the home and school contexts.