Pediatric TBI: An Introduction

>> Amy Natho:  Welcome, everybody.  I would like to welcome you to the SpeechPathology.com E-learning Expert Seminar entitled “Pediatric TBI: An Introduction.”  My name is Amy Natho and I'll be your moderator for this online course.  At this time it is my great pleasure and honor to introduce Victoria Harding.  Tori Harding provides specialized program and location development for Neurorestorative and acts as the Clinical Projects Coordinator for Virginia NeuroCare, a Defense and Veterans Brain Injury Center program in Charlottesville, Virginia.  Tori's primary research and clinical interest areas include outcome measurements in post-acute settings, the self-efficacy mechanism in post-acute brain injury, neurogenic communication disorders, and family training for long-term success and advocacy. As a Speech-Language Pathologist, she works as a clinician and an educator and as a Certified Brain Injury Trainer.  She teaches through the Academy of Brain Injury Specialists. Currently a Ph.D. candidate at James Madison University, Tori received her Master’s degree of Business Administration at Plymouth State University and completed her Master of Science in Speech-Language Pathology at Dalhousie University, Nova Scotia, Canada.  So welcome, Tori.  Thank you for coming back and sharing your expertise with us again today.

>> Tori:  Well, sure thing.  Thank you so much for the opportunity to be here and for folks participating, the time that you have given here to huddle up to discuss the topic of pediatric TBI in this introductory format. 

I wanted to speak briefly about the flow of the presentation. The intent is to look at models of outcome of childhood TBI.  I think that is important because you need to know where you're going and what some of the multifactorial inclusions of an outcome model for childhood TBI treatment are.  We will also look at some of the recovery process, and the concept of children who “grow into” their traumatic brain injury, as opposed to an adult model.  We’ll talk about some of the persistent cognitive and linguistic deficits that children may present with, and some interventions and support challenges, including some examples for the child who is now in school who experienced a TBI earlier in life.  So thanks again for being here. 

I just wanted to go over a quick “411” that is probably not news to those of you attending, and that is the idea that traumatic brain injury in childhood is the most prevalent cause of death and long-term disability in children, and it affects all socio-economic levels.  Let's just sit with that for a moment.  This is talking about traumatic brain injury specifically, so not progressive neurological disorders or developmental diagnoses or a brain injury that is due to a birthing complication or acquired brain injury like an anoxic event (e.g., a near drowning).  These are truly traumatic events and I think there is a lot of inconsistency with the definitions of TBI.  It seems to vary according to specialties and circumstances.  Often the term “brain injury” is used synonymously with “head injury,” which may not be associated with a neurological deficit.  There are some problems with inclusion criteria, and we can probably spend about an hour talking about what traumatic brain injury is, within the scope of an acquired brain injury.  But for today we're going to talk about a traumatic brain injury as a non-degenerative, non-congenital insult to the brain from an external mechanism or force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions with an associated diminished or altered state of consciousness.  We're talking about a TBI that is caused by a bump, blow or jolt to the head or penetrating injury that disrupts the normal functions of the brain. 

Challenges of Pediatric TBI

Some of the challenges of pediatric TBI are, of course, that it is the leading form of acquired brain injury in children.  To me, that seems like an epidemic if we're talking about the leading form of acquired brain injury.  The costs of childhood TBI are certainly considerable to the child.  There is pain and suffering.  Certainly, there are personality changes; that is something that families reliably report is consistent.  There is compromise of ability to learn, and some poor peer relations as a result of the neural changes and social dysfunction.  To the family, there is the loss of their child, and increased burden of parenting now that there is a child with special needs, including health needs and education needs.  To educators, there is the challenge of teaching children who do not fit that traditional learning disability profile – somehow, it is qualitatively different.  And for society, there is a cohort of individuals who may be marginally employable, or, in a worst case scenario, lacking in social judgment.  These are all some of the changes that we want to address when working with a child with traumatic brain injury.