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The Initiation of Rehabilitation Therapies and Observed Outcomes in Pediatric Traumatic Brain Injury

Reuter-Rice, Karin, PhD, NP, FCCM, FAAN1–3; Eads, Julia K., BSN, RN4; Berndt, Suzanna, MPA1; Doser, Karoline, MA5

doi: 10.1097/rnj.0000000000000116

Purpose Pediatric traumatic brain injury (TBI) is associated with immense physical, emotional, social, and economic burden. This study examined timing and frequency of rehabilitation services provided by the inpatient interdisciplinary team in children admitted for a TBI. Understanding the timing and frequency of rehabilitation services could guide TBI recovery.

Design and Methods This is a 3-year prospective observational study of previously healthy children (n = 35) admitted for a TBI to an urban Level 1 trauma hospital. Children with mild, moderate, and severe TBI were included. Initiation and frequency of the interdisciplinary rehabilitation team’s care and neurocognitive-functional outcomes were analyzed. Outcome measures included the Glasgow Outcome Scale-Extended Pediatrics and the Speech Pathology Neurocognitive-Functional Evaluation at hospital discharge and first follow-up visit.

Results The initiation and the frequency of rehabilitation services were found in all severities of TBI. Timing and frequency of services also aligned with varied severities. Children with moderate TBI showed the most improvement in Glasgow Outcome Scale-Extended Pediatrics and the Speech Pathology Neurocognitive-Functional Evaluation on their first follow-up visit, whereas children with mild and severe TBI demonstrated little change in outcome at their first follow-up visit and had varied services based on their hospital course.

Conclusion Services by interdisciplinary rehabilitation teams were provided across all brain injury severity groups, despite the lack of comprehensive rehabilitation guidelines. Varied neurocognitive and functional outcome changes measured found children with moderate TBI had the greatest change in outcomes. Further research is warranted to assess the timing and frequency of services and their relationship to neurocognitive-functional outcomes.

1Duke University School of Nursing, Durham, NC, USA

2Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA

3Duke Institute for Brain Sciences, Durham, NC, USA

4Duke University Health Systems, Durham, NC, USA

5Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark

Correspondence: Karin Reuter-Rice, Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Durham, NC 27710. E-mail:

Cite this article as: Reuter-Rice, K., Eads, J. K., Berndt, S., & Doser, K. (2018). The initiation of rehabilitation therapies and observed outcomes in pediatric traumatic brain injury. Rehabilitation Nursing, 43(6), 327–334. doi: 10.1097/rnj.0000000000000116

© 2018 Association of Rehabilitation Nurses.
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