A Neuropsychological Approach to Pediatric Brain Injury Rehabilitation



Kimberly Davis


Kimberly Davis
William Watson
Corey Anderson



Although acquired brain injury remains the leading cause of death and disability for children in the United States, estimates from the Center for Disease Control suggest that mortality rates for traumatic brain injury, the leading cause of acquired brain injury in the US, has demonstrated a slight downward trend. (Faul, Xu, Wald, Coronado, 2010). With decreased mortality, however, children are being admitted to rehabilitation hospitals at higher levels of acuity and complexity. These children present unique challenges to acute rehabilitation teams as well as highlight the chronic morbidity that is often associated with pediatric brain injury. As children with brain injury survive at greater rates and begin transitioning into adulthood, the vastly heterogeneous patterns of behavioral, cognitive, emotional, and sensorimotor sequelae are becoming more fully realized.

Given this realization, there is stronger understanding for the need for specialized, pediatric rehabilitation teams that are multi- or interdisciplinary, with different disciplines working together toward common goals. In fact, empirical research has demonstrated interdisciplinary teams are critical for service integration and greatly enhance successful outcomes following brain injury (Strasser, Uomoto, & Smits, 2008). Pediatric brain injury rehabilitation specifically, requires expertise in several areas due to the complexity of behavioral, cognitive, emotional, and sensorimotor sequela that often present barriers to traditional rehabilitation approaches. Moreover, brain injury recovery often occurs in stages that include disorders of consciousness, periods of confusion and disorientation, as well as longer stretches of recovery from cognitive impairments. The rehabilitation approach must often adapt and change in considerable ways during each of these phases. A deeper understanding of the neuropsychological approach to rehabilitation can help all members of the interdisciplinary team more optimally address the complexities of pediatric brain injury.

The neuropsychological approach to pediatric rehabilitation espouses the core foundational competencies inherent to the field, including knowledge of 1) brain-behavior relationships across the developmental continuum, 2) evidenced-based assessment including standardized and unstandardized modalities, 3) intervention and rehabilitation with the brain-injured patient and their family system, and 4) interdisciplinary skills well-suited to the rehabilitation setting. The panel will discuss how knowledge of brain-behavior relationships across the lifespan and at different stages of recovery can assist with development and implementation of rehabilitation treatment plans following brain injury. Additionally, the panel will describe the use and collection of quality data to inform medical decision making and interventions along the continuum of rehabilitative care. Application of behavioral health intervention skills in supporting coping and adjustment of patients and families, as well as the transition to adulthood, will be reviewed. Finally, the panel will highlight ways in which this approach can be adopted and generalized by members of other disciplines within settings for which inclusion of a pediatric neuropsychologist is not available.



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