Recovery may be lifelong process for children with brain injury

In the last ten years, a new understanding of pediatric brain injury and recovery has emerged. Professionals now understand that recovery may be a lifelong process for the child's entire circle of family, friends, and healthcare providers. The latest efforts to advance medical and rehabilitative services to move children from medical care and rehabilitation to community reintegration are discussed by the leading experts in a recently published special issue of NeuroRehabilitation.

"Recovery extends well beyond the technical period of rehabilitation," say guest editors and noted authorities Peter D. Patrick, PhD, MS, Associate Professor Emeritus of the University of Virginia School of Medicine in Charlottesville, and Ronald C. Savage, EdD, Chairman, North American Brain Injury Society and International Pediatric Brain Injury Society. "Children, adolescents, and families struggle to regain the momentum of their life so as to reduce problems, increase opportunity, and support increased participation in work, play, home, and relationships."

Neural plasticity introduces unknown challenges in the care of the recovering brain, and the issue addresses the most challenging and demanding medical conditions that children may confront following severe brain injury. However, children do most of their recovery at home, in school, and in the community, beyond medical surveillance. "Family-centered" approaches to developing interventions are emerging. For example, Dr. Damith T. Woods and colleagues report on a novel telephone support program to help parents manage challenging behavior associated with brain injury.

Children and adolescents with brain injuries have difficulty adjusting to their injuries and altered abilities, and frequently suffer from low self-esteem and loss of confidence. A study by Carol A. Hawley finds that children with traumatic brain injury have significantly lower self-esteem than normal children, and recommends that rehabilitation strategies promote a sense of self-worth.

Re-entry into school is a major milestone of recovery and the issue highlights a number of efforts to help children improve and return to a positive developmental trajectory. An article by Beth Wicks describes an innovative program in Britain that looks at "education as rehabilitation," translating successful adult vocational programs into educational rehabilitation programs for children. Lucia Willadino Braga and colleagues report on a program based on cooperative learning that helped preadolescents with acquired brain injury develop metacognitive strategies and improve self-concept, thereby helping empower the preadolescents in their social relationships.

"Over the years and in multiple places around the world, innovative and creative efforts have slowly revealed effective interventions for recovery," comment Dr. Patrick and Dr. Savage. "Increasingly the interventions are evidence-based. This issue is a contribution to the effort to improve outcomes for children and families."