EARLY FUNCTIONAL OUTCOMES IN CHILDREN WITH TRAUMATIC BRAIN INJURIES

D. Rosen (Marcus)¹, J. Potterton²

¹University of the Witwatersrand, Paediatrics, Johannesburg, South Africa, ²University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa

Background: Traumatic Brain Injury (TBI) is a common cause of disability in children and adolescents, yet research on the outcomes of these children is scarce, particularly in low-middle-income countries.Currently, there is limited data regarding the epidemiology of paediatric traumatic brain injuries in Sub-Saharan Africa. The epidemiological studies undertaken at the Red Cross Memorial Hospital in the Western Cape have highlighted the great need for further research in this topic (Schrieff et al., 2013).
In addition, most studies exploring the functional outcomes in children with TBI are conducted in high income countries where the children receive extensive inpatient rehabilitation (Anderson et al., 2005b, Kramer et al., 2013). These results are not entirely transferable to the South African context as access to inpatient rehabilitation centres is limited. It is estimated that only two percent of people with disabilities living in LMIC countries have access to rehabilitation services (Hyder et al., 2007).

Purpose: The objective of this study was to determine the early functional outcomes in children with traumatic brain injuries with or without confounding injuries. The study also aimed at identifying the impact the child’s injury had on the family and how it had affected the child’s independence.

Methods: All children with TBI who met the inclusion criteria at a large tertiary hospital were included in this longitudinal cohort study.Motor function was assessed using the Gross Motor Function Classification System (GMFCS); the Gross Motor Function Measure (GMFM-88) and the Movement Assessment Battery for Children – Second Edition (MABC-II). After three months, the participants’ independence and the parent’s quality of life was assessed via the Assistance to Participate Scale (APS) and the Pediatric Quality of Life-Family Impact Module (PedsQL-FIM). Ethical clearance was obtained and informed consent and assent was signed before participation.

Results: 84 participants (3-12 years) with TBI, were included. The cohort was heterogeneous and included: mild (n=71), moderate (n=6) and severe (n=7) head injuries. There were statistically significant improvements (p<0.00) in the primary motor outcome measures at hospital discharge and follow-up. The GMFCS levels decreased, indicating improved ambulatory function. The mean total score on the GMFM-88 was 99.38% (SD: ±2.62) indicating almost perfect motor scores. The MABC-II revealed that 76.06% demonstrated no motor disabilities, however, 23.95% were classified as ‘at risk’ of motor impairment.

Conclusions: Motor function recovered in 76.06% of the participants.

Implications: Paediatric and adolescent TBI is a worldwide problem. It is known to be prominent in LMIC such as South Africa, yet appropriate surveillance of the condition is lacking. There is a paucity of data available regarding the demographics of PTBI in South Africa, particularly the Gauteng region. Furthermore, motor function recovery in the acute and subacute period following cerebral insult is minimally researched in this population group. Early and accurate predictors of outcomes post paediatric and adolescent TBI are vital for streaming resources, community re-entry, long-term treatment planning, family adjustment and coping techniques (Kramer et al., 2013, Medrano et al., 2013a). Long term follow-up is warranted to determine residual functional deficits in this sample.

Funding acknowledgements: University of Witwatersrand provided individual FRC grants

Keywords:
Paediatric
Traumatic Brain Injury
Functional Outcomes

Topics:
Paediatrics

Did this work require ethics approval? Yes

Institution: University of the Witwatersrand

Committee: Human Research and Ethics Committee (Medical)

Ethics number: M1711107