Brain Injury's Long-Term Impact

Traumatic brain injury rehabilitation appears to taper off two years after injury

(RxWiki News) In the one to two years after a child experiences traumatic brain injury, progress can be made in their function and quality of life. But improvement then appears to slow down.

A recent study has found that a group of children with traumatic brain injury did not noticeably improve between two and three years after their injury.

"If they make a helmet for it - wear it."

The study, led by Frederick Rivara, MD, MPH, from the Departments of Pediatrics and Epidemiology and the Harborview Injury Prevention and Research Center at the University of Washington in Seattle, looked at the long-term outcomes of children who experienced traumatic brain injury.

The study involved 769 children total, including 595 who had experienced mild, moderate or severe traumatic brain injury when they were under 17 years old.

Most of these children — 513 of them — experienced mild injury while 69 had moderate injury and 13 had severe traumatic brain injury.

The children's brain functions were assessed three years after their injuries to see if they had improved between 2 years and 3 years after the injury.

These children were compared to 174 children who were treated in the emergency department for an arm injury and then assessed three years later for this study.

Three different standard assessment scales were used for the study.

The children who had experienced moderate or severe traumatic brain injury were 16.1 (moderate) and 17.9 (severe) points below where they had been before injury on the assessment related to their quality of life.

A change of 4 to 5 points on the quality of life scaled is considered meaningful. The scale runs from 0 to 100.

The children who had moderate or severe traumatic brain injury also did more poorly on the other two assessments, including one related to their participation in activities.

The children with mild traumatic brain injury scored slightly lower on an assessment of self-care compared to the children with arm injuries, but their results were not significantly different for the other assessments.

Overall, the researchers found the children who had traumatic brain injury did not improve much in the third year since their injury.

One limitation of the study, however, is that the results are based on reporting from the parents and, when relevant, the children.

Still, the children did not appear to make much progress during their third year after their injury.

"Our study found that those with moderate or severe traumatic brain injury continued to have statistically and clinically significant deficits in function 36 months after injury, with no statistically significant improvement seen between 24 and 36 months," the authors wrote.

The calculations were adjusted to account for the children's age, gender, race/ethnicity, health insurance status, household income and education level of the parents.

Previous studies with these children showed that they did improve between 12 and 24 months after their injury. Therefore, the children's improvement appears to plateau after the two-year mark past their injury.

Aside from prevention then, the researchers stated that better interventions need to be developed for treatment immediately after the injury to try to decrease the long-term brain function and quality of life difficulties.

The study was published August 27 in the Journal of Neurotrauma. The research was funded by the National Center for Injury Prevention and Control at the U.S. Centers for Disease Control and Prevention. The authors declared no competing interests.

Review Date: 
September 24, 2012