Traumatic brain injury and kids: New treatment guidelines issued
March 1, 2019
Science Daily/Oregon Health & Science University
To help promote the highest standards of care, and improve the overall rates of survival and recovery following TBI, a panel of pediatric critical care, neurosurgery and other pediatric experts today issued the third edition of the Brain Trauma Foundation Guidelines for the Management of Pediatric Severe TBI.
Each year in the United States, more than 600,000 children are seen in emergency rooms due to traumatic brain injury, a disruption to the normal function of the brain caused by a bump, blow or jolt to the head. Severe TBI results in approximately 7,000 childhood deaths annually, while survivors of the condition may suffer from long-term health conditions such as seizures, learning difficulty and communication disorders.
To help promote the highest standards of care, and improve the overall rates of survival and recovery following TBI, a panel of pediatric critical care, neurosurgery and other pediatric experts today issued the 3rd edition of the Brain Trauma Foundation Guidelines for the Management of Pediatric Severe TBI.
The updated guidelines reflect the addition of nearly 50 research studies, and include eight new, or revised, treatment recommendations for health care providers that range from the use of intracranial monitoring to the use of hypertonic saline to reduce acute brain swelling.
An executive summary of the guidelines published in the journals Pediatric Critical Care Medicine and Neurosurgery; the full guidelines are available via Pediatric Critical Care Medicine, an official journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
"These guidelines are vital to the proper care and treatment of children with serious brain injury," said co-author and clinical investigator Nathan Selden, M.D., Ph.D., Campagna Professor and Chair of the Department of Neurological Surgery at the OHSU School of Medicine in Portland, Oregon. "Now, health care providers around the world will have access to the best medical evidence and recommendations to help save and improve countless lives."
An associated manuscript, also published in Pediatric Critical Care Medicine, describes an algorithm designed to guide first and second tier therapies for infants and children with severe TBI. The tool for bedside use by caregivers, which supplements evidence-based recommendations in the updated guidelines, was created using a validated, consensus-based expert opinion process.
"We believe a combination of research findings and real-life experience will further advance the bedside care of infants and children with severe TBI, especially in treatment scenarios where scientific and clinical research is lacking," said first author Patrick Kochanek, M.D., Grenvik Professor and Vice Chairman of Critical Care Medicine and Director of the Safar Center for Resuscitation Research at the University of Pittsburgh. "This algorithm will also help to identify key research priorities to help ensure the ongoing momentum of consistent, high-quality care for patients across the globe."
The original Brain Trauma Foundation Guidelines published in 2003 and were last updated in 2012. The 3rd edition was developed as part of the Brain Trauma Evidence-based Consortium based at the Stanford University School of Medicine. The Pacific Northwest Evidence-based Practice Center at OHSU managed the effort, which included experts from OHSU, the University of Pittsburgh, Boston Children's Hospital, Phoenix Children's Hospital, Children's National Medical Center, Seattle Children's Hospital, the University of Utah, the University of British Columbia, and Duke University.
https://www.sciencedaily.com/releases/2019/03/190301192651.htm
Teens with concussion may benefit from earlier physical therapy
June 27, 2018
Science Daily/Wolters Kluwer Health
For adolescents with symptoms following a concussion, starting physical therapy (PT) earlier -- within less than three weeks after the injury -- provides outcomes similar to those of later PT.
"Multimodal PT interventions administered by licensed physical therapists may be feasible and safe even within the first few weeks after injury to help facilitate prompt recovery and mitigate the onset of secondary effects from delayed treatment," write Catherine Quatman-Yates, DPT, PhD, of The Ohio State University, Columbus, and colleagues. The study is part of a JNPT special issue on "Rehabilitation Management of Concussion," highlighting research-driven changes geared toward promoting return to activity in young patients with concussion.
Similar Outcomes for Teens with Concussion Undergoing Earlier or Later PT
The researchers looked how the timing of PT affected the course of concussion-related symptoms in 120 adolescents: 78 females and 42 males, median age 14 years. Physical therapy was classified as early (beginning 0 to 20 days after concussion) in 27.5 percent of patients, middle (21 to 41 days) in 32.5 percent, and late (42 days or after) in 40 percent.
The PT program consisted of progressive exercise; vestibular/oculomotor training (targeting inner ear/balance and visual symptoms); and cervical spine manual therapy, stretching, and strengthening exercises. This multimodal treatment was delivered by licensed physical therapists with special training in concussion treatment.
Whether started earlier or later, PT led to similar reductions in concussion-related symptoms. The number of sessions and duration of PT care were similar across groups. There was a low rate of adverse events, most of which were unrelated to PT.
Symptoms worsened in a few patients, more commonly in the late PT group. Some of these patients may have had concussion-related impairments not directly addressed by PT, such as anxiety, depression, or sleep problems.
Recent research has led to new insights into medical management of concussion in children and adolescents. Past guidelines recommended complete physical and cognitive (mental) rest after concussion, until symptoms resolved. But recent studies have suggested that resting for more than a day or two has limited benefits, and may even be linked to increased concussive symptoms.
Today, concussion management is shifting toward a shorter period of rest, followed by gradual return to usual activities, guided by the patient's symptoms. Physical therapy has been recommended for adolescents with persistent symptoms of concussion, generally after three weeks.
The new study provides evidence that starting PT earlier is a safe and feasible approach for adolescents after concussion, with improved symptoms regardless of the timing of the intervention. "Introducing PT earlier in the recovery process may be beneficial in minimizing the potential burden of longer recovery trajectories," Dr. Quatman-Yates and coauthors write. They emphasize the need for further research to determine PT's role in the "optimal plan of care" for young patients with concussion.
Other articles in the special issue include a neuroscience perspective on the role of rest versus physical activity in recovery for young people with concussion, along with new research on changes in vestibular/oculomotor function and the role of balance testing after concussion.
Physical therapists can play a critical role in evaluating and choosing targeted interventions most likely to result in the best outcomes for patients with concussion, according to a Guest Editorial by Karen L. McCulloch, PT, PhD, NCS, and Kathleen Gill-Body, PT, DPT, MS, NCS, FAPTA. They write, "We are in an ideal position to continue our process of returning people to activities and roles that they care about...because it is what we do."
https://www.sciencedaily.com/releases/2018/06/180627160258.htm
Brain injury researchers find retrieval practice improves memory in youth with TBI
December 3, 2014
Science Daily/Kessler Foundation
Brain injury researchers have identified retrieval practice as a useful strategy for improving memory among children and adolescents with traumatic brain injury, researchers have found. Difficulties with memory and learning are common after TBI in childhood. To improve academic achievement and long-term outcomes such as employment, effective neurorehabilitative strategies need to be identified, they note.
Difficulties with memory and learning are common after TBI in childhood. To improve academic achievement and long-term outcomes such as employment, effective neurorehabilitative strategies need to be identified.
The researchers studied 15 patients with TBI and impaired memory, aged 8 to 16 years. They compared results of three memory strategies: massed restudy (cramming), spaced restudy (restudying of material at timed intervals), and retrieval practice (quizzing during the learning stage). Participants were tested on verbal-paired associates and face-name pairs.
"We found that retrieval practice resulted in better recall," said Dr. Coyne. "Overall, retrieval practice was the best learning strategy for each of the participants, indicating that this method can improve learning and memory in this age group with TBI. There's a need for randomized controlled trials to confirm this finding, and look at the impact of retrieval practice on academic achievement."
http://www.sciencedaily.com/releases/2014/12/141203161136.htm