Journal of pediatric rehabilitation medicine
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J Pediatr Rehabil Med · Jan 2009
Acute brain injury and therapeutic hypothermia in the PICU: A rehabilitation perspective.
Acquired brain injury from traumatic brain injury, cardiac arrest (CA), stroke, and central nervous system infection is a leading cause of morbidity and mortality in the pediatric population and reason for admission to inpatient rehabilitation. Therapeutic hypothermia is the only intervention shown to have efficacy from bench to bedside in improving neurological outcome after birth asphyxia and adult arrhythmia-induced CA, thought to be due to its multiple mechanisms of action. Research to determine if therapeutic hypothermia should be applied to other causes of brain injury and how to best apply it is underway in children and adults. Changes in clinical practice in the hospitalized brain-injured child may have effects on rehabilitation referral practices, goals and strategies of therapies offered, and may increase the degree of complex medical problems seen in children referred to inpatient rehabilitation.
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J Pediatr Rehabil Med · Jan 2009
Injury severity variables as predictors of WeeFIM scores in pediatric TBI: Time to follow commands is best.
After pediatric traumatic brain injury (TBI), early prognosis of expected function is important for optimizing care. The power of several common brain injury severity measures for predicting functional outcome in children with TBI was investigated; the severity variables studied were Glasgow Coma Scale (GCS) score, time to follow commands (TFC), duration of post-traumatic amnesia (PTA), and total duration of impaired consciousness (TFC+PTA). Outcome was assessed using the Functional Independence Measure for Children (WeeFIM) at discharge from inpatient rehabilitation (n = 120) and, in a subset of children, at 3 months following discharge. ⋯ Models in which TFC and PTA duration were entered as separate variables and as a combined variable (TFC+PTA) were all significantly predictive of WeeFIM scores at discharge; however, TFC accounted for the greatest portion of variance in WeeFIM scores. Among children with moderate to severe TBI who received inpatient rehabilitation, TFC was the best predictor of general functional outcome at discharge and follow-up. Our findings highlight the need for careful and consistent assessment of TFC to assist in predicting functional outcomes as early and accurately as possible.