A comprehensive model of care for rehabilitation of children with acquired brain injuries.
BACKGROUND
Acquired brain injury (ABI) is a leading cause of death and lifelong acquired disability in children and remains a significant public health issue. Deficits may only become fully apparent when developmental demands increase and once cognitive processes are expected to be fully developed. It is therefore necessary to provide organized long-term follow-up for children post ABI. Despite these recommendations, it has been shown that only a small proportion of children received specialized rehabilitation and adequate follow-up after ABI.


OBJECTIVE
The aims are: (i) to describe a comprehensive model of care devoted to children with acquired brain injuries; and (ii) to provide descriptive data analysing the characteristics of children followed up, the type/amount of services provided and general outcomes.


METHODS
The programme features an in- and outpatient rehabilitation facility, where multidisciplinary rehabilitation and specialized schooling are provided. The ultimate goal of the programme is to promote each child's successful reintegration in school and in the community. Adequate preparation of discharge is essential, long-term follow-up is organized, and an outreach programme has been developed to deal with the complex delayed psychosocial issues.


RESULTS
Overall outcome, as measured by the Glasgow Outcome Scale, improved dramatically between admission (3.3; SD = 0.45) and discharge (2.15; SD = 0.74). Most of the children were discharged home with an adequate personalized plan for ongoing rehabilitation and school adaptations. Analysis of the outreach programme underlines the more challenging issues arising in late adolescence-early adulthood.


CONCLUSIONS
Given the specificities of childhood ABI, long-term specific care must be organized and co-ordinated, regardless of injury severity.
Physical Medicine and Rehabilitation Department for children with acquired neurological injuries, Hôpital National de Saint Maurice, 14, rue du Val d'Osne, 94415 Saint Maurice, France. m.chevignard@hopital-saint-maurice.fr
M
M
Chevignard
H
H
Toure
D G
DG
Brugel
J
J
Poirier
A
A
Laurent-Vannier
D001930:Brain Injuries / Q000534:rehabilitation*; D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000592:standards; D002675:Child, Preschool; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000592:standards; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012041:Regional Medical Programs / Q000458:organization & administration / Q000592:standards