Community integration following severe childhood traumatic brain injury.
OBJECTIVE
Severe childhood traumatic brain injury (TBI) is the leading cause of death and acquired disability in children, causing impairments in children's sensory-motor, cognitive and behavioural functioning, with devastating consequences on community integration. Community integration is the ultimate goal of rehabilitation; it is a complex outcome, with many variables contributing to it.


RESULTS
Community integration and quality of life (QOL) are lower in children who sustained severe TBI at a younger age. Further, a wide range of injury-related, demographic and postinjury factors influence outcomes, and should serve as targets for specific interventions. An increasing number of interventions targeting cognitive, behavioural or family-related issues have been developed, with promising results.


CONCLUSIONS
Children should benefit from early integrated patient and family-centred specific care, and receive long-term follow-up until early adulthood, with regular assessments, enabling detection and treatment of any emerging problem, and to ensure the acquisition of independent living skills and stable vocational outcome when this is possible. So far, few well conducted intervention studies are available, but their number is increasing with positive results on the trained skills. Well designed studies using large samples and looking at generalization of the skills in everyday life are needed.
Rehabilitation Department for Children with Acquired Brain Injury, Hôpital National de Saint Maurice, Saint Maurice, France. m.chevignard@hopital-saint-maurice.fr
Mathilde P
MP
Chevignard
Neil
N
Brooks
Jean-Luc
JL
Truelle
D000203:Activities of Daily Living / Q000523:psychology; D001930:Brain Injuries / Q000523:psychology* / Q000534:rehabilitation*; D002648:Child; D006233:Persons with Disabilities / Q000534:rehabilitation*; D006801:Humans; D008134:Long-Term Care / Q000379:methods* / Q000523:psychology / Q000639:trends*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000592:standards; D015397:Program Evaluation / Q000592:standards; D011788:Quality of Life / Q000523:psychology; D012111:Residence Characteristics; D012720:Severity of Illness Index; D012917:Social Adjustment; D012944:Social Support