Developmental trajectories of infants and toddlers with good initial presentation following moderate or severe traumatic brain injury: A pilot clinical assessment project

摘要

Objective: The purpose of this study was to review the feasibility and usefulness of instituting a clinical protocol ofnscheduled assessments for children after a moderate or severe traumatic brain injury (TBI) sustained before the age of 2 years andnshowing no immediate deficits at hospital discharge, as well as to explore the early developmental trajectories of these children.nDesign: Exploratory analytical cohort study.nSetting: Pediatric Trauma Center Out-patient services.nParticipants: 31 children were followed within the clinical protocol of scheduled assessments.nOutcome measures: The protocol included an immediate post-injury clinical assessment of infants who sustained a TBI andnfollow-up assessments at the ages of 9 months, 18 months (if injured prior to that age), 30 months, and 42 months. Domainsnassessed at each scheduled visit included hearing, speech and language, motor performance, personal social abilities, and adaptivenbehaviors.nResults: Clinicians reported few difficulties with scheduling or administering the assessments, maintaining a 67% participationnrate at the end of the follow-up period, thus demonstrating the feasibility of the protocol in this population. Scores on the majoritynof formal tests showed high variability and 15–20% of children presented with clinically significantmotor and/or language delays.nBy 42 months of age, difficulties with adaptive behavior and personal social abilities were identified in our sample of childrennwhen compared to published norms. Qualitative clinical findings from professionals identified between 25–50% of children withnpotential attentional difficulties throughout the follow-up period.nConclusion: Findings from this study demonstrate the feasibility of implementing a clinical protocol of assessment for infantsnand toddlers who sustain a TBI before the age of 2 years and present with no impairments at the time of discharge from hospital.nDevelopmental problems in this population appear to be easier to identify later in the toddler years as opposed to immediatelynfollowing the TBI, emphasizing the importance of providing screening for developmental issues in this population prior to schoolnentry.