A traumatic brain injury (TBI) is any injury to the head that interferes with the normal functioning of the brain. This can be a violent blow or bump, which can result in a sudden jolt, or a penetrating injury that pierces the skull and the brain tissue.
TBIs can range from mild (commonly known as a concussion) to severe, potentially resulting in unconsciousness or memory loss.
Children participating in school sports have a particularly high risk of experiencing TBI. The Centers for Disease Control and Prevention (CDC) report that in 2009, almost 250,000 children and adolescents aged 19 and younger received treatment for sports and recreation-related TBIs and concussions.
The CDC also note that between 2001 and 2009, the number of people under 19 years old diagnosed with sports and recreation-related TBI or concussions rose by 57 percent.
Around 435,000 children aged between 0 and 14 visit the emergency department as a result of TBI every year.
The long-term effects of TBI include difficulties in reasoning, language, or emotions and sensations. Chronic traumatic encephalopathy - a neurodegenerative disorder associated with repeated TBIs - also ranks among the possible long-term effects.
A new study, presented at the annual meeting of the Association of Academic Physiatrists in Las Vegas, reports on the results of two decades' worth of research into the long-term effects of TBI on children, as well as possible interventions for recovery.
The role of the family environment in TBI recovery
The research - carried out by scientists from Cincinnati Children's Hospital Medical Center (CCHMC) - looks at the impact of TBI on children for an average of 7 years after the traumatic event.
Some of the findings shed light on the role of parenting practices and home environment on recovery from TBI.
Children with mild to moderate brain injuries are twice as likely to develop attention problems than their healthy counterparts, and those with severe TBI are five times more likely to have secondary ADHD, the researchers found.
However, children with severe TBI show fewer symptoms if they grow up in optimal family environments, whereas children with mild injuries often display persistent symptoms if they come from a socially disadvantaged or chaotic family.
Overall, many children do not display any deficits at all. Those that do, however, show most long-term damaging effects on skills such as speed and information processing, inhibition, and reasoning.
The effect of family interventions on TBI recovery
Throughout the past two decades, CCHMC scientists have also investigated possible interventions for improving the cognition and behavior of those affected by TBI.
The researchers believe that an early response from the family is crucial for long-term positive health outcomes. They suggest that effective parenting is a key early intervention for TBI recovery.
Therefore, scientists developed a web-based program that offers training to families dealing with TBI. The program includes training in problem-solving, communication, and self-regulation.
Several randomized trials of such programs showed a decrease in behavior problems and an improvement in executive cognitive functioning in older children with TBI. A computerized trial, for instance, showed improvements in sustaining attention in children between 12 and 17 years old.
Web-based programs also improved the interaction between parents and their children.
Little is known about the interplay between genes, the environment, and their role in TBI recovery.
To this end, CCHMC researchers will be collecting DNA samples from the saliva of more than 330 children enrolled in the Approaches and Decisions in Acute Pediatric TBI Trial, as well as continuing to investigate the role of environmental factors such as family and home environment, parenting styles, and socioeconomic status.
The main health outcome investigated will be overall functioning at 3, 6, and 12 months after the injury, and the secondary outcome will be a comprehensive evaluation of cognitive and behavioral functioning 1 year after the injury.
Researchers are also using neuroimaging techniques in order to understand the brain structure and brain activity behind persistent post-TBI symptoms. For example, a CCHMC study that has not yet been published looks at the neural connectivity following aerobic exercise, in an attempt to improve long-term TBI symptoms.