Summary

  1. There is Level 4 evidence to suggest head elevation reduces intracranial pressure in children post TBI.
  2. There is Level 1b evidence that use of hypertonic saline in the intensive care unit setting results in a lower frequency of multiple early complications and a shorter intensive care unit stay compared with lactated Ringer’s solution. Further, an increase in serum sodium concentrations significantly correlates with lower intracranial pressure and higher cerebral perfusion pressure.
  3. There is Level 1b evidence that a single bolus of 3% saline reduces intracranial pressure and increases serum sodium levels, when compared to 0.9% saline.
  4. There is Level 4 evidence that continuous infusion of 3% saline is effective at reducing intracranial pressure in children following a severe TBI.
  5. There is Level 3 evidence that children who sustain a severe TBI from non-accidental trauma have poorer outcomes and higher odds of mortality following a decompressive craniectomy, when compared to accidental trauma victims.
  6. There is Level 4 evidence to suggest that children with a severe TBI have secondary complications following a decompressive craniectomy that may prolong rehabilitation.
  7. There is Level 1a evidence to suggest that therapeutic hypothermia (24, 48 and 72 hours) does not significantly improve mortality rates or outcomes, in relation to normothermia therapy.
  8. There is Level 1a evidence that intracranial pressure is not improved long term (>24hrs) following hypothermia treatment in children following a TBI.
  9. There is Level 1b evidence that hypothermia treatment maintained for 48 hours preserves antioxidant defenses in children following a severe TBI, when compared to normothermia.
  10. There is Level 1b evidence that 72 hours of hypothermic treatment with a cooling cap improves short-term intracranial pressure levels and reduces biomarkers of brain damage (S-100, NSE, CK-BB), compared to normothermia therapy.
  11. There is Level 1b evidence that amantadine improves the level of consciousness in children post ABI compared to placebo but not level of arousal.
  12. There is Level 2 evidence that amantadine and pramipexole improve the levels of consciousness in children and adolescents with TBI.
  13. There is conflicting evidence regarding fentanyl use for reduction of intracranial pressure and improvement of cerebral perfusion pressure for children following a severe TBI.  
  14. There is Level 3 evidence that pentobarbital administration is effective for reduction of intracranial pressure, but may cause cardiovascular compromise.
  15. There is Level 2 evidence that magnesium sulfate does not affect hemodynamics (intracranial pressure, cerebral perfusion pressure, mean arterial pressure) in children post-TBI.
  16. There is Level 1a evidence that administration of dexamethasone inhibits endogenous production of glucocorticoids and has no proven impact on recovery post brain injury.
  17. There is Level 1b evidence that phenytoin does not reduce the occurrence of early seizures in children. 
  18. There is Level 1b evidence from a second study that phenytoin is ineffective in reducing late seizures in children.
  19. There is Level 4 evidence that children that develop early post-traumatic seizure under levetiracetam prophylaxis are younger and have experienced abusive head trauma, compared to those that did not develop post-traumatic seizure.
  20. There is Level 1b evidence that the administration of enhanced immune formulas are not superior to regular formulas in regards to increasing caloric and protein intake; however enhanced immune formulas do reduce interleukin-8 and early gastric colonization.
  21. There is Level 5 evidence that food texture and the caregiver are important factors when feeding a person post ABI.
  22. There is Level 1b evidence that online problem solving therapy improves externalizing behaviours in adolescents, when compared to an internet resource control group.
  23. There is Level 2 evidence that cognitive behavioural therapy is effective to reduce parent-adolescent conflict compared to children who did not receive therapy.
  24. There is Level 4 evidence that behavioural therapies for children with ABI are effective at reducing or eliminating problematic behaviours.
  25. There is Level 2 evidence that the use of amantadine can decrease the amount of aberrant behaviours compared to usual care among children with a TBI.
  26. There is Level 3 evidence that amantadine is safe to administer in children following a TBI and facilitates rate of recovery post-traumatic brain injury.
  27. There is Level 1b evidence that a memory and training program improves selective, but not sustained attention, and memory in children following an ABI.
  28. There is Level 2 evidence that computerized attention skills training programs improve sustained, but not selective, attention compared to healthy controls.
  29. There is Level 2 evidence that specific remediation programs for attention improve attention performance.
  30. There is conflicting evidence that methylphenidate interventions improved cognitive behavioural function compared to placebo, in children following a TBI.
  31. There is Level 2 evidence supporting using a pager system to improve memory and planning activities in adolescents with a TBI.
  32. There is Level 4 evidence that rehabilitation focused around diary entries and self-instructional training improves memory deficits in children post-TBI.
  33. There is Level 2 evidence that sensory stimulation paired with cognitive neuropsychological rehabilitation improves intellectual development in children with severe TBI.
  34. There is Level 2 evidence that intellectual function is significantly increased with cognitive rehabilitation.
  35. There is Level 1a evidence supporting the use of online counsellor assisted problem solving programs to improve executive function in adolescents who have sustained a TBI.
  36. There is Level 1b evidence that the SMART program improves higher-order cognitive deficits compared to a control group with bottom-up processing training.
  37. There is Level 1b evidence that metacognitive therapy improves learning strategies and executive function in children and adolescents with an ABI.
  38. There is Level 4 evidence from one study supporting the use of goal management therapy to improve parental ratings of executive function in young children who have sustained a TBI.
  39. There is Level 2 evidence that problem solving interventions improve executive function and metacognitive abilities in children post-ABI.
  40. There is Level 5 evidence that children that sustain a brain injury after 5 years of age are more likely to return to normal consonant production, compared to children who sustain an injury prior to language skill consolidation.
  41. There is Level 4 evidence indicating the EPG treatment is effective treating the articulatory component of dysarthria post TBI in children.
  42. There is Level 4 evidence that peer-group training of pragmatic language skills may benefit children with communication deficits following brain injury.
  43. Based on the findings of a single RCT, there is Level 2 evidence that injury-related information interventions do not improve knowledge or awareness of injury-related deficits, memory function or behavioral problems in children.
  44. There is Level 1b evidence suggesting that home based exercise programs improve balance compared to regular daily activities in children who have sustained an ABI.
  45. There is Level 1a evidence that online problem solving program with therapist assistance is not superior to an internet resource comparison group at improving parent-teen communications and conflict.
  46. There is Level 2 evidence that online problem solving with audio support is not superior to without audio support with regards to improving adolescent behavioural issues and depression.
  47. There is Level 1b evidence that an online parenting skills workshops (I-InTERACT) improves positive parental involvement towards children, when compared with an internet resource group.
  48. There is Level 2 evidence that an online parenting skills program (I-InTERACT) is not superior to an internet resource comparison group at improving caregiver stress, distress, depression, and self-efficacy.
  49. There is Level 2 evidence that Stepping Stone Triple P combined with Acceptance and Commitment Therapy improves parental distress, confidence, psychological flexibility, and conflict, but not depression, when compared to usual care.
  50. There is Level 2 evidence that a face to face family problem solving therapy is superior to usual care in terms of reduction of child behavioural problems, but not parental distress or relationship satisfaction.
  51. There is Level 2 evidence to suggest that family based therapy is superior to standard clinician-directed care for children post-TBI to improve cognitive and physical outcomes.
  52. There is Level 1b evidence that the allocation of community resource coordinators post-discharge is not superior to standard care to improve functional outcomes in children following a TBI.
  53. There is Level 4 evidence that a multidisciplinary outpatient program may improve functional abilities following brain injury for children.
  54. There is Level 1b evidence that family based online problem solving programs compared to an internet resource comparison group improves everyday functioning as well as functioning in school and the community in adolescents following a TBI.
  55. There is Level 4 evidence that interventions directed at strengthening the social interactions of children with brain injury may be beneficial; however, more research is required prior to making a more definitive conclusion.
  56. There is Level 5 evidence that upper limb lycra splints improve the quality of movement in some individuals with traumatic brain injury.
  57. There is Level 2 evidence that botulinum toxin type A is an effective treatment for children and adolescents with upper and lower limb spasticity.
  58. There is Level 4 evidence that intrathecal baclofen pumps are effective at reducing spasticity in the upper and lower limbs for children with hypoxia.
  59. There is Level 2 evidence to suggest that constraint induced movement therapy improves motor function of the hemiparetic limb compared to no care, in children following a TBI.
  60. There is Level 2 evidence that virtual reality simulators are useful in measuring patients’ self-care and attentional abilities, with a view to using them in motor rehabilitation interventions.
  61. There is Level 4 evidence that use of a Nintendo Wii console can be used to improve the amount and intensity of physical activity, and help patients to achieve motor functioning goals.
  62. There is Level 2 evidence suggesting that body-weight supported treadmill training paired with physiotherapy is efficacious in improving gait and motor function compared to physiotherapy alone.
  63. There is Level 4 evidence that reach training with robot mediation improves upper limb motor function in children that have sustained an ABI.
  64. There is Level 4 evidence that the lack of visual response in infants with shaken baby syndrome at ophthalmologic examinations may lead to fatal outcomes.
  65. There is Level 4 evidence that the presence of poor papillary response, the presence of a RH, a midline shift, circular perimacular retinal folds and peripheral retinoschisis may also lead to fatal outcomes among individuals with shaken baby syndrome.
  66. There is Level 1a evidence that PURPLE intervention program is effective to reduce maternal knowledge of infant crying and shaken baby syndrome, compared to an infant safety control group.
  67. There is Level 4 evidence supporting the role of education programs for informing the caregivers of shaken baby syndrome and its detrimental effects.