Key Points

  • Elevating the head of the bed post TBI is effective at lowering intracranial pressure in children.

 

  • Use of hypertonic saline in the intensive care unit setting results in a lower frequency of early complications and shorter intensive care unit stays.

 

  • An increase in serum sodium concentrations significantly correlates with lower intracranial pressure and higher cerebral perfusion pressure.

 

  • Continuous infusion of hypertonic saline reduces intracranial pressure and stabilizes serum sodium levels in children with severe TBI.

 

  • A decompressive craniectomy reduces elevated intracranial pressure in children with TBI.

 

  • Despite the potential benefit of a decompressive craniectomy for reduction of intracranial pressure, there are numerous secondary complications that must be acknowledged when considering a decompressive craniectomy for children with severe TBI.

 

  • Predictors of poor outcomes after a decompressive craniectomy include non-accidental head trauma, delay (>4hrs) in surgery following admission, and intraoperative bleeding that exceeds 300mL.

 

  • Long term intracranial pressure does not significantly improve following moderate hypothermia treatment compared to normothermia.

 

  • Induced hypothermia for 24, 48, and 72 hours has not yet been shown to reduce the risk of poor outcomes (death, severe disability etc.) in children post TBI.

 

  • Hypothermic treatment for 48 and 72 hours aids in the protection from secondary damage in children following a TBI.

 

  • Dopamine enhancing drugs may facilitate rate of recovery post acquired brain injury in children; however, due to the small sample sizes more definitive research is needed.

 

  • The effect of fentanyl administration on intracranial pressure and cerebral perfusion pressure is inconclusive.

 

  • Pentobarbital is effective at reducing intracranial pressure and improving refractory intracranial hypertension levels but has cardiovascular compromise as a side effect; additional studies are needed.

 

  • Magnesium sulfate does not affect intracranial pressure, cerebral perfusion pressure, or mean arterial pressure in children post-TBI.

 

  • Administration of dexamethasone inhibits endogenous production of glucocorticoids in children and has no proven impact on recovery post brain injury.

 

  • Phenytoin does not reduce early or late seizures in children post ABI.

 

  • The rate of early post-traumatic seizure is high among children that receive levetiracetam prophylaxis.

 

  • Enhanced immune formulas are not superior to regular formulas in regards to caloric and protein intake; however, they do have potential beneficial anti-inflammatory properties in children post-TBI.

 

  • Food texture and the person feeding are important factors when feeding a child post acquired brain injury.

 

  • Behavioural therapies for children are effective at mitigate behavioural problems in children following an ABI. Little is currently known with respect to family factors that influence treatment, behavioural therapies for preschool children, and therapy for behaviours beyond the scope of externalizing problems.

 

  • Online problem solving therapy improves externalizing behaviours in adolescents following a moderate TBI.

 

  • Cognitive behavioural therapy improves behavioural and psychological problems in children following a severe TBI.

 

  • Amantadine has been shown to decrease undesirable behaviours post TBI in children.

 

  • Amantadine has also been shown to be safe to administer and to improve the rate of recovery in children post TBI.

 

  • Cognitive rehabilitation programs are beneficial for the improvement of attention and memory for children following brain injury.

 

  • Evidence regarding the efficacy of methylphenidate to improve cognitive and behavioural function following a pediatric TBI is conflicting.

 

  • Cognitive rehabilitation can improve intellectual function for children following brain injury.

 

  • Memory aids may be effective at reducing memory deficits after an ABI.

 

  • Counsellor assisted problem solving programs are effective at improving executive function in adolescents.

 

  • The SMART intervention improves high-order cognitive function in adolescents post-ABI.

 

  • Goal management therapy is effective to reduce parental ratings of their child’s executive function.

 

  • Metacognitive treatment programs for pre-adolescents that are assisted by therapists improve executive function and increase the use of metacognitive learning strategies.

 

  • Interventions that target problem solving are effective to improve executive function and metacognitive abilities.

 

  • Pragmatic skills training may help to improve communication following brain injury.

 

  • Injury-related information provided to participants and parents has not been yet shown to have an effect upon knowledge and awareness of injury-related deficits, memory or behavioral problems in children.

 

  • Home based exercise programs improve functional balance in children with an ABI.

 

  • Online parenting skills workshops are not superior to internet resource comparison groups in reducing caregiver stress, depression, and self-efficacy. However, such workshops are efficient at improving positive parental behaviours towards children.

 

  • Web-based teen problem solving intervention programs are effective in reducing parental depression, anxiety, and distress compared to an internet resource comparison group.

 

  • Family-based interventions benefit children or adolescents and their families following brain injury.

 

  • Stepping Stone Triple P with Acceptance and Commitment Therapy improves parental outcomes and children’s short-term behavioural problems post-ABI.

 

  • Family problem solving therapy face to face improves child behavioural problems post-TBI, but not parental distress or relationship satisfaction. 

 

  • Family based rehabilitation is superior to clinician-directed care to improve cognitive and physical outcomes in children following a TBI.

 

  • Community resource coordinators post-discharge did not improve functional outcomes in children post-TBI.

 

  • Multidisciplinary outpatient programs may improve functional outcomes for children following brain injury.

 

  • Online family problem solving interventions improve everyday functioning, specifically in the school and community domains, for adolescents that have sustained a TBI.

 

  • The benefits of interventions directed at improving social interaction for children with brain injury are unclear. More research is required.

 

  • Upper limb lycra splints improve the quality of movement in some children with traumatic brain injury.

 

  • Botulinum toxin type A effectively improves both upper and lower limb spasticity in children and adolescents following brain injury.

 

  • Intrathecal baclofen pumps reduce upper and lower limb spasticity in children with hypoxia.

 

  • Constraint induced movement therapy improves upper limb function in children post TBI; however future research is warranted.

 

  • Virtual Reality-based Therapy has been shown to improve motor abilities in children post ABI.

 

  • Further research is required to observe the efficacy of VR-based Therapy as part of a rehabilitation program.

 

  • Robotic assisted therapy improves motor function in both upper and lower extremities in children that have sustained an ABI.

 

  • Permanent severe neurological outcomes and disabilities are often the result of shaken baby syndrome.

 

  • Ophthalmologic examinations can be used to reveal the severity of brain injury resulting from shaken baby syndrome.

 

  • The PURPLE intervention for shaken baby syndrome increases knowledge of crying and effects of shaken baby syndrome, as well as behaviours of walking away during infant inconsolable crying.

 

  • Education programs on infant crying and safety are effective to inform parents on the dangers of shaken baby syndrome.