Unfortunately, with my years of experience in Pediatrics with Home Health and Early intervention I have seen too many cases of Traumatic Brain injuries (TBI) in working in connection with CPS and the foster care system. I also spent time at an acute and long term rehabilitation center for head injuries my first year out of physical therapy school before later changing my focus to Pediatrics. Not all brain injuries are because of intentional abuse or trauma but even just one case related to this is devastating. TBI is the leading cause of death and disability in children. TBI is a form of non-degenerative acquired brain injury resulting from a bump, blow, or jolt to the head (or body) or a penetrating head injury that disrupts normal brain function (Centers for Disease Control and Prevention, 2015).
Brain injuries in infants and children can also be caused by:
infections around the brain (meningitis or encephalitis)
stroke
hypoxic-ischemic events which can result from a near-drowning accident
prolonged seizures
or cardiac (heart) complications
Secondary injury occurs as an indirect result of a brain insult. It results from processes initiated by the initial trauma and typically evolves over time. These include:
ischemia (insufficient blood flow)
hypoxia (insufficient oxygen in the brain)
hypo/hypertension (low/high blood pressure)
cerebral edema (swelling of the brain)
raised intracranial pressure (increased pressure within the skull), which can lead to herniation (parts of the brain are displaced)
hypercapnia (excessive carbon dioxide levels in the blood)
meningitis (infection of the meningeal layers) and brain abscess biochemical changes (changes in levels of neurotransmitters, sodium, potassium, etc.)
epilepsy
Brain injury can be classified as focal or diffuse. A child can have both types of injury as a result of trauma.
Focal injuries usually happen after a direct blow to the head, causing a skull fracture. There is often bruising to the brain below the level of the fracture.
Diffuse injuries often happen after a motor vehicle accident, a fall, or in shaken baby syndrome, where the brain has had a shake that causes damage to the connections between nerve cells. This type of damage is called diffuse axonal injury and is spread across a larger part of the brain than a focal injury. Because a larger part of the brain is damaged, it means a child may have more problems as a result of the injury.
How can Pediatric Physical Therapy Help Children With Traumatic Brain Injuries?
Similar to what was discussed in the previous blog about Cerebral Palsy, the obstacles and neurological involvement of children with TBI, can be addressed and helped by a Pediatric physical therapist. Obstacles that can regress and delay motor development because of a TBI are also typically abnormal muscle tone, abnormal movement patterns, abnormal reflexes, lack of motor control and coordination, muscle weakness, and abnormal sensory awareness. The principle of neuroplasticity combined with neuromuscular training and rehabilitation can help a child to form new neural connections to work towards gaining developmental milestones again. Depending on the severity of the brain injury and the parts of the brain involved, therapy may need to include helping the family acquire and be instructed in the use of positioning and adaptive equipment.
