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INTRODUCTION

Rehabilitation medicine is the multispecialty discipline focused on the diagnosis, functional optimization, and improvement of quality of life of individuals with congenital and acquired disabilities. Disabilities are described using the World Health Organization’s International Classification of Function, Health, and Disability (ICF). Three aspects are evaluated in every patient: (1) the impact of the disability on body structure and function, (2) the impact of the disability on activity and participation in society, and (3) the environmental factors with an impact on the individual’s function. These three areas are the common framework for discussion of a disabling condition and its appropriate therapeutic intervention.

PEDIATRIC BRAIN INJURY

ESSENTIALS OF DIAGNOSIS & TYPICAL FEATURES

  • Pediatric Brain Injury severity is classified using a variety of factors, including the Glascow Coma Scale, duration of loss of consciousness, and duration of posttraumatic amnesia.

  • Brain injury in young children has psychosocial implications throughout the developmental continuum.

Various estimates indicate that there are up to 500,000 pediatric traumatic brain injuries in the United States every year, resulting in 37,000–50,000 hospitalizations. Mortality rates vary significantly by region (relative risk 1.19–4.2 nationally), but, overall, pediatric brain injuries result in 2000–3000 deaths annually. The cost of these injuries is significant, particularly when also considering that survivors of pediatric brain injury may have long-term deficits with lifetime needs.

Pathogenesis

Brain injury is classically divided into two categories based on the timing of the pathologic findings: primary and secondary injury.

Primary injury occurs at the time of trauma and is characterized by immediate mechanical disruptions such as parenchymal shearing, tearing, and bruising as well as initial neuronal death from cellular energy crises. Treatment of primary brain injury is prevention. This includes proper use of car seats; helmets; fencing around pools; and modification of playground equipment, for example, lower climbing heights and soft, energy absorbing wood chips or padding to dissipate forces during a fall.

Secondary injury occurs as a sequelae of primary injury hours to days after the initial insult. Continued metabolic stressors on neurons from neurochemical derangements as well as changes in intracranial pressure and perfusion pressures from cerebral edema or hemorrhage are the main contributors to secondary injury. Mitigation of secondary injury focuses on monitoring and modulation of intracranial pressures. The complex biochemical cascades involved in secondary brain injury may represent potential future therapeutic targets.

Clinical Findings

Classification & Assessment of Injury Severity

Traumatic brain injury is usually categorized as open or closed. Open injuries are the result of penetration of the skull by missile or sharp object or deformation of the skull with exposure of the underlying intracranial tissues. Closed injuries are the result of blunt trauma to the head, which causes movement (intracranial acceleration or deceleration and rotational forces) and compression of brain ...

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