Recovery and Outcome
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Recovery and Outcome from Acquired Brain Injury
Developmental Factors
Recovery and long-term outcome following a sustained TBI is a complicated process, dependent on a number of factors, including:
- Pre-injury status of the child and family
- The age of the child at time of injury
- Length of time elapsed since injury
Pre-injury Status
The presence of pre-injury psychiatric,
neuropsychological and/or family problems can interfere with recovery and
long-term outcome. For example, a child with pre-existing ADHD, depression or
behavioral disorder (e.g., oppositional defiant disorder) may show increased
problems in controlling their attention, emotions and/or behavior following
damage to the frontal regions of the brain. Goldstein and Levin (1990)
reported evidence that suggests certain children might be at higher risk for
sustaining a TBI. Children with psychological and behavioral problems that
include risk taking may be over-represented in the population of children with
TBI. A child with a language learning disability may show even greater problems
in reading and spelling because of further damage to the areas mediating these
skills as well as damage to skill areas that were pre-injury strengths that
would help the child to compensate for their deficits. Yeates, et al (1997) demonstrated
that the pre-injury family environment is a significant factor. Children with
severe TBI who lived with poorly functioning families showed less-rapid recovery
over time and lower functioning 12 months post-injury compared to higher
functioning families.
Age of Child at time of Injury
One of the most common
misperceptions that exist is that a TBI sustained earlier in life leads to a
more favorable outcome compared to an injury sustained later ("the earlier the
better"). This view was based in part on clinical observations of children who
sustained strokes in early childhood who later showed recovery of language
ability. More recent research has indicated that children who sustain diffuse injuries to the brain in infancy
or early childhood have less favorable outcomes in cognitive and academic
development than children injured in adolescence (Anderson and Moore, 1995).
Injuries sustained before age seven have been linked to greater impairment of
perceptual-motor, spatial, verbal and written-language skills; attention and executive functions. These findings need
to be tempered in that outcomes vary from child to child. Some children may not
display any change in cognitive or personality development following significant
brain injury. See Taylor and Alden
(1999) for more information.
Time Since Injury
Time since injury has been identified as another
important factor in understanding the effects of TBI sustained in childhood. It
is common for children with severe TBI to show rapid recovery in the first few
months of injury with a slower rate of recovery in the years to follow. It is
uncertain whether children with severe TBI deteriorate in overall level of
functioning over time. However, the development of secondary complications such
as seizures and hydrocephalus may result in some periods of
decline followed by improvement.