Treating Brain Injuries in Children and Adolescents
Brain injuries remain a serious issue for people of all ages throughout the United States; like the elderly, children and adolescents face a particularly high risk. Young people’s brains have not yet fully developed, and injuries can slow or halt that development, leading to lifelong complications. For this reason, brain injuries are especially dangerous when sustained by children. What seems like a mild concussion may result in years-long developmental problems, and some brain injuries may even result in death. In fact, traumatic brain injuries (TBIs) are the leading cause of death for children and teens in the United States. In its most recent data, the Centers for Disease Control and Prevention (CDC) estimates that among children 14 and under, traumatic brain injuries accounted for approximately 64,000 emergency department visits and 18,000 hospitalizations in 2013.
If your child has fallen, been in a sports accident, or sustained a head injury in any way, you should take them to the doctor immediately. Oftentimes, head injuries appear to heal in just a few days; however, there may be underlying internal damage, the symptoms of which may not appear for weeks, months, or even years. If your child’s brain injury was the result of the negligence or intentional harm of another individual, you may be eligible to seek compensation for the cost of the injury. Contact one of the experienced brain injury attorneys at the Dolman Law Group, with an office located in Tampa Bay, Florida, at (727) 451-6900 for a free case evaluation and to determine your eligibility for compensation.
Once your child has been assessed for and diagnosed with a traumatic brain injury, his or her doctor will likely establish a treatment plan. Each child who sustains a traumatic brain injury will have distinctive needs based on his or her specific injury; your child’s treatment plan will depend on his or her age, developmental status, previous level of function, and the severity of the injury. This guide provides general approaches to treating brain injuries in children and adolescents; however, as mentioned above, you should always consult with a doctor first if you suspect that your child has sustained a brain injury.
Treatment Approaches for Pediatric Traumatic Brain Injuries
The American Speech-Language-Hearing Association (ASHA) groups treatment approaches for child brain injuries into four categories: (1) restorative, (2) habilitative, (3) compensatory, and (4) functional/contextualized. No approach is mutually exclusive, and oftentimes clinicians recommend multiple approaches depending on the severity of the brain injury. Below we discuss the four approaches:
Restorative treatment approaches. These approaches use direct therapy to retrain the body; their goal is to restore or improve bodily function. Treatment targets specific actions and begins with an introduction of small tasks and activities, gradually increasing the difficulty of each task.
Habilitative treatment approaches. One of the real dangers of brain injuries to children and adolescents is the fact that their brains have not yet fully developed, so an injury may cause them to miss important developmental milestones. The younger a child is when he or she sustains a brain injury, the higher the likelihood of developmental issues. Habilitative treatment approaches target skills that a child may not have developed yet, such as cognitive thinking, speech, language, and swallowing. As a child with a TBI ages, he or she may reveal additional developmental struggles that should be addressed through a habilitative approach.
Compensatory treatment approaches. Compensatory treatment approaches focus on helping an injured child adapt to impairments that cannot be improved. This includes adaptations and modifications meant to teach children new and innovative ways to complete their daily activities, and it involves incorporating accommodations that allow a child to participate in an activity that he or she otherwise could not participate in, such as changing the environment or the response. Accommodations for children suffering from a traumatic brain injury are common in academic settings and often include enlisting the services of a note taker, listening to audio and/or video lessons, receiving extra time during exams, and more. Additional modifications might include changes in curriculum, shortened class schedules or school days, and reduced assignments.
Functional/contextualized treatment approaches. As children who have sustained a TBI get older, they should have social, vocational, and educational goals. These types of individualized approaches hinge on collaboration with teachers, caregivers, and peers to help a child function and gain certain skills that are important for both the child and the family. Functional/contextualized treatment approaches encourage competence and independence in the child’s regular social and educational settings.
Treatment Options for Brain Injuries in Children and Adolescents
If your child has been diagnosed with a brain injury, you should work with his or her doctor to establish a treatment plan that addresses all resulting impairments. The CDC reports that TBIs can cause a variety of short-term and long-term functional impairments, which the CDC groups into four separate categories: (1) thinking, (2) sensation, (3) language, and (4) emotion. The following list of treatment options includes possible elements of a care plan for impairments that fall into any of the four categories.
Alternative and augmented communication (AAC). When children sustain TBIs that impair their speech, writing, or other communication skills, specialists enlist the use of AAC. Whether temporary or permanent, AAC refers to aiding or replacing spoken communication with symbols, signs, and gestures. This includes employing the use of pictures, objects, finger spelling, and/or speech-generating devices.
Behavioral intervention. If your child sustained an injury to his or her frontal lobe, you might observe changes in behavior that include agitation, aggression, impulsiveness, or self-harm; these changes may interfere with your child’s day-to-day life. After a TBI, caregivers work to replace these behaviors with functional alternatives through proactive measures. For example, they will provide your child with a structured routine that focuses on improvement. This treatment option prevents negative behaviors before they occur. Another approach to behavior modification includes focusing on the consequences of behavior with special attention to reinforcing positive behaviors. Behavioral intervention may also include metacognitive skills training that promotes self-awareness and self-regulation of negative behavior.
Cognitive-communication intervention. This treatment option focuses on broad functional communication and targets skills that your child specifically struggles with. When devising a treatment plan, your child’s doctor will carefully weigh the relationship between cognitive thinking and communication to ensure maximum success. Cognitive-communication treatments include a wide variety of actions that range from breaking a task down into small steps to providing internal strategies to complete tasks. Below we discuss some examples of the most commonly used cognitive communication treatments:
- Computer-assisted treatment that uses special software programs to improve functions through repeated practice of tasks that focus on attention, memory, problem-solving, language, and speech.
- Direct attention training (DAT) focuses on repeated activities that improve a child’s attention span, selective attention, divided attention, and ability to shift attention. DAT goes hand-in-hand with metacognitive skills training when dealing with pediatric brain injuries.
- Drill and practice treatment uses repetition to strengthen the nerve pathways associated with particular activities or tasks.
- Dual-task training focuses on helping a child complete more than one task at a time, which is a skill often affected by TBI.
- Errorless learning occurs when a clinician tries to reduce the number of errors committed by an injured child by breaking a task down into steps, modeling behavior, discouraging guessing, and correcting errors, with declining support in each repetition.
- External aids are used to promote better attention, time management, organization, and easy recall of information. They might be high-tech, like computers, tablets, and smartphones, but low-tech items, such as calendars, checklists, maps, and notebooks will also work.
- Internal aids are mental strategies that children learn to help remember things and improve function. Some examples include visual imagery, word association, mnemonics, and grouping or chunking information to remember large amounts of information.
- Metacognitive skills training focuses on self-awareness, self-monitoring, and self-regulation to promote behavioral success. This approach is often integrated with DAT training.
- Project-based intervention includes involving your child in a collaborative tangible project that helps promote planning, organization, positive social interaction, and self-regulation.
- Sensory stimulation is primarily used in severe TBI cases where a victim is in a coma. Doctors and caregivers systematically expose a patient to a wide range of audio, visual, tactile, olfactory, and kinesthetic stimuli to improve consciousness and prevent sensory deprivation.
- Strategic learning intervention helps older children regain or develop the ability to organize and synthesize details from written and oral sources, a skill typically developed in early adolescence. Children and teens who have sustained a TBI often face academic challenges, many of which stem from not being able to think abstractly or organize their thoughts.
- Task analysis focuses on one specific skill. A clinician will break down the target task into small digestible steps for a child to learn. After practicing the steps, children chain them together to complete the task.
Language intervention. Language is connected to many cognitive and communicative functions, such as processing speed, working memory, and executive function. The exact method varies and depends on a child’s development at the time of his or her injury, as well as the specific struggles he or she may face. Young children often need help identifying sounds, developing their vocabulary, and improving their word fluency as they learn how to read. Older children and teens may need help with inference, comprehension, discourse processes, and literacy.
Social communication intervention. Children and adolescents who have sustained a TBI often struggle with social skills; they may need to learn or relearn how to appropriately communicate in a social setting. Social communication intervention helps with conversation skills, impulse control, and discussion norms—like taking turns and staying on topic. If engaged in this treatment option, doctors, caregivers, educators, and parents might role play, use videos, and/or coach children to help them improve their ability to interact socially.
Speech intervention. Brain injuries in children and adolescents can cause a wide range of speech problems, from apraxia to respiration to fluency. In some cases, the damage might be permanent, resulting in the long-term need for AAC. A speech pathologist will evaluate your child to determine the best strategy given his or her specific circumstances. In mild to moderate TBI’s, some of these disorders can be managed or even fully corrected. If a child needs a tracheotomy, he or she may also need a speech valve to help them communicate.
Feeding and swallowing intervention. When children and adolescents who have experienced a TBI have feeding and swallowing problems—clinically referred to as dysphagia—they may struggle to remain hydrated and ensure that they ingest enough vitamins and minerals needed to maintain good health. Severe injuries often result in the use of feeding tubes, and victims might struggle with food and fluid intake. Feeding and swallowing intervention involves training or retraining the body to orally ingest food and water.
Hearing and balance intervention. According to the ASHA, when children and adolescents sustain TBIs, changes in hearing and balance may prove to be some of the most challenging struggles. Oftentimes, these changes exacerbate other consequences. Doctors treat hearing loss with hearing aids and assistive technologies intended to manage these difficulties. When children with a TBI have balance problems or suffer from vertigo, they might have a range of other symptoms, including migraines or headaches. These conditions can be treated with medication, or they might just disappear on their own. Treatments for vertigo vary widely across cases, so your doctor will guide you on the best course of action if your child suffers from balance issues following a TBI.
Contact a Tampa Bay Attorney to Discuss Next Steps
If your child has sustained a TBI, you need to focus your full attention on assisting with his or her recovery. Let one of our experienced personal injury attorneys at the Dolman Law Group handle the legal details of your case while you focus on your child’s rehabilitation. If your child suffered a brain injury due to another individual’s careless or negligent behavior, you may be eligible to seek compensation for the full cost of the injuries. Call the Dolman Law Group today at (727) 451-6900, or contact us online, to schedule your free consultation and discuss the details of your case with one of our experienced attorneys.
Dolman Law Group
800 North Belcher Road
Clearwater, FL 33765