Cognitive Rehabilitation for Children and Youth with Brain Injury

TBI Rehabilitation and Children

By Carolyn Rocchio

Treatment for cognitive functioning after brain injury

Cognitive rehabilitation is a “systemically applied set of medical and therapeutic services designed to improve cognitive functioning and participating in activities that may be affected by one or more cognitive domains” (Katz, Ashley, et al, 2006).

There is no longer any doubt about the effectiveness of cognitive and behavioral rehabilitation   following brain injury. However, insurance companies too frequently move patients with brain injury out of the medical model more rapidly for cost savings.  Children and youth comprise a very low percentage of those who receive any meaningful extended rehabilitation of functional impairments.  Most children and youth are discharged home to the care of parents and school systems.

Children are not “little” adults…their brains are still developing

During the developmental years, the child’s brain is not yet fully formed.  Nor is it as sophisticated as the brain of an adult.  In these developmental years which extend through the late teens and early twenties, children are expected to reach a number of milestones as they grow and mature.  A brain injury interrupts the normal developmental process.  This can subsequently have an impact on the child’s academic achievement and ability to socially interact with family and peers.  In most cases, the burden and responsibility of follow up care and remediation of the child’s deficits fall to parents and educators.

Parents are usually neither educated nor prepared to recognize and assess how the injury has affected their child’s learning capabilities and interactions within the family.  Yet parents ultimately become the case managers for their child’s follow-up services at school and in the community.  Educational systems vary significantly nationwide; however, all must comply with the Individuals with Disabilities Education Act which is the foundation for special education in all states. 

The student with a brain injury will have changing educational needs as the latent effects of the trauma to the brain emerge over time.   So it is important for educational programs for these students to include check points and flexibility to address the student’s emerging and developing special needs after an acquired brain injury.  Parents and educators can be most effective when they work as partners on behalf of the child and student. 

Cognitive rehabilitation for children requires special considerations

little boyThe following key factors must be considered when designing and providing cognitive rehabilitation for children and youth:

  • Effects of the injury may be delayed; the younger the child when injured, the more likely that expected developmental milestones may be delayed or unattained.
  • Youngsters with brain injuries need different approaches to learning to compensate for cognitive deficits in school.
  • Increased guidance and cognitive models of rehabilitation can provide necessary checkpoints and flexibility to support optimal maturation when brain injury negatively impacts the child’s interactions with family and peers.
  • Dual roles of parenting and case management increase stress for parents.  They require educational resources, information and support to successfully assist with the child’s transition from the medical and rehabilitation arena to the school system and community.

Transition from hospital to school after brain injury is critical

Ideally, day cognitive rehabilitation programs resembling school-like environments can provide children with individually designed approaches to academic achievement with feedback from therapists experienced in brain injury rehabilitation.  These programs facilitate the child’s transition from medical to school systems and the community.  This transition is critical as schools focus on learning and achievement, not on remediation of cognitive deficits.  A few hospital to school transition programs for children with acquired brain injuries exist within some large urban pediatric medical centers; however, overall their availability ranges from scarce to non-existent in local communities.  

Cognitive rehabilitation for children requires partnerships with parents and monitoring the brain injury’s effects on the child’s development and academic achievements.  The future holds the promise of greater interventions to enhance the progress of children with brain injuries. Research that is more focused on longitudinal studies can provide the information that will ultimately lead to the development of more comprehensive models of care for children with acquired brain injuries.

References

Katz, DI, Ashley, MJ, O’Shanick, GJ & Connors, S. Cognitive Rehabilitation: The evidence for funding and case for advocacy in brain injury. Retrieved January 16, 2009 from Brain Injury Association of America website at www.biausa.org/policyissues.htm.

Haarbauer-Krupa, J (2009).  Cognitive Rehabilitation for Children and Youth: Moving toward collaborative partnerships. Brain Injury/Professional 6(2) 20-22.

Recommended reading

This Fact Sheet is based on a special issue of Cognitive Rehabilitation: Efficacy and Best Practice of the Brain Injury/professional (vol. 6, issue 2) 2009.

Brain Injury/professional is the largest professional circulation publication on the subject of brain injury and is the official publication of the North American Brain Injury Society (NABIS). Brain Injury/professional is published jointly by NABIS and HDI Publishers.  Members of NABIS receive a subscription as a benefit of NABIS. Visit www.nabis.org to join.

6 responses to “Cognitive Rehabilitation for Children and Youth with Brain Injury”

  1. You can reply to any blog post by commenting at the bottom or you can use the Contact Us page on the green header bar at the top or just go to http://www.lapublishing.com/help.php?section=contactus

    I look forward to hearing your suggestions.
    M. Lash

  2. Does your blog have a contact page? I’m having problems locating it but, I’d like to shoot you an email. I’ve got some ideas for your blog you might be interested in hearing. Either way, great website and I look forward to seeing it expand over time.

  3. Jefferson Dewaard says:

    I really liked your article.Really looking forward to read more. Great.

  4. Rehab says:

    Hello there, I’ve been reading the web log a couple of weeks and just wanted to state your way with words is top notch. Good luck.

  5. Dear Jordan,
    We do have a cognitive communication manual with funtional exercises on vocabulary, word comprehension and reading comprehension by Kathryn Kilpattick that may be useful. You do not mention the child’s age but this manual would be suitable for an adolescent.

    We also have a manual on language demands for students in middle school and high school which is titled Learning and Cognitive Communicative Challenges by R DePompei and J Tyler.

    The tip card Teaching strategies has a practical list of strategies that may be especially useful and you can request a free tip card and catalog by going to our bookstore (see tab at top of page.

    If you have any more questions, just give us a call and we’d be glad to provide more details and suggestions.

  6. Jordan says:

    I work with a child who has been having daily seizures for years and definitely has brain damage. Do you have any suggestions for teaching reading? Thanks!

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