Childhood traumatic brain injury (TBI) is a global health concern, with the highest estimates reporting that 280 per 100,000 children sustain a mild TBI, or concussion, during adolescence. The brain region most commonly affected by TBI regulates social cognition, and, accordingly, pediatric moderate-to-severe TBI patients sometimes report long-term chronic social impairment, such as poor social and academic skills, social withdrawal, poor adaptive functioning, deficits in fluid reasoning and processing speeds, and higher risk of peer victimization.
These symptoms are troubling given that greater involvement in life situations and activities, more succinctly called social participation, is the ultimate goal of post-TBI rehabilitation. Despite this, little research exists on the possible factors, either environmental or injury-related, that may affection participation several years down the line.
A research team oversaw a large study to determine any factors associated with social participation seven years after childhood TBI. They distributed self-report surveys to 70 participants aged 7 to 22 years, half of whom had sustained a moderate-to-severe TBI in childhood and half of whom were uninjured (control group). To compare the youths’ self-reported experiences with an outside perspective, parents of participants received the same surveys, which gauged levels of engagement, executive function, quality of life, and environmental factors, among other things, to determine participation. These surveys showed that:
- Parents reported significantly lower participation among childhood TBI participants, which the children’s self-reports did not indicate.
- Injury severity had a much greater influence on participation than social or familial environmental factors.
- Participants who had suffered a severe TBI had more serious functional outcomes, lower executive functioning, more behavioral difficulties, greater fatigue, and lower quality of life.
These findings suggest that healthcare professionals treating pediatric TBI patients should ideally use a combination of self- and parent-reporting to create more effective and individually tailored rehabilitation plans. Social participation is already a metric that should be individually determined, as it includes many factors regarding a patient’s specific impairments, capacity, performance, culture, and environment. Self-reporting showed not to be a reliable source from adolescents, who may have problems differentiating between capacity (what the child can do in an ideal environment) and performance (what the child actually does). Individual, flexible participation goals are an important component of both short- and long-term treatment plans after pediatric TBI.
Câmara-Costa H, Francillette L, Opatowski M, et al. Participation seven years after severe childhood traumatic brain injury. Disability and Rehabilitation. (August 2020).