Study: Recovery Plateaus, Then Gains Ground; Recovery Toughest for Severe Injuries
By Kathleen Doheny
WebMD Health News
Reviewed by Hansa D. Bhargava, MD
Jan. 24, 2012 -- Serious head injuries in kids can affect development for years, and parents worry their child may never recover fully or get worse.
Now, Australian researchers who followed a small group of children for 10 years after head injuries from falls or car accidents have some answers.
They find, not surprisingly, that severe brain injury is associated with the poorest recovery.
However, they also find an ''injury threshold'' beneath which children with less severe brain injuries may escape serious problems. They make developmental progress, although they may never catch up entirely with peers.
Environment matters in recovery, says study researcher Vicki Anderson, PhD, professor of pediatrics and psychology at the University of Melbourne.
"After injury, we can improve outcomes by optimizing the child's environment," Anderson tells WebMD. For instance, a stimulating home environment helped pave the way for a better recovery, says Anderson, who is also director of critical care and neuroscience research at Murdoch Childrens Research Institute at Royal Children's Hospital.
The study is published online in Pediatrics.
Head Injuries in Kids: Study Details
About 1 in 30 newborns will have a traumatic brain injury by age 16, some researchers have found. Researchers also know that the impairments after these injuries persist until at least five years after the accident. However, less is known about which factors matter for recovery.
In this small study, Anderson's team evaluated 40 children who had a traumatic brain injury. The accidents happened when they ranged in age from 2 to 7. They divided them into three groups depending on how bad the injury was:
- Seven had mild injuries.
- Twenty had moderate injuries.
- Thirteen had severe injuries.
A mild injury often results from a fall, Anderson tells WebMD. Motor vehicle accidents are a leading cause of severe brain injury.
The researchers compared the children with brain injuries to healthy children without them. At the study start, this comparison group had 32 children. By the 10-year mark, the comparison group only had 16.
They tested the children on several measures, including their IQ, thinking skills, and social and behavioral skills. They also measured their adaptive ability -- such things as their response to daily demands and any learning difficulties.
They tested them after the accident and again after 12 months, 30 months, and 10 years.
Head Injuries in Children: 'Kids Begin to Do Better'
As expected, those with the most severe injuries had the worst outcomes.
These severely injured children had problems with thinking skills especially, Anderson says.
Their IQ was affected, too. Those who had severe accidents had an IQ at the 10-year follow up that was at the lower end of average or low-average. Compared to the healthy children, their average IQ scores were 18 to 26 points lower, the researchers found.
Whatever the severity of the injuries, the children appeared to need time to recover, Anderson found. The recovery ''trajectories'' plateau from five to 10 years, she says.
After that, the children stabilize and can make gains. This suggests that continued treatment can help, even many years later, Anderson says.
Although this was a relatively small study, the findings are different from what was previously thought.
The study results are at odds with some common beliefs. Many experts believe that children who suffer these brain injuries get worse as time goes on, Anderson says. Not true, she tells WebMD.
"The negative effects of these injuries stabilize after about two or three years and the injured kids begin to do better but never catch up to their healthy peers," she says.
Being in a family that is psychologically healthy was linked with better outcomes, Anderson found.
Head Injuries in Kids: Suggestions for Parents
The study provides valuable information, says Doug Johnson-Greene, PhD, MPH, associate professor, director of neuropsychology, and vice chair of rehabilitation medicine at the University of Miami Miller School of Medicine. He reviewed the study findings for WebMD.
The new research has a longer follow-up than most studies, he tells WebMD. It also includes very young children, while other research has not.
For a long time, he agrees, the prevailing wisdom has been that recovery after childhood head injuries is never fully complete. It's often said that kids ''grow into their impairments," Johnson-Greene says. "That's a fancy way of saying [the impairments] become more obvious."
The bottom line from the new research? ''A head injury does not inevitably imply that your child will have impairments forever. This provides some added evidence that impairments may not be as persistent as we once thought," he says.
The research does reinforce what experts have believed, that the more severe the head injury, the tougher the recovery to normalcy, he says.
But parents can help their child, Johnson-Greene says, by asking for appropriate treatment from a board-certified neuropsychologist.
Providing the child with a stimulating and mentally healthy home environment can also help, he agrees. To do that, parents can schedule family outings and play board games with their children, among other activities, he says.
Patience is key, he tells WebMD: "For most head injuries, except mild ones, we talk about recovery that more commonly takes years as opposed to months."
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SOURCES: Vicki Anderson, PhD, deputy director, Integrated Mental Health Program, Royal Children's Hospital; director, Critical Care & Neuroscience Research, Murdoch Childrens Research Institute.Doug Johnson-Greene, PhD, MPH, associate professor, director of neuropsychology, and vice chair of rehabilitation medicine, University of Miami School of Medicine.Anderson, V. Pediatrics, published online Jan. 23, 2012.
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