Aim
In adults, duration of post‐traumatic amnesia (PTA) is a powerful early predictor of functional outcomes in traumatic brain injury. The aim of this work was to assess the predictive validity of PTA duration for outcomes in children (6–18y).
Method
PsycINFO, MEDLINE, Web of Science, and Embase were searched for papers published to January 2014. Ten studies met inclusion criteria: they used standardized instruments to assess PTA and functional outcomes, and examined relationships between the two. Outcomes were classified according to (1) the International Classification of Functioning, Disability and Health (ICF) core sets for neurological conditions for post‐acute care and (2) global functioning and quality of life. Methodological quality was rated for each study.
Results
The search identified 10 studies of moderate mean quality (M=11.8 out of 18). Longer PTA duration related to worse functional outcomes: global functioning and in the two ICF categories (‘body function’, ‘activities and participation’). Relationships between PTA duration and quality of life and the ICF category of ‘body structure’ were not examined. PTA duration was, in 46 out of 60 (76.67%) instances, a stronger predictor of outcomes than other indices of injury severity.
Conclusion
Longer PTA duration is a valid predictor of worse outcomes in school‐age children. Thus, PTA should be routinely assessed in children after traumatic brain injury.
Introduction: Existing resources to support adolescents with acquired brain injury (ABI) in transition from school to the ‘adult world’ are variable. This study evaluated an intervention using a coaching approach to support adolescents during this transition phase.Method: The study design was a parallel-group randomised controlled trial (RCT). Participants (n = 43) aged 14–19 years were randomised to intervention (n = 21) or no-intervention control (n = 21) conditions. The intervention group received six coaching sessions over an average of 22 weeks. Outcome measures evaluated changes reported by the adolescent (satisfaction, emotional functioning and hope) and their parent (participation, behaviour and support needs).Results: Relative to baseline, there was no significant improvement for those in the intervention group in comparison to the control group on any of the outcome measures.Conclusion: The results of this RCT do not support coaching as an intervention for adolescents with ABI.
Sleep is vital for our physical and mental health. Studies have shown that there is a high prevalence of sleep disorders and sleep difficulties amongst adults with intellectual disabilities. Despite this, sleep is often overlooked or its disorders are considered to be difficult to treat in adults with intellectual disabilities. There is a significant amount of research and guidance on management of sleep disorders in the general population. However, the evidence base for sleep disorders in adults with intellectual disabilities is limited. In this review paper, we look at the current evidence base for sleep disorders in adults with an intellectual disability, discuss collaborative working between intellectual disabilities psychiatrists and sleep medicine specialists to manage sleep disorders, and provide recommendations for future directions.
Fifty children aged 8 to 15 years consecutively admitted to a children's hospital with TBI and PTA>24 were tested in a retrospective cohort study where the main measure was the Westmead PTA Scale (WPTAS). The group analyses show that orientation to time took longer to recover than orientation to person and place, but not memory, while the individual analyses revealed that when orientation to time was grouped with memory, 94% of children recovered orientation to person and place before orientation to time and memory (examiner and pictures). Correlation coefficients between age and the number of days taken to recover skills were not found to be significant. It was established that, in terms of the natural sequence of skills recovery in children aged 8 to 15 years following moderate to severe TBI, recovery of orientation to time is more closely aligned to memory than to orientation to person and place. It was also established that WPTAS items are developmentally appropriate for children aged 8 to 15 years who have sustained TBI. These findings are clinically important because monitoring recovery from PTA both impacts the rehabilitation offered to individuals during acute care and aids discharge planning.
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