Traumatic Brain Injury: Diagnosis, Acute Management, and Rehabilitation
New Zealand Guidelines Group. (2006).
Wellington (New Zealand): New Zealand Guidelines Group, 1-240.
This guideline provides recommendations for the assessment and treatment of individuals with traumatic brain injury (TBI). The target audience of this guideline is acute rehabilitation treatment providers, funding agencies, individuals with TBI, and their carers. While the majority of the recommendations are geared toward adults, a number of recommendations are specific to children and adolescents.
New Zealand Guideline Group
<div>No adequate evidence exists regarding the evaluation of children and young people post-TBI for augmentative-alternative communication. Information for adult populations should be used with caution which recommends "the assessment for, and prescription of, augmentative communication devices by a suitably accredited clinician" (Good Practice Point; p. 108).</div>
<div>A speech-language pathologist with expertise in TBI should lead the communicative assessment and develop communication strategies for children with TBI (Good Practice Point). The evaluation should:</div>
<ul>
<li>include assessment of expressive language, language comprehension, cognitive communication disorder, acquired dyslexia, and acquired dysgraphia (Grade C Evidence),</li>
<li>be appropriate to the child's age and development (Good Practice Point),</li>
<li>be conducted in an educational environment (Grade C Evidence), and</li>
<li>include case coordination and planning for school reintegration should be completed soon after acute injury (Grade C Evidence).</li>
</ul>
<div>"Trial and error learning should be avoided in people with memory impairment" (Grade B Evidence; p. 98).</div>
<div>Teachers, educators, and parents should receive education and training tailored to the specific needs of the school and the child receiving rehabilitation post-TBI and be aware of factors that may contribute to academic failure (e.g., impairments in memory and learning, behavioral and emotional self-regulation, rate of recovery, ability of rehabilitation team to address learning problems) (Grade C Evidence).</div>
<p>No adequate evidence exists regarding cognitive rehabilitation of children and young people post-TBI. As such, the following recommendations for adult populations with memory, attention, and/or executive functioning difficulties should be used with caution:</p>
<ul>
<li>incorporate compensatory strategies (Grade C Evidence), external memory aids (Grade A Evidence), trial-and-error learning (Grade B Evidence), and cognitive rehabilitation techniques focused on procedural learning and principles (Good Practice Point);</li>
<li>incorporate treatment to improve attention and information processing (Grade A Evidence);</li>
<li>incorporate treatment at the acute phase to improve executive function deficits in a structured environment (Grade A Evidence); and</li>
<li>incorporate functionally oriented cognitive rehabilitation (Grade B Evidence).</li>
</ul>
<p>Additionally, cognitive rehabilitation for young children and adolescents should be aimed at "regaining lost functionality" and the "ongoing need to develop more advanced cognitive skills as the child matures" (p.102). </p>
<div>There is no adequate evidence to guide decision-making in the assessment of dysphagia for children with TBI. Recommendations for adults should be used with caution and include a detailed diagnostic and rehabilitative assessment to address diagnosis, causality, disability, and the need for/benefit from rehabilitation (Good Practice Point).</div>
<div>No adequate evidence exists regarding the physical rehabilitation of children and young people post-TBI. Information for adult populations should be used with caution which recommends the coordination of dysphagia treatment by a speech-language pathologist with dysphagia expertise (Grade C Evidence). Long-term continued monitoring and follow-up of swallowing should be provided to children with clinically significant traumatic brain injury (Grade C Evidence).</div>
<div>For individuals with TBI, "cognitive rehabilitation should include teaching compensatory techniques" (Grade C Evidence; p. 98).</div>
<div>Cognitive rehabilitation for memory deficits post TBI should include the use of external memory aids (Grade A Evidence).</div>
<div>Cognitive rehabilitation should be functionally-oriented (Grade B Evidence) and include treatment in structured environments targeting difficulties in executive functioning (Grade A Evidence), attention, and information processing skills (Grade B Evidence).</div>
<div>Speech-language pathologists should lead the communication assessment in individuals with TBI (Good Practice Point). Individuals should be assessed for functional deficits in several areas including: speech, language production and comprehension, cognition, memory, sensory function, and swallowing (Grade C Evidence).</div>
<div>A speech-language pathologist should lead dysphagia assessment and treatment planning for individuals with TBI (Good Practice Point). Dysphagia assessment should include a detailed diagnostic assessment and a "rehabilitation-focused assessment, which addresses the need for, and potential to benefit from, rehabilitation" (Good Practice Point; p. 83).</div>
<div>Individuals with visual and/or hearing loss post TBI should be assessed and treated by a multidisciplinary team with the appropriate experience or in conjunction with a specialist service (Good Practice Point).</div>
<div>Communication and language treatment should take into account the individual's pre-morbid communication style and cognitive deficits, include family and carers in developing communication strategies and provide opportunities to practice communication skills in natural environments (Grade C Evidence).</div>
<div>Treatment for TBI should include communication aids when appropriate (Grade B Evidence).</div>
<div>No adequate evidence exists regarding the assessment of hearing loss in children and young people post-TBI. Recommendations for adults with TBI should be used with caution which includes assessment of hearing loss by the appropriate audiology specialist or in conjunction with a specialist service (Grade C Evidence).</div>
<div>Suitably accredited clinicians should assess the need for and prescription of augmentative communication devices for individuals with TBI (Good Practice Point).</div>
