6 - Traumatic brain injury

Summary

Children can acquire traumatic brain injury (TBI) when they experience an acute, external force to the skull. Many cases of childhood TBI are preventable but unfortunately, various potentially effective protective measures such as bicycle helmets and car seats are not always used appropriately or consistently (Agran, Castillo & Winn, 1992; Marshall, Koch & Egelhoff, 1998; Thompson, Rivara & Thompson, 1996). About 180 per 100,000 children incur TBI every year, accounting for approximately 30% of all childhood injury deaths, and there is considerable long-term morbidity in the survivors of those with relatively severe injuries (Rivara, 1994; Kraus, 1995). Rates are higher for boys than for girls, and whereas falls are the most common cause in young children, motor vehicle accidents become increasingly prevalent in older children. This chapter will review the most common neurobehavioral sequelae of pediatric TBI, describe empirically validated approaches to assessment and intervention, and explore avenues for future research.

Pathophysiology and injury severity

TBI can cause cerebral impairment through a combination of primary and secondary mechanisms (Hackbarth et al., 2002; Statler et al., 2001). Primary injuries result from accelerating or decelerating forces, including linear displacements that cause focal lesions such as cortical contusions, and intracranial rotations that lead to diffuse lesions such as axonal stretching. Secondary lesions result from disruption of cerebral circulation and cellular homeostasis, including cerebral ischemia and edema, as well as neurotoxicity due to increases in excitatory amino acids.