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Towards a Better Understanding of Early Atraumatic Brain Injury

Towards a Better Understanding of Early Atraumatic Brain Injury

Ratings: (0)|Views: 493|Likes:
Published by Alan Challoner
Acquired brain injury is common and may follow traumatic and non- or atrau¬matic insults. It has major individual patient and public health implications. Although head trauma is the leading cause of an acquired brain injury, non¬-traumatic injuries are also common. Importantly, the survival rate of children who have suffered both types of brain injury continues to increase, in part reflecting the improved (and still improving), acute and resuscitative medical and surgical treatment given at the time of, and immediately following, the injury.
This paper clearly indicates that there is a plethora of information that should be of special interest to those who are treating or caring for a brain-injured patient; especially those who have been injured in childhood and even more importantly if the injury is sustain in infancy. None of the foregoing material is to do with pre-natal conditions or peri-natal injuries such as anoxia.
It is shown that the earlier a child has its brain damaged the more important it is for that child to receive immediate attention and that attention should follow it during the rest of its life unless there is a complete recovery.
However, the survival of these children is clearly at some cost — to both the child and their family — and this includes a corresponding increase in the mor¬bidity rate, in which children are often left with significant difficulties. These difficulties will obviously range from mild to severe and may be transient or permanent. In addition, children may have difficulties that are limited to just one area, or more typically, the difficulties and their problems are multiple and complex and there will be major implications for physical and educa¬tional (and, subsequently, career) achievements and social interaction.
When there is a serious trauma to the head that injures the brain it is almost always possible to gain a realistic understanding of which areas have been damaged from the nature of the injury. However, when the damage occurs atraumatically — more often due to toxins that have passed the blood/brain barrier — then it becomes difficult to be sure where the brain injuries lie. This is especially so if the injury has occurred in the pre-development stage of a child’s life. It is hoped that this paper will help that situation by having drawn together much of the science that has been published to date.
The problems that occur from atraumatic brain damage are multiple and often serious and long-lasting; indeed they will probably exist for the rest of the sufferer’s life. It is so important therefore for a full understanding to be gained about the nature of the injury, how it affects the patient’s behaviour and how the professionals involved in his/her care can bring about a sustained programme of rehabilitation in a safe and secure environment. It is also their responsibility not only to educate the parents and carers in following appropriate courses of action but also to give them optimum opportunity to learn about the nature of the injury and how it will affect the patient’s life from that time forward.
This not only involves pragmatic behaviour but the consequences of any disorders that arise subsequent to the injury such as those to the hormone and metabolic systems; language and speech; the sleep cycle; memory and the possible evolution of an autistic syndrome and PTSD.
There also needs to be a demanding involvement of all the professionals as well as the family and carers when consideration is given to the use of drug intervention. This is vital, for any drug that is in contemplation to be used will not have been tested in clinical trials in this population of patients. There will probably be few anticipated responses, indeed some may be paradoxical.
Paediatric traumatic brain injury is a major cause for concern when considering both the number of children sustaining injuries and the large number of children incurring life-long difficulties that impac
Acquired brain injury is common and may follow traumatic and non- or atrau¬matic insults. It has major individual patient and public health implications. Although head trauma is the leading cause of an acquired brain injury, non¬-traumatic injuries are also common. Importantly, the survival rate of children who have suffered both types of brain injury continues to increase, in part reflecting the improved (and still improving), acute and resuscitative medical and surgical treatment given at the time of, and immediately following, the injury.
This paper clearly indicates that there is a plethora of information that should be of special interest to those who are treating or caring for a brain-injured patient; especially those who have been injured in childhood and even more importantly if the injury is sustain in infancy. None of the foregoing material is to do with pre-natal conditions or peri-natal injuries such as anoxia.
It is shown that the earlier a child has its brain damaged the more important it is for that child to receive immediate attention and that attention should follow it during the rest of its life unless there is a complete recovery.
However, the survival of these children is clearly at some cost — to both the child and their family — and this includes a corresponding increase in the mor¬bidity rate, in which children are often left with significant difficulties. These difficulties will obviously range from mild to severe and may be transient or permanent. In addition, children may have difficulties that are limited to just one area, or more typically, the difficulties and their problems are multiple and complex and there will be major implications for physical and educa¬tional (and, subsequently, career) achievements and social interaction.
When there is a serious trauma to the head that injures the brain it is almost always possible to gain a realistic understanding of which areas have been damaged from the nature of the injury. However, when the damage occurs atraumatically — more often due to toxins that have passed the blood/brain barrier — then it becomes difficult to be sure where the brain injuries lie. This is especially so if the injury has occurred in the pre-development stage of a child’s life. It is hoped that this paper will help that situation by having drawn together much of the science that has been published to date.
The problems that occur from atraumatic brain damage are multiple and often serious and long-lasting; indeed they will probably exist for the rest of the sufferer’s life. It is so important therefore for a full understanding to be gained about the nature of the injury, how it affects the patient’s behaviour and how the professionals involved in his/her care can bring about a sustained programme of rehabilitation in a safe and secure environment. It is also their responsibility not only to educate the parents and carers in following appropriate courses of action but also to give them optimum opportunity to learn about the nature of the injury and how it will affect the patient’s life from that time forward.
This not only involves pragmatic behaviour but the consequences of any disorders that arise subsequent to the injury such as those to the hormone and metabolic systems; language and speech; the sleep cycle; memory and the possible evolution of an autistic syndrome and PTSD.
There also needs to be a demanding involvement of all the professionals as well as the family and carers when consideration is given to the use of drug intervention. This is vital, for any drug that is in contemplation to be used will not have been tested in clinical trials in this population of patients. There will probably be few anticipated responses, indeed some may be paradoxical.
Paediatric traumatic brain injury is a major cause for concern when considering both the number of children sustaining injuries and the large number of children incurring life-long difficulties that impac

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Published by: Alan Challoner on Jan 11, 2010
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