Developmental trajectories of infants and toddlers with good
initial presentation following moderate or severe traumatic brain injury: A
pilot clinical assessment project
Affiliations: Montreal Children's Hospital of the McGill University
Health Center, Montreal, PQ, Canada | Faculty of Medicine, McGill University, Montreal, PQ,
Canada | Faculté de Médecine, Université de
Montréal, Montreal, PQ, Canada
Abstract: Objective: The purpose of this study was to review the feasibility
and usefulness of instituting a clinical protocol of scheduled assessments for
children after a moderate or severe traumatic brain injury (TBI) sustained
before the age of 2 years and showing no immediate deficits at hospital
discharge, as well as to explore the early developmental trajectories of these
children. Design: Exploratory analytical cohort study. Setting: Pediatric Trauma Center Out-patient services. Participants: 31 children
were followed within the clinical protocol of scheduled assessments. Outcome measures: The protocol included an immediate post-injury clinical
assessment of infants who sustained a TBI and follow-up assessments at the ages
of 9 months, 18 months (if injured prior to that age), 30 months, and 42
months. Domains assessed at each scheduled visit included hearing, speech and
language, motor performance, personal social abilities, and adaptive behaviors. Results: Clinicians reported few difficulties with scheduling or
administering the assessments, maintaining a 67% participation rate at the
end of the follow-up period, thus demonstrating the feasibility of the protocol
in this population. Scores on the majority of formal tests showed high
variability and 15–20% of children presented with clinically significant
motor and/or language delays. By 42 months of age, difficulties with adaptive
behavior and personal social abilities were identified in our sample of
children when compared to published norms. Qualitative clinical findings from
professionals identified between 25–50% of children with potential
attentional difficulties throughout the follow-up period. Conclusion: Findings from this study demonstrate the feasibility of implementing a clinical
protocol of assessment for infants and toddlers who sustain a TBI before the
age of 2 years and present with no impairments at the time of discharge from
hospital. Developmental problems in this population appear to be easier to
identify later in the toddler years as opposed to immediately following the
TBI, emphasizing the importance of providing screening for developmental issues
in this population prior to school entry.
Keywords: Traumatic brain injury, children, language development, motor development
