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Current location: China paper Ce Medi Clin Text traumatic brain injury in children status and progress of rehabilitation
China paper Center [ ] Yang Xue, Xiao agricultural Editor: studa20
Abstract Traumatic brain injury (TBI) in children one of the most common injuries. Whether in the acute phase after trauma or a long period of time, TBI can cause a variety of clinical symptoms and neuropsychological impairment, serious impact on the lives of children, learning, and social function. With the clinical diagnosis and treatment and intensive care technology improved, the mortality rate of children with acute TBI has been decreasing. TBI caused by impairment and long-term sequelae are becoming the main reason for the health of children. Early rehabilitation can significantly promote functional recovery of children with TBI to improve the quality of life of children. Pediatric rehabilitation many ways, such as physical therapy, occupational therapy, physical therapy, psychological therapy, hyperbaric oxygen therapy and other family support, but what is the best in rehabilitation has been in dispute, and more a more rational approach needs further rehabilitation exploration. This article focuses on the status of children with TBI and progress of rehabilitation methods.
Key words pediatric traumatic brain injury rehabilitation
[Abstract] Traumatic brain injury (TBI) is one of the most common trauma for children.It can lead to multiple medical and neuro-mental funct


ional impairments, and severely affect children's living, educational and social function, both in the acute care setting as well as over the much longer term.The mortality of pediatric TBI has been decreased gradually with the enhancement of clinical and intensive care technique.The functional impairments and long-term sequeals caused by TBI are being the main reason to children's low quality of life. Early rehabilitation can significantly promote children's functional restoration, and improve their quality of life.There are many rehabilitation opproaches, such as exercise therapy, occupational therapy, physical therapy, psychotherapy, hyperbaric oxygen therapy, family-supportive therapy, and so on.However, there is ongoing debate with respect to the most efficacious approach to rehabilitation.The future researches should emphasize on exploring more opproaches.This text is aimed to rekinds of rehabilition opproaches and the advances.
[Key words] traumatic brain injury; rehabilitation; children
Traumatic brain injury (traumatic brain injury, TBI) is the most common injuries in children is one. TBI can cause a variety of clinical symptoms and neuropsychological impairment, serious impact on the lives of children, learning, and social function. And long after the traumatic period of time, some children still have a variety of neuropsychiatric sequelae like, a serious threat to children's health and lives. With the clinical diagnosis and treatment and intensive care technology improved, the mortality rate of children with acute TBI has been decreasing. TBI caused by impairment and long-term sequelae are becoming the main reason for the health of children. Regardless of the severity of TBI in children how early rehabilitation can be achieved remarkable efficacy [1]. Therefore, early rehabilitation to improve the prognosis of TBI and improve the quality of life of children is very important. TBI now introduced a variety of children's status and progress of rehabilitation methods.
1 Pediatric Epidemiology and causes of TBI
In the U.S., the incidence of TBI in children is approximately 185/100 000 per year [2]. With the development of national economy and transportation, the incidence of TBI in children is also increasing every year. The two incidence peaks: in early childhood (5 years) and late adolescents (15 to 17 years). In general, major causes of TBI in children caused traffic accidents, falls, sports and entertainment sports and collision [3]. It also changes with age: more infants and young children caused by fall, young children often due to collision of pedestrian and bicycle injuries, many students were injured in sport, many young people were injured in motor vehicle accidents [2].
2 children the importance of TBI rehabilitation
Rice [1] to 3 815 cases of TBI in children a retrospective study shows that children with TBI rehabilitation can significantly improve all aspects of functionality. Rehabilitation must be given to stimulate the nerve remodeling, and promote all aspects of children with TBI impaired function (movement, behavior, emotional, social, psychological, etc.) recovery, and promote the development of the system functionality and maturity, is functional recovery, and TBI in children necessary to obtain better long-term functional outcome of the step. Rehabilitation team through individual and concise training to enable children to re-experience the life of TBI and face life's challenges. Early injury to begin rehabilitation of children, benefit from greater functional impairment of these children, the disabled and the low incidence of complications and long-term functional prognosis.
3 pediatric TBI rehabilitation methods
And adults, as the rehabilitation of children with TBI can be divided into two periods: acute and subacute phase. Processing and evaluation of acute injuries immediately after the start, its main purpose is the treatment and prevention of TBI complications, such as intracranial hypertension, intracranial hemorrhage, hypoxemia, and hypotension. Subacute rehabilitation is recovered by a series of clinicians, including physicians, physical therapists, physicians neuropsychology, occupational therapy, speech pathologist, movement therapist, special educator, and social workers to participate in multidisciplinary co-operated completed. Mainly in the acute phase of the main drugs and surgical treatment, subacute rehabilitation methods are continuously developed and perfected.
3.1 The exercise therapy exercise therapy (exercise therapy) can damage the system or organ of the basic functions of targeted training, to promote their functional recovery, or compensation, is the most basic, the most active and most important means of rehabilitation. Bobath therapy commonly used method, Vojta therapy, Ueda therapy, Rood therapy, Peto (Conductive Education) and so on. And the Peto method and Vojta therapy, combination therapy on the field, can improve motor function in children with TBI rehabilitation patients. Mandatory use of movement therapy (constraint-induced movement therapy, CIMT) is a neurological disease in recent years for a new rehabilitation therapy, also began to widely used for brain injuries. The theoretical basis is now generally agreed that acquisition of apraxia, but there are a lot of controversy. Mandatory use of exercise therapy on motor function in patients with brain injury rehabilitation is an effective method, especially in improving the daily life of patients with upper extremity ability [4]. CIMT therapy but does not make the full recovery of motor function in patients with normal, and can not completely solve the defects of motor function after brain injury problems [5].
Although exercise therapy is the core of clinical neurology and rehabilitation, but has not been systematic, and its focus areas in the central nervous system function than functional recovery of compensation. The new exercise therapy is in early development and testing phase [6], it is hoped that experimental psychology, sports physiology and neuroscience principles to achieve functional recovery purposes. Exercise therapy in clinical trials of new faces methodological challenges, including the provisions of treatment, the parameters of the standard and effective treatment standards. It also needs more clinical evidence to support the largest of its rehabilitation can play a role yet to be evaluated to further clarify the exercise therapy in the treatment of the important role of rehabilitation.
3.2 occupational therapy occupational therapy (occupational therapy) content include: (1) limb-bit to maintain the functional training, such as sitting, prone, stand in the posture control; (2) upper limb functional training; (3) the training of hand function, including Big Movement (pick up, drop, etc.) and fine motor (pinch, painting, holding, etc.); (4) Cognitive and intelligence training, such as the finder chart, literacy, identification and orientation; (5) daily movement training, such as toileting, dressing, eating and so on. Occupational therapy can promote the children in the physical, mental and social aspects to achieve maximum independence. Therapy combined with certain drugs work, can enhance the effect of rehabilitation.
Occupational therapy has mainly focused on the compensatory damage functions and special features of the re-training, which is another problem faced by the unbalanced nature of the clinical. Occupational therapy is not always directed at the disability itself, but against the demands arising from this disability. Each patient's clinical manifestations vary widely, so the individual occupational therapy is particularly important. Occupational therapy theory and practice are all developed in Western countries, Asian countries lagging behind, but it is international, its work in clinical practice, there are many uncoordinated and confusing place, need to further develop and perfect.
3.3 physical therapy currently used a lot of physical therapy, such as electrical stimulation, heat therapy, ultrasound therapy, hydrotherapy, cold laser therapy, pulsed magnetic field therapy.
Transcutaneous electrical stimulation with neuromuscular electrical stimulation (TENS), neuromuscular electrical stimulation (NMES), functional electrical stimulation (FES) and so on. Pulsed electrical stimulation is based on the electrophysiological changes in ion concentration and distribution. [7], human tissue is made of water, salts and charged colloidal composition of complex biological conductor. When changing the frequency of a wave pulse current in the human body, the tissue directional movement of ions will occur, remove the membrane polarization, the ion concentration and distribution of a significant change, thus affecting the function of human tissues. Electrical stimulation impulses to the brain via afferent nerve pathways, and enhance sensory motor neuron excitability, and thus help patients properly control the activities of the target muscle. In addition, electrical stimulation can reduce pain and inflammation.
Hydrotherapy is the use of water temperature, buoyancy, gravity vortex, blisters of mechanical stimulation to improve motor function in children and promote their neurobehavioral development. Warm water therapy and cold hydrotherapy treatments points, there are some new methods such as high temperature water bath, water massage, underwater traction. Kimberly et al [8] on 20 healthy persons were found, warm water therapy significantly increased blood flow to the lower leg, and promote wound recovery. Hydrotherapy also sedative and hypnotic effects, can reduce the neuropsychiatric symptoms of children with TBI. Hydrotherapy and its effects on the mechanism of the literature and research is relatively lacking, future studies should focus on the design methodology of hydrotherapy, water temperature, depth, special care, hydrotherapy in the details and resolve technical problems.
The role of physical therapy principles, parameters, settings, indications, contraindications and so lack the necessary clinical trials, further research, systematization and standardization.
Psychotherapy 3.4 children on TBI emotional, social and behavioral sequelae (such as impulsive, irritability, inability to concentrate, etc.) treatment is rarely assessed. Effective measures may also belong to the traditional behavior therapy, including behavioral enhancement, psychological treatment and complained of symptoms for the use of psychotropic drugs. Post-TBI cognitive behavioral therapy can reduce psychological stress of patients and improve cognitive function. The use of psychotropic substances is an important psychological component of treatment, which can effectively improve the TBI patients can not concentrate, irritability and other mental symptoms. Ylivasaker [9] also mentioned in his latest article, the use of psychotropic drugs on the behavior of children after TBI and emotional disorders is effective.
In addition, many other aspects of psychological therapy are beginning to be applied to rehabilitation treatment. There is a sense of self-training can strengthen the physical training and other psychological effects of treatment, and enhance the confidence of patients, good for patients to interact with the therapist cooperation, strengthening the treatment effect [10]. More psychological approach should be integrated as an adjunctive therapy in the rehabilitation of children with TBI to obtain the best recovery results.
3.5 Family Support therapy studies have confirmed many of the family support treatment in the prognosis of TBI patients in the active role. Wade et al [11] assessed called FPS (a family-centered problem-solving intervention) the effect of the project, they found, FPS group of parents of children with TBI reported more subjective symptoms, which is expected to reduce the behavior of children problem. FPS parents of children with TBI also can improve problem-solving skills, to reduce the stress, thereby enhancing their ability to care for children. Treatment At present, the family support network and telephone channels. Family support and treatment needs to carry out a complete system, children with family members of TBI training and education. However, the implementation of the project requires a lot of manpower and material res, its high cost. Assessment of its effectiveness only at an early stage, future research needs to assess its long-term effects, and the accumulated experience of establishing this system, to better implement and carry out. Links in the paper for * [Management theory] high-tech business center in Heilongjiang Province, Mode of Operation (glx84


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