ACRM Conference: Progress in Rehabilitation Research

Brad Kurowski, MD, Juliet Haarbauer-Krupa, PhD, and  Ann Glang, PhD

CBIRT Director, Ann Glang, PhD presented with Juliet Haarbauer-Krupa, PhD, and Brad Kurowski, MD at the 2017 American Congress of Rehabilitation Medicine (ACRM) Conference, October 23-28 in Atlanta, GA.  They presented on, "CDC: The Report to Congress on the Management of Traumatic Brain Injury in Children.” 


Background: Children and adolescents have some of the highest rates of emergency department visits due to traumatic brain injury (TBI) and are vulnerable to a range of long-term consequences following TBI. TBI in children may be particularly damaging as the injury may precede or occur during critical stages of brain development. Further, neurocognitive and neurobehavioral impairment can impact academic and social outcomes in ways that reverberate throughout the lifespan. Consequently, follow-up care and monitoring beyond the acute injury phase are critical. Although most TBIs in children are considered mild, even a mild TBI can have long-term impact. The TBI Act of 2014 directed the CDC in consultation with the National Institute of Health, to conduct a review of scientific evidence related to brain injury management in children and to submit a Report to Congress (RTC) that describes the results and makes recommendations related to improving the management of TBI in children. The purpose of this presentation is to describe the key findings and recommendations of the Report to Congress on the Management of Traumatic Brain Injury in Children. 
Methods: The report was developed through a collaboration between CDC scientists and researchers that specialize in the medical and educational management of TBI. A diverse group of external reviewers provided feedback on the initial outline and first draft of the report. The goal of the RTC is to identify gaps in the research and provide action-oriented recommendations for researchers, clinicians, consumers, advocates and policy makers. The report is scheduled for release in March 2017. 
Results: The management of TBI in children is complex, and dependent upon multiple service delivery systems. These systems are not optimally coordinated to provide care across the child’s lifespan. In particular, there is large variation in follow-up care and service delivery at the state level with respect to pediatric trauma center utilization, service delivery in the schools, early intervention services, service access, transition to adulthood, and family support. This variation and the lack of understanding by caregivers, healthcare professionals, and educators regarding the potential for TBI effects beyond the initial injury creates challenges for optimal care. Addressing identified barriers can promote children’s achievement of long term milestones as adults, such as high school graduation, employment, and engagement in healthy lifestyle practices. Improving the developmental trajectory for children with TBI through consistent, evidence-based management is a critical public health issue. 
Conclusion: Improving the management of TBI in children is critical to reducing the public health burden of TBI. Report findings and recommendations will support action at the federal and state levels and will assist individual communities in ensuring optimal management of TBI in children.