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Emerald Group Publishing Limited
The long-term implications of childhood acquired brain injury
Article Type: Guest editorial From: Social Care and Neurodisability, Volume 5, Issue 3.
Welcome to this Special Issue which focuses on the long-term implications of childhood acquired brain injury (ABI). A great deal of previous research has concentrated on short and medium term outcomes after brain injury in children, but those working in the field will know that paediatric ABI can have a long-term impact. A child's brain continues to develop past adolescence and into early adulthood. Consequently, an injury to the brain during that period of development can lead to the later emergence of difficulties and problems, even if a good recovery appears to have been made previously.
For this Special Issue, we sought to include papers which consider the long-term impact of ABI. Two of these papers present findings of studies which include a 15 year follow-up of children with brain injury. The paper by Rosema and colleagues from Australia investigates social and psychological outcomes 15 years post brain injury. They found that adolescents and young adults with ABI also had a higher risk of developing psychological problems following their transition into adulthood compared to healthy controls. Brain injury survivors also reported more problems on internalising symptoms such as depression, anxiety and withdrawal. However, survivors did not report more social problems than their peers. It would be interesting to see if these findings can be replicated in other countries.
The paper by Woods and colleagues from Australia describes an evaluation of a behavioural intervention programme for challenging behaviours following paediatric ABI. Parents who received training in the intervention, the “Signposts” programme, reported significant reductions in dysfunctional parenting practices, stress and family burden. This work is clinically relevant and interesting, particularly to those working in childhood brain injury and rehabilitation. Readers may wish to consider the findings in relation to own their clinical practice.
The next paper in this Special Issue by Gracey and colleagues from the UK also considers behavioural and emotional dysfunction after ABI, this time in a specialist community rehabilitation setting. They compared children with ABI to children referred to mental health services and sought to identify clinical predictors of peer relationship problems. The study confirmed the significant effect of childhood ABI on relationships with peers, concluding that those injured at a younger age fared worst. This has implications for the development of timely and effective interventions to prevent such problems.
The other long-term follow-up study by Nilsson and Emanuelson in Sweden examines childhood traumatic brain injury; education and medical disability. This descriptive study found that paediatric brain injury leads to future problems with employment and educational attainment. However, despite finding evidence of high unemployment and medical disability, few of the study participants were classified as disabled by an insurance company and almost half did not receive compensation following their injuries.
It is very interesting to consider the ways in which the needs of children with ABI are met through insurance claims in different countries and the potential differences that this may make to their future outcomes. Nilsson and Emanuelson comment regarding the potential implications of the fact that many children in their study received no compensation. Although not legal professionals, we are aware that the system for claiming damages in the UK is very different from that described in Sweden and from the one in the USA, to which reference is also made.
In the UK there is no specific classification or “scale” of long-term disability or a definition of this by percentage, with regard to injuries sustained. There are no fixed monetary awards for levels or types of disability within what is termed personal injury litigation. In the UK, for a claim for compensation to be pursued, “blame” must initially be established (proven and accepted) against an individual or individuals considered to have caused the injury through fault or negligence. After which, the level of damages will be calculated to take into account a wide range of factors, including: past and future care of the child from the time of the injury; need for additional aids and equipment; specific rehabilitation needs; and future losses caused by the injury. The compensation must be aimed at enabling the child (then and in the future) to revert to a position in which they would have been had the injury not occurred, as far as this is possible by the provision of additional funds.
In the UK, children's personal injury claims are frequently not finalised until the child reaches their teens or early adulthood, in order that their levels of ability/disability can be accurately assessed and it is clear how this will affect their future. This includes calculations of effects on their educational and employment prospects. However, sums of money can be released on an ongoing basis prior to this in order to provide any necessary aids, equipment or rehabilitative support. It is in the best interests of the insurance companies to ensure that this happens to maximise outcomes and, therefore, reduce future losses. Aspects of the final settlement, for instance, those relating to future care or case management, are now often provided via periodical payments that are guaranteed for life and increase incrementally to reflect future rising costs.
This does mean that for those children in the UK who sustain a traumatic brain injury and whose parents consult an appropriately experienced personal injury lawyer, appropriate levels of rehabilitation and final monetary compensation should be provided. This should mean that the types of intervention described in the papers by Woods, Gracey and colleagues and shown to be effective should, in principle, be available when required. However, the situation is very different for those children for whom no-one can be considered to be at fault in respect of their injuries or for those who have sustained an ABI as a result of other causes, such as illness. There is no equivalent statutory system to provide similar levels of intervention for these children.
We believe that there is scope for further research and review of the systems for compensation on an international basis to establish: the potential benefits and future outcomes of timely and appropriate financial provision to enable intervention; and the best and most effective systems, comparing those in different countries. We also believe that this review should include ways to ensure that all children with ABI can receive appropriate intervention, regardless of the cause of this.
Dr Beth Wicks - is a Specialist Education Consultant, based at Beth Wicks Consultancy Ltd, Nottingham, UK.
Dr Carol A. Hawley is an Associate Fellow, based at Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.