Page 18 - Mobility Management, October/November 2020
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The Impact of Brain Injuries in Children Is Complicated
By Laurie Watanabe
To demonstrate the challenge of working with a young child with a brain injury, Angie Kiger, M.Ed, CTRS, ATP/SMS, Clinical Strategy & Education Manager at Sunrise Medical, described a former client: “By the time we got him in our rehab hospital, he was 14 months. He was the unrestrained front-seat passenger in an automobile accident, and he went through the windshield. He did have a spinal cord injury, high level; that we knew. But that was all the informa- tion we had. He was never diagnosed at the acute [care] facility of having a traumatic brain injury.
“Everybody on the rehab team thought, ‘He went through a windshield; he has to have a brain injury.’ But we didn’t know. As you can imagine, his caregiver was arrested, and we could not get information on where he was [in his development] prior to the injury. Was he just not very interactive because of his age? Did he have words? Because some 14-month-olds do have words; some don’t. We had no idea if he had any underlying delays prior.”
That lack of a baseline is just one of the challenges of working with children who have brain injuries.
“Quite often, an adult and a child can be involved in the same car accident, but they get a different brain injury just because there’s a difference in the head-to-body ratio,” said Stefanie Laurence, BScOT, OT Reg. (Ont.), Clinical Educator, Motion Specialties. “For a child, the head is larger in proportion to the body. There are differences
in what a child’s head can buffer because their cranial sutures are not closed. So if they have [brain] swelling, there’s some buffering because the sutures can open to absorb to some degree. You don’t see that in adults: Your skull is solid, so you might see a more severe injury because if there’s brain swelling and you can’t relieve the pressure, your brain is getting squashed in that hard shell.”
“Children’s brains are hard at work forming new pathways,
and their brains have a high level of neuroplasticity,” said Kristen Wagner, PT, DPT, Certified Brain Injury Specialist and Team Lead at Children’s Healthcare of Atlanta — Scottish Rite. “The potential for

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