Unmet Therapy Needs Common in Children With Traumatic Brain Injury

child head wound
child head wound
Children hospitalized for traumatic brain injury tend to have unmet needs for educational and rehabilitation services approximately 2 years after a traumatic brain injury event.

Children with moderate to severe traumatic brain injury (TBI) and complicated mild traumatic brain injury (cmTBI) are likely to have unmet service needs, including needs for occupational therapy (OT), speech therapy (ST), physical therapy (PT), mental health services, physiatry services, and educational services, as reported in Pediatrics.

A total of 170 parent-child dyads were enrolled in the prospective cohort study, representing children with cmTBI (n=123) or moderate to severe TBI (n=47). Investigators assessed service needs of children based on parent reports at 6, 12, and 24 months from baseline. The criteria of an unmet need included having no therapy services in the previous 4 weeks, no educational services since the TBI event, and no physiatry services since the prior evaluation. Services in this analysis included OT, ST, PT, mental health, education, and physiatry.

Children who did not require a need for any service domain continued to remain that way for up to 2 years after injury; however, there was an increased need for educational services for longer durations between injury. In children with moderate to severe TBI, unmet need for all service domains increased with increased time since injury. The greatest increase in unmet needs occurred across the educational and ST services domains.

In addition, children who had experienced a TBI 1 year before were at a greater risk for having unmet needs in physiatry and OT services compared with children with a TBI 6 months before assessment. At 24 months after TBI, children were also more likely to have unmet needs for physiatry, PT, and ST services compared with 6 months after TBI. In addition, having a cmTBI was associated with a greater likelihood of having unmet needs for mental health, PT, and OT services compared with children with moderate to severe TBI.

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A limitation of this analysis is the inclusion of predominantly white teenage boys who resided in urban areas, which may reduce generalizability of the findings.

Children affected by TBI and “cmTBI or who are in the chronic phase of recovery, should be assessed for functional impairments to determine if additional services will improve their outcomes.”


Fuentes MM, Wang J, Haarbauer-Krupa J, et al. Unmet rehabilitation needs after hospitalization for traumatic brain injury. Pediatrics. 2018;141(5):e20172859.