Initial evaluation of functional outcomes in children with traumatic brain injury (TBI) and their families: Development of an outcomes model

Progress in the development of therapy for children with TBI is contingent upon establishing optimal predictors and measures of outcomes. In order to develop a multidimensional model of functional outcomes, we have focused on 3 predictive factors - severity of the injury, family functioning, and pre-existing conditions - and 2 measures of outcomes - neuropsychological performance and adaptive behaviors. Hypothesis: In children with TBI, the degree of disturbance in functional outcome, as measured by neuropsychological performance and adaptive behaviors, is directly influenced by the baseline state, which includes family functioning and pre-TBI neurological or behavioral problems, in addition to the severity of injury. Methods: Baseline state was measured by: 1) GCS for severity of injury; 2) the Vineland Adaptive Behavior Scales (VABS) administered to parents for pre-TBI neurological or behavioral problems; and 3) Family Inventory of Life Events (FILE), Family Environment Scale (FES), and Parenting Stress Index (PSI) for family functioning. Six months post-TBI, children were evaluated using the Kaufmann-Brief Intelligence (K-BIT), Peabody-Picture Vocabulary (PPVT-IH), Beery Visual Motor Integration (VMI) tests, in addition to follow-up VABS, FILE, FES, and PSI. Results: 19 TBI subjects, 10 with severe (GCS < 8) and 9 with mild-moderate (GCS ≥ 8), were evaluated at baseline. Families of children with severe TBI reported abnormal life events (FILE scores 500± 163 vs. 85±75, severe vs. mild-moderate, mean ±SD, p<0.005). VABS scores did not differ between severely and mild-moderately injured children at baseline. Post-TBI, maiadaptive behaviors were more prevalent in the severely injure. Mean ±SD K-BIT (87.3±0.6), PPVT-III (94.7±5.5). and VMI (94.3±9.6) scores did not differ from scores in age-appropriate standardized populations and did not correlate with severity of injury in children evaluated to date. Conclusions: Abnormal family life events may be an important baseline factor in childhood TBI. Given the multiple variables measured in this study, a larger sample size may be necessary to demonstrate the anticipated association between severity of injury and neuropsychological functional outcomes.