Children with brain injury are part of “emerging” disabilities. Medical breakthroughs succeeded in to save lives that until recently were not deemed viable . Furthermore, the causes related to this disability, such as accidents, are deeply rooted in our society. Therefore, DCSI is and will be a public health problem due to the complexity of its consequences and the multiple health, social and economic effects on families.
The coordination of health and social areas is a priority to successfully address the various action fields that comprise the DCSI, starting with prevention, hospital protocols, rehabilitation, long-term care, and last, but not least, community integration strategies.
Given the novelty and specific complexity of this new neurological disability, the most accurate diagnosis of the current situation is of paramount importance when it comes to proposing health strategies and support services in the medium and long term.In the case of infants, it’s worth noting that their brain is still developing, so , only as the evolutionary stages that activate the cerebral areas have been reached, can some of the deficiencies caused by the DCSI be perceived, which adds to the complexity of the diagnosisi, and requires a longer follow-up.
The focus should not be limited to the acute event, but rather has to be prolonged until the maximum functional capacity that the event allows has been recovered. A multidisciplinary and coordinated attention between stakeholders, services and professionals must be given.
There is no unanimity in the national and international scientific community regarding the definition of SCD, nor is there a unique and globally accepted identification of which pathologies and ages are encompassed by this term.
The DCS is the injury produced in the brain after birth that causes a decline in the health and quality of life of those who suffer it. Considering that the brain is the control organ of all vital functions, the lesions produced in it can affect any function of the organism in the form of physical, cerebral or sensory sequels.
When we refer to DCSI we are delimiting the brain injury that occurs in children and adolescents until the age of 18.
In the pediatric age it is necessary to define the DCSI of the infantile cerebral paralysis (PCI) and of the degenerative diseases of the nervous system. PCI is defined as a disorder of postural tone and movement, persistent but not invariable, secondary to a non-progressive aggression to an immature brain. The age limit is not clearly established, but the literature generally limits PCI to secondary injury to prenatal, perinatal and neonatal (first month of life) lesions.
Degenerative diseases of the nervous system are a group of diseases with deterioration in some neurological function, variable in symptomatology, etiology and age of presentation. Its own definition is its progressive character, but sometimes the progression is not clear at the onset of the disease and it is not uncommon for the onset of symptoms to be related to a traumatic event, which can lead to confusion.
Therefore, we should exclude from the definition of ISDC:
Problems occurring during gestation and at birth are excluded because they are “congenital”.
Complications and sequelae of prematurity are excluded, which are generally presented as infantile cerebral palsy, as they are considered to be related to birth.
The causes can vary, the most common ones are head injuries and strokes, but other brain injuries such as tumors, brain infections, anoxias, etc., are also capable of producing it.
Cranioencephalic injuries occurred as a consequence of traffic accidents, falls or blows.
Stroke: ischemic or hemorrhagic.
Expansive processes of the central nervous system: brain tumors.
Encephalic infectious diseases: encephalitis, meningoencephalitis.
Nervous system surgery: epilepsy surgery.
Radiotherapy and / or chemotherapy at the level of the central nervous system.
Cerebral anoxia: cardio-respiratory arrest, drowning.
The treatment of ISDC goes through a series of phases that focuses on different aspects and involve very different personal and material means.
|Acute Phase||Hospitalization UCIP||Plant (Unit of neurorehabilitation)|
|Subacute Phase||Plant (Unit of Neurorehabilitation)||Outpatient treatment|
Brain injury involvement occurs in body and body structures, activities and participation, following the CIF classification. In a practical clinical way, the sequels can be grouped into:
Motors (loss of strength, alteration of muscle tone, alteration of coordination and balance and apraxia understood as a disorder in the execution of movement.).
Sensory: auditory or visual or olfactory alterations.
Swallowing and eating disorders.
Impaired communication and language: deficits in verbal fluency, naming and verbal reasoning. Difficulties in both receptive and expressive vocabulary. Decreased verbal comprehension. More evident difficulties in social situations and in the school context.
Speed of processing: slower thinking and responses.
Attention and concentration: high levels of distractibility and poor concentration.
Visoperceptive and spatial skills: They cause difficulties in writing, calculus, drawing and influence the interpretation of non-verbal signals during social interactions.
Memory and learning: Difficulties in new learning or Integration with previous knowledge.
Executive functions: Difficulties in planning, organizing, initiating or executing behaviors, monitoring executions.
At the emotional and behavioural level: disinhibition: inappropriate social behaviours, impulsivity, increased irritability or tantrums: oppositional and/or defiant behaviours, fatigue and apathy, anxiety: secondary to increased awareness (loss of capabilities), depression: may be primary (due to harm) or secondary to increased awareness, fears: to treatments, to suffer a DCS again, to the future, post-traumatic stress.
Incontinence of sphincters, fatigue.
Pathology associated with epilepsy.
In addition, the DCSI leads to an alteration of the family dynamics and therefore affects the whole socio-familiar environment of the patient.
The purpose of rehabilitation is to improve and/or compensate for those functional capacities diminished or lost after brain injury. It includes four components:
- Evaluation to determine the rehabilitative approach.
- Planning of realistic and relevant objectives for the patient and his/her family.
- Measurement: interventions must be measurable, achievable, and time-limited to verify initially set goals.
- Revaluation of intervention and objectives before beginning a new cycle of the rehabilitation process.
The therapeutic objectives have to be agreed in the multidisciplinary team, with the patient-family binomial being the centre of action.