In addition to understanding the injury, impairments and impacts described above, brain injury specialist rehabilitation with children and young people also needs to consider:
- a child or young person’s developmental stages and challenges
- family-centred care
- life transitions for children and young people
- transition to decision-making for adolescents and young people and the practice implications of these perspectives.
There are many developmental stages and milestones from birth to adulthood.
For example milestones for babies relate to the baby’s ability to move, see, hear, communicate and interact with others. There are physical, motor, cognitive, language and social milestones for each age group from babies to adults.
The development and functioning of the brain are some of the essential ingredients for meeting milestones.
‘Formerly, it was a widely-held, but unsubstantiated belief that children were wonderfully resilient and could bounce back even after a severe brain injury and that in general, the prognosis for functional recovery of previously-learned skills is better the younger the child is when the injury is acquired.
‘However, more recent research suggests that younger children are just as, or perhaps even more, vulnerable to the effects of brain injury than people who are injured in later childhood. Moreover, the prognosis for acquiring new skills is worse the younger the child is at the time of the brain injury.
‘Children's brains are still undergoing significant development. While most brain maturation occurs in the early years, birth through age 5, five peak maturation periods in normally developing children have been identified. These peaks occur at approximately 3-5 years, 8-10 years, 14-15 years, 17-19 years, and 21-22 years.’14
After brain injury, these maturation peaks may be significantly affected depending on the age of the child, the type of brain injury and the region of the brain affected.
Exposure to experience and to more formal learning through education allows neural pathways to develop new connections throughout young adulthood.
If damage to the brain occurs at any time during brain development in childhood and adolescence, then the normally occurring neuronal growth may be disrupted impacting on the child’s development of skills and slow the pace of their development over time.
Family-centred care is an approach to healthcare that provides an expanded and enhanced view of how care should be provided to individual clients in the context of the strengths and needs of their families.23 Family-centred care is viewed as critically important in providing healthcare to children, especially those with serious medical conditions.
In the family-centred care of children, the client and his or her family members are fully involved with healthcare providers to make informed decisions about the healthcare and support services the child and family receive. In addition, in a family-centred approach to healthcare, all aspects of the structure and process of care are oriented towards supporting and involving the family in the care experience with the goal of improving quality and other important outcomes, including psychosocial outcomes, clinical outcomes, resource distribution, and patient and family satisfaction.23
Children and young people having brain injury specialist rehabilitation may also move through life transitions including one or more of the following:
- from hospital to home
- from pre-school to home
- from primary school to secondary school
- from secondary school to further studies
- from secondary school to work.
Each of these life transitions comes with its own challenges and may require appropriate interventions if the child or young person has a brain injury.
Transition is defined as ‘the purposeful planned movement of adolescents and young adults with chronic physical and medical conditions from child-centred to adult oriented health care systems’.41
Some adolescents and young people in brain injury specialist rehabilitation will transition from child-centred to adult oriented healthcare systems.
Ensuring a seamless transfer and transition from children’s to adult healthcare services is necessary to achieve improved health outcomes for young people. Good seamless transfer and transition from children’s to adult healthcare services can lead to:
- better functional outcomes such as increased adherence, improved self-management and knowledge of their condition and improved wellbeing
- better access to appropriate health services for young people with a chronic condition
- improved morbidity and mortality rates
- a reduction in avoidable hospital admissions.
Everyone involved has a part to play to effectively transition adolescents and young people from child-centred to adult oriented healthcare systems.
- The young person – by identifying and working on areas of their life where they could gain further independence.
- Families – by helping them to identify areas that they may need some help with and encouraging them to make decisions by offering choices in a number of areas of their life.
- Clinicians – by being open, transparent and collaborating. Also being willingly to work together with the young person and gradually increase their responsibility for their decisions
- Case manager – helping the young person with goal setting, advising on possible services, educating the young person and their family about the transition process and helping the young person become more independent.