Rehabilitation after head injury

Abstract

Each year 150 000 children attend Accident and Emergency Departments in the UK with traumatic head injuries and of these some 40 000 are admitted.l The great majority of such in-patients have minor injuries and will be discharged within 48 h, but 5% of them will have serious head injury.2 Approximately 400 children die each year from their injury the majority before they reach hospital.3 Most serious head injuries occur in road traffic accidents when the child is a pedestrian or cyclist or, less usually, a passenger in a vehicle. Less common causes are falls from heights or playground equipment, and in the younger age group child abuse.4 A significant number of children suffering minor head injury will develop subtle long term intellectual or behavioural sequelae, and at least 50% of those with severe injury will be left with major motor and/or cognitive impairment. There has been growing concern in recent years that a condition which exacts such a toll in terms of morbidity and mortality in childhood has been viewed with little professional consistency both in its acute management and its rehabilitation. Optimum management of the condition is hampered principally by two factors. Firstly, children with head injury are not a homogeneous group but constitute a wide spectrum of clinical variation, and secondly, service provision varies from centre to centre and district to district and may depend on factors such as local ‘tradition’ or indeed, personal whim.