The Importance of Orientation in Evaluating Recovery in Pediatric Traumatic Brain Injury

Abstract

Objective: Decisions about whether children who have sustained a traumatic brain injury are ready to transition from a medical facility to home and school life requires insight into their cognitive status. This study evaluates whether orientation to time, place, and self (Ox3) serves as sufficient indicator of general cognitive status to support such decisions. Design: Participants with and without TBI were administered the PTBI in one to three individual testing sessions. Performance on Ox3 items were compared between groups, as well as performance on subtests representing broader cognitive and linguistic skills. Setting: Pediatric brain injury in patient acute and rehab units. Participants: Twenty-eight children with TBI (18 male, 10 female) between the ages of 6 and 16 years of age served as participants. Of these, 12 were initially classified as severe, 6 moderate, and 10 mild on the Glasgow Coma Scale. Interventions: NA Main Outcome Measures: The Pediatric Test of Brain Injury (PTBI) is a criterion-referenced, standardized test designed to measure neurocognitive, language and literacy abilities in children recovering from brain injury. The entire test, including its Orientation subtest, was administered to participants during the acute phase of recovery (within 3 months of injury). Results: Despite no differences between the TBI and control group on the Orientation subtests, deficits occurred in other cognitive-linguistic domains that are relevant to functioning outside medical and rehabilitation environments. Furthermore, even neurologically-normal children sometimes failed some Ox3 items. Conclusion: The findings on Orientation items from the PTBI indicates that caution is warranted in applying the “Ox3” standard for evaluating cognitive status to a pediatric TBI population.