Language, intellectual and educational outcomes after moderate-to-severe traumatic brain injury sustained before the age of 18 months

ABSTRACT

Objective: The aim of this study was to assess long-term outcomes in terms of oral language, intellectual ability, education, following very early moderate-to-severe TBI.

Methods: Children who had been hospitalized in rehabilitation after moderate-to-severe TBI sustained before 18 months of age were contacted once they had reached school age. Detailed oral language and intellectual ability assessment were performed, and information on ongoing education was collected.

Results: 52 children met inclusion criteria; 21 (40.4%) participated [13 males, mean age 7.5 years (SD = 1.9), age at injury 0.7 years (SD = 0.5), time since injury 6.8 years (SD = 1.8)]. Performance was in the clinical range (<-2SD) for: syntactic comprehension (67%; mean z-scores −2.6; SD = 3.1), syntactic expression (62%; −2.1; SD = 1.3), lexical stock extent (57%; −1.5; SD = 1.5), lexical access skills (48%; −1.9; SD = 2), and semantic organization (32%; −0.9; SD = 1.2). Full-scale IQ was <90 for 91%. Only eight children followed mainstream education without adaptations. Performance on all language tests (except lexical stock extent) was significantly poorer for children with a personal school aid or those in specialized education.

Conclusions: Early moderate-to-severe TBI causes significant delayed language (especially syntactic aspects of language) and cognitive disabilities, with consequences on long-term educational outcome. These children require long-term follow-up and timely interventions.

KEYWORDS:

• Traumatic brain injury
• child
• language
• cognitive
• long-term outcome

Declaration of Interest

The authors report no conflict of interest.

Additional information

Notes on contributors

Jeanne Vassel-Hitier

Jeanne Vassel-Hitier is a speech and language therapist, who has been working for over 25 years in a Rehabilitation Department devoted to Children and Adolescents with Acquired Neurological Injury. She has particular interest in language, pragmatics and communication disorders following acquired brain injury, and assessment and interventions for very young children following various brain insults.

Valentine Verdier

Valentine Verdier is a clinical neuropsychologist who has been working for more than 10 years in an outreach team devoted to adolescents and young adults who sustained acquired brain injury. She is very involved in interventions in the long-term, aiming to improve patients' participation, academic and vocational outcomes following various brain injuries sustained during childhood.

Stéphanie Rasquier

Stéphanie Rasquier is a speech and language therapist, who performed her clinical training under the supervision of Jeanne Vassel-Hitier in a Rehabilitation Department devoted to Children and Adolescents with Acquired Neurological Injury. The study reported here was the topic of her graduation dissertation.

Anaïs Chalard

Anaïs Chalard is a speech and language therapist, who performed her clinical training under the supervision of Jeanne Vassel-Hitier in a Rehabilitation Department devoted to Children and Adolescents with Acquired Neurological Injury. The study reported here was the topic of her graduation dissertation.

Anne Laurent-Vannier

Anne Laurent-Vannier is a Medical Doctor specialised in Physical Medicine and Rehabilitation. She has developed and organised a large Rehabilitation Department devoted to Children and Adolescents with Acquired Neurological Injury, and created an outreach team devoted to children, adolescents and young adults who sustained acquired brain injury, dealing with long-term psychosocial, behavioural and vocational issues. She has thus developed a specific comprehensive care pathway in the Paris area for children and adolescents with acquired brain injuries, aiming at promoting recovery and optimising community and school reentry, family and social integration, overall independence and vocational outcomes.

Mathilde Chevignard

Mathilde Chevignard is a Medical Doctor specialised in Physical Medicine and Rehabilitation. She works in a Rehabilitation Department devoted to Children and Adolescents with Acquired Neurological Injury, and an outreach team devoted to adolescents and young adults who sustained acquired brain injury. Her research focus is on outcome measurement and interventions to improve everyday functioning, participation and quality of life following childhood acquired brain injury, with particular interest in the field of ecological assessment of cognitive and behavioural deficits.