TDNet Discover

Background: Traumatic brain injury (TBI), a leading cause of death and disability in pediatric patients, disrupts the brain's normal functioning. The symptoms and severity of TBI can vary widely from patient to patient;therefore, treatment should be individualized for each patient. While guidelines for the acute management of pediatric TBI exist, there are no definitive long-term management protocols for the pediatric population. Objective: To determine if pediatric TBI patients benefit from adjuvant cognitive therapy compared to pharmacological treatment alone to improve cognitive and executive functioning. Methods: An evidence-based clinical review was conducted utilizing the following databases: PubMed, JAMA, and MedLine. Most studies included in the review included pediatric patients, though one adult only study was included due to the limited number of pediatric clinical trials. A quality assessment was performed to analyze the quality and significance of each included article. Results: This review included one randomized clinical trial (RCT) and two systematic reviews. The patient population varied between children and adults, individuals under age 18 and individuals greater than 18 years respectively, all of whom experienced a traumatic brain injury. The internal validity of all three articles was rated “good”. Within the three articles, two studies found methylphenidate, a central nervous system stimulant, significantly improved attention control, attention being one of the main factors affected in pediatric TBI. Two studies found that cognitive therapy showed improvements in specific areas of cognitive functioning, including executive functioning and verbal memory following TBI. Conclusion: Both methylphenidate and cognitive therapy result in improvements as solo therapies and have been shown to prevent further degradation of the patient's condition. We were v unable to find any studies that evaluated the effectiveness of pharmacological treatment in combination with cognitive therapy and the benefits of such combination on long-term outcomes. Further research is warranted to continue improving outcomes for pediatric TBI patients and decrease the negative impacts on their daily lives.