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European Journal of Physical and Rehabilitation Medicine 2012 September;48(3):423-31


lingua: Inglese

Pediatric rehabilitation of severe acquired brain injury: a multicenter survey

Gazzellini S. 1, Strazzer S. 2, Stortini M. 1, Veredice C. 1, Beretta E. 2, Lispi M. L. 1, Petacchi M. E. 3, Menna M. 4, Cipriani P. 5, Zampolini M. 6, Castelli E. 1

1 Bambino Gesù Children’s Hospital, Rome,Italy; 2 Eugenio Medea Scientific Institute, La Nostra Famiglia, Bosisio Parini, Lecco, Italy; 3 Eugenio Medea Scientific Institute, La Nostra Famiglia, Conegliano Veneto/Pieve di Solingo, Treviso, Italy; 4 Istituto Serafico, Assisi, Perugia, Italy; 5 Stella Maris Scientific Institute, Calambrone, Pisa, Italy; 6 ASL-3 Umbria, Foligno, Perugia, Italy


BACKGROUND: Epidemiological and descriptive data concerning the clinical and socio-demographic characteristics of severe acquired brain injuries (ABI) in pediatric age are meager. In particular, in Italy we only find data concerning traumatic brain injury (TBI) in adults. Earlier data show that the most prevalent etiology in ABI is traumatic and that greater clinical impairments are reported for patients with non-traumatic etiologies.
AIM: The main aims of the GISCAR (Gruppo Italiano per lo Studio delle Gravi Cerebrolesioni Acquisite e Riabilitazione) study are: 1) to define the clinical features of pediatric patients with severe neurological disabilities; 2) to determine the etiology and onset modality of the cerebral lesions; and 3) to analyse the characteristics of the rehabilitation processes and patient outcome in terms of disability, strategies for treatment and clinical picture.
DESIGN: Quasi-epidemiologic.
SETTING: In-patient.
POPULATION: 184 pediatric patients with severe ABI were recruited.
METHODS: Data collection was done by means of an assessment protocol created and used by a group of Italian neurorehabilitation centers. Traumatic and non traumatic aetiologies (NTBI) have been treated separately.
RESULTS: Traumatic etiology of ABI is the most prevalent (51.6%, N. 95) and about twice as many males as females are involved. Of these cases, 70.5% (N. 67) are the result of a car accident, either as a pedestrian or as a passenger, representing a crucial area for preventive action by the public health services. Eighty-six (46.7%) patients were in the acute state, 19 (10.3%) in subacute state and 76 (42.9%) in chronic condition. The results show that the positive trend for the TBI group was steeper than for NTBIs. Neuropsychological data are also discussed.
CONCLUSIONS AND CLINICAL REHABILITATION IMPACT: We report the first Italian descriptive study on pediatric patients affected by ABI of traumatic or non traumatic etiology. The main points concerning rehabilitation are that major differences between aetiologies must be taken into account and that ABI of any severity in the acute phase may lead to long term disability, confirming the high social and economic impact of this pathology. Our study demonstrates the great importance of providing specialised rehabilitation centers for pediatric patients, and increases awareness of the importance of ABI prevention.

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