Treating Neurotrauma in Children, TBI, Phoenix Children's Hospital
When a child is severely injured in a car accident and suffers a traumatic brain injury (TBI), the ambulance crew could be making its way to Phoenix Children’s Hospital’s Trauma Center.
Our Level 1 (highest level) Pediatric Trauma Center has emergency room nurses and physician specialists who are experienced with spine and brain injuries in children. The equipment in the Trauma Center is designed for children – not for larger sized adults - so everything they need is waiting for them. And since Phoenix Children’s Hospital is deeply involved with cutting-edge research, the patient at the Trauma Center will receive the most up-to-date treatments.
Stabalizing the neurotrauma patient
Once a neurotraumatic event occurs, the Trauma Center staff does not work on reversing the damage, but rather on stabilizing the patient’s oxygen flow to the brain. Much attention is spent on ensuring that the body and brain receives adequate blood flow, and that blood pressure is maintained. A body will often react to any trauma by a drop in blood pressure, but that can have a devastating impact on brain cells that need a steady flow of blood supply to help in the healing and recovery process. The Trauma Center nurses use intravenous fluids, medication, and elevation of the head to keep the vascular system of the neurotrauma patient working smoothly.
After a severe injury, the body will react to the stress with a fluctuating body temperature, so the Trauma Center staff will monitor body temperature carefully. A higher body temperature can rob brain cells of precious nutrients and oxygen flow. Phoenix Children’s Hospital has been on the forefront of research into the use of hypothermia (deliberately lowered body temperature) as a way to slow down the damage to brain cells and cut the risk of brain swelling.
About half of all neurotrauma patients require surgery to alleviate the hematomas (pocketing or pooling of blood) or contusions, bleeding and bruising of the brain and spinal cord. Phoenix Children’s Hospital’s staff of surgeons and surgical nurses is experienced with this branch of pediatric neurosurgery.
Surgery is sometimes required to alleviate the secondary complications that arise with neurotrauma to help relieve any pressure from swelling brain and spinal tissues, or remove infected tissues.
Complications from neurotrauma include:
- Intraventricular hemorrhage
- Hydrocephalus or post-traumatic ventricular enlargement: Swelling of the brain’s ventricles that contain cerebrospinal fluid
- Cerebrospinal Fluid Leaks: Tears or punctures to the skull can pierce the membrane that holds cerebrospinal fluid, leading to leaks of the fluid into the rest of the brain
- Bleeding and damage to the major arteries in the brain
- Cranial nerve injuries
Following a patient’s stabilization and neurological assessment, rehabilitation begins for our neurotrauma patients. A child's brain can rapidly "rewire" itself and begin healing, so it is vital to begin the recovery process as soon as possible.
The team of therapists, nurses and physicians are part of the Frances H. McClelland Rehabilitation Program, the only rehabilitation program in Arizona focused solely on children.
Our young patients’ brains are still developing, so the rehabilitation specialists understand the unique needs of pediatric rehabilitation patients. The approach is child-friendly and family-centered, so parents, siblings and grandparents are all encouraged to get involved in the healing process. Rehabilitation – both in-patient and out-patient – can range from:
- Physical Therapy – To regain motion and strength
- Occupational Therapy - To improve cognitive, physical, and motor skills
- Audiology – Some neurotrauma patients suffer damage to the hearing after a severe brain injury. The audiology therapists will diagnose auditory assessments and treatment
- Speech-language therapy – It is not uncommon for our young patients to struggle with feeding/swallowing, communication and cognition skills after a neurotrauma. Our speech-language therapists will work with the families and patients to improve these skills.