Pediatric Cognitive Rehabilitation Roadmap

Research Objectives: To provide clinicians with a structured framework for the application of evidence-based cognitive rehabilitation strategies for children with acquired brain injuries across the neurorehabilitation continuum of care. The roadmap aims to provide guidance in the determination of assessments, evidence based therapeutic strategies and goals specific to defined stages of brain recovery.

Design: This proposed roadmap defines four stages of cognitive recovery, including disorders of consciousness, confusional states, cognitive and behavioral dysregulation, and acute cognitive impairment. It provides interdisciplinary assessment tools to identify a patient’s current stage, monitor progress, and determine transitions between stages. It also utilizes research from ACRM’s cognitive rehabilitation training, along with additional pediatric specific evidence-based cognitive rehabilitation interventions, to guide the selection of cognitive rehabilitation approaches specific to each stage of recovery based on variables such as allowance of errors, types of cues and the timing of feedback necessary for optimal acquisition. To implement this interdisciplinary cognitive rehabilitation program at our hospital, our staff first completed ACRM online cognitive rehabilitation training. We then conducted in-services to train our staff on the use of the roadmap to guide the application of the stage specific assessments and strategies within our pediatric ABI population.

Setting: Blythedale Children’s Hospital (inpatient and day hospital neurorehabilitation program)

Participants: Pediatric ABI patients admitted to our hospital.

Interventions: n/a

Main Outcome Measures: n/a

Results: This roadmap has assisted in individualized treatment planning, school accommodations, and transition planning, along with improvement in interdisciplinary communication and collaboration. It also resulted in clearer guidelines for families and schools on how to accommodate students’ deficits to improve daily function and adjust plan to foster increased independence over time.

Conclusions: This pediatric cognitive therapy roadmap aims to improve overall pediatric cognitive rehabilitation including staff competency, caregiver education, and classroom recommendations. We also hope this tool and its breakdown of the brain injury recovery trajectory into four stages may provide additional prognostic indicators in future research.

Author(s) Disclosures: No disclosures to report