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Bright Futures

Articles and Updates from Phoenix Children's

March 18, 2021, Laura J. Wilner, MD
The Teen Patient with a Brain Injury: Why a Pediatric Acute Inpatient Rehabilitation Facility Makes Sense
The Teen Patient with a Brain Injury: Why a Pediatric Acute Inpatient Rehabilitation Facility Makes Sense

As many medical professionals have often noted, children are not just “little adults.” And as much as teenagers wish to be considered “grown up,” we know they have needs that differ from the adult population. Taking this to heart, Phoenix Children’s recognizes the additional unique services children and adolescents require as a part of their rehabilitation process, including their stay in the Phoenix Children’s Acute Inpatient Rehabilitation Unit. Our inpatient rehabilitation program and the continuum of care provided after discharge is tailored to the specific needs of children and adolescents. This starts with staff consisting of fellowship trained pediatric and adolescent physiatrists as well as pediatric certified therapists, nurses and allied health providers.

Having a teen patient in an inpatient rehabilitation program housed within an acute care pediatric hospital guarantees access to specialty providers and services who are all geared to the 18 and under population. From physicians to psychologists, nurses to social workers, everyone demonstrates competencies and comfort in caring for and addressing the needs of the teen patient.

Patient and family-centered care is at the heart of children’s hospitals and it’s the backbone of comforting and supportive features at Phoenix Children’s such as parents rooming at bedside, parents involved in patient care rounds and family spaces throughout the hospital. Age appropriate TV, movies and games are available for the teenage group as well. And we can’t forget The Zone – a state-of-the art play area that provides an escape for patients and their families from daily life in the hospital. This procedure and doctor free area gives patients of any age a safe place to forget about the hospital for a while and just be a kid. Video games, air hockey, scheduled activities and celebrity visits are just a few of the ways The Zone meets the needs of all ages - teens included. An active Phoenix Children’s Child Life Department also provides individual activities and distractions, support and incorporation of rehabilitation goals into recreational activities. A patient- and family-centered approach should always include the incorporation of parents, siblings and friends in the rehabilitation environment.

Education is the work of children and having the in-house Phoenix Children’s 1 Darn Cool School educational support and services of teachers specializing in assisting patients with brain injury is a key element for teens in our inpatient rehabilitation program. Our employed teachers are part of the full rehabilitation daily schedule of therapies and interventions. They aren’t just tutors, but active members of our interdisciplinary team of providers who contribute by providing one-on-one work in cognitive tasks with patients not ready to tackle actual homework, coordinating return-to-school plans with team member input and communication with the school systems, and helping teens who can do their grade level work to keep up as much as possible while hospitalized. We also have pediatric neuropsychologists who are specially trained to address the evaluation of cognitive and behavioral skills relative to patient age and provide detailed recommendations for the successful transition back to academic learning as well as community reintegration.

Emotional support is provided by our social workers and counseling with our pediatric psychologists, who are focused on this age group, is very important along the rehabilitation journey. Teens have fears, frustrations and losses they may have to deal with including peer group relationships (“Will my friends abandon me?”), self-sufficiency issues (“I’ve been fairly independent and now mom is sleeping at my bedside”), school reintegration concerns (“What if I need special education services or can’t return to my classroom?”), developmental challenges and self-image (“What if I walk funny or have to use a wheelchair,” or, “What might transition to adulthood look like now after my brain injury?).

There are common medical issues facing adolescents during rehabilitation following a brain injury that would not always be thought about in the adult world. Considerations for goal setting and expectations for outcomes for teen patients will differ from those with adult patients. Adolescent patients may still be growing which can impact decision making regarding selection of medical equipment. The pediatric literature has shown there to be very little correlation between initial severity of brain injury to ultimate functional outcome which is contrary to the adult literature, indicating that pediatric and adolescent recovery from even severe brain injury can be markedly more positive than expectations for adults with similar injuries.

Teenage turmoil is real. During adolescence the brain is still under construction, developing from back to front and that means that the prefrontal cortex area which is responsible for decision-making, planning, problem-solving and impulse control hasn’t fully developed. The adolescent has one foot in childhood and one foot stepping over into adulthood. There is huge variation as to how far that second foot has moved toward adulthood when an illness or injury strikes. Therefore, it’s important the inpatient rehabilitation program selected for a teenage patient can provide all the important adolescent-oriented services to maximize the recovery of these patients in a most challenging time of life. It’s equally important that the subsequent transition of patient care from inpatient to outpatient therapy and medical care be equally as focused on the uniqueness of this age group.   

Phoenix Children’s has the only CARF-accredited Pediatric and Adolescent Inpatient Rehabilitation Program in Arizona and 70% of patients served in this program have traumatic and non-traumatic brain injuries. Phoenix Children's provides a full continuum of care for pediatric and adolescents from inpatient rehabilitation to outpatient rehabilitation therapy services throughout the valley along with ongoing medical care and management of brain injury sequelae through our Physical Medicine and Rehabilitation provider clinics.

For more information or referral to our inpatient program, contact our Connected Care Center at 602-933-DOCS or visit the website.

For more information about physical, occupational and speech/cognitive therapy services for brain injuries, contact 602-933-0980. The Barrow Neurological Institute at Phoenix Children’s Division of Pediatric Neuropsychology can also provide comprehensive assessments of cognition after brain injury. Call 602-933-0414 or visit us online here.

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