ABSTRACT

According to the Centers for Disease Control (CDC, 2003, p. 8), a “traumatic brain injury (TBI) is caused by a blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.” TBI continues to be a leading cause of death (Graham, 2001; Jankowitz & Adelson, 2006) and one of the most frequent causes of disability in children (Arffa, 1998; Bigler, Clark, & Farmer, 1996; Kraus, 1995) with an estimated annual childhood and adolescent incidence between 180 to 300 per 100,000 (Adelson & Kochanek,1998; Anderson, Catroppa, Rosenfeld, Haritou, & Morse 2000; Guthrie, Mast, Richards, McQuaid, & Pavlakis, 1999). The two age groups that are at the highest risk for TBI are children younger than 5 years of age and older adolescents and young adults between the ages of 15 to 19 years (Langlois, Rutland-Brown, & Thomas, 2004). Young children are most often victims of falls while adolescents and young adults are injured following motor vehicle accidents (Donders, 2007). Males are nearly twice as likely as females to sustain a TBI, while hospitalization rates for TBI are reported to be the highest in African Americans and American/Indians/Alaskan Natives (CDC, 2003). Available epidemiological fi ndings further suggest a similar distribution in severity of brain injuries in different age groups (Bauer & Fritz, 2004), although milder injuries are more often reported in pediatrics compared to adults. In addition, approximately 75% of the reported injuries are concussions or other forms of mild TBI (CDC, 2003). Long-term sequelae occur less often in mild injuries, though some investigations suggest persistent defi cits in 5%–15% of injuries (Hawley, Ward, Magnay, & Long, 2002). Moreover, age appears to play an important role in both incidence and outcome (Anderson & Moore, 1995; Anderson et al., 2001). In fact, although better survival rates have been reported in children compared to adults with TBI, the long-term consequences are typically more devastating due to their age

and thus compromised developmental potential (Mazzola & Adelson, 2002).