Did you know children with spinal injuries are at increased risk of neuropsychological difficulties?

Research shows that there can be substantial cognitive difficulties in those with spinal cord injuries. Those with chronic injuries are at greater risk of ongoing difficulties in a range of cognitive domains so integrating neuropsychological principles offers promise for improving the overall recovery and quality of life.

Causes are unclear but can be related to co-occurring brain trauma and/or secondary medical factors resulting from the injury, such as hypoxic conditions, invasive treatments and prolonged hospitalisation, not to mention the ongoing long-term impact on development as a result of change in functioning and care needs.

In young children, mild to moderate brain injuries may be undetected or unassessed where medical stabilisation and rehabilitation needs to take priority. The significant impact of prolonged hospital admissions and reduced access to typical learning environments including nursery/school, peers, and play should not be under-estimated in its impact upon ongoing development.

Development of cognition, social understanding, emotion regulation and attachment can all be significantly impacted. While typical development is undoubtedly disrupted by such a catastrophic injury, it can be unclear whether this disruption amounts to a delay which can be amenable to therapies and environmental enrichment, or a more longstanding difficulty requiring support.

It is important to be aware that these difficulties may emerge over time as the child develops more slowly than others their age. This means that they do not acquire the skills seen in their peers and the gap begins to widen. A child who initially appears to be doing well may have “late effects” as a result. It is crucial to monitor cognitive development and consider the emergence of difficulties as the child gets older, their environment becomes more complex, and the demands on their abilities increases. This can be stressful, confusing or frustrating for a child and may present as anxiety or behavioural outbursts.

In older children, life-changing physical injury can also negatively impact psychosocial functioning with changes in self-image, identity, independence, social relationships and missed schooling. These factors can add to the picture contributing to the development of anxiety and depression. Having a parent with mental health problems following the trauma of the injury to their child can also increase these risks.

Difficulties with cognition, emotions and behaviour can all have a negative impact on the rehabilitation program, family functioning and social integration of children with spinal injuries; all crucial to the child’s development. A full understanding of these effects is important to maximise outcomes.

Neuropsychological assessment can help in formulating the child’s cognitive, emotional and behavioural presentation in the context of their family’s functioning. Recommendations can be developed to inform the ongoing enrichment and multidisciplinary intervention needed to maximise their skills, while providing the right support for the child and family to enable them to thrive and reach their potential.