School Function In Children After Traumatic Brain Injury: Developing A New Outcome Measure

Trauma remains the leading cause of morbidity and mortality for children. Traumatic brain injury (TBI) is responsible for large population-level costs, and protracted burden on family and caregivers. TBI can significantly impact a child's ability to learn and attain important educational and social milestones. Coordinated reintegration into the school environment is paramount in order to achieve optimal outcome. To date, no validated instrument exists for teachers to be able assess the function of children in school after suffering TBI. By using Food and Drug Administration guidelines on Patient Reported Outcomes (PRO), and National Institutes of Health guidelines on mixed methods research, this thesis aims to develop a validated measure of school function in children after TBI, as assessed by the educational professional most closely involved with that child's education. There are multiple intended uses of this instrument. It will serve as a means for teachers to assess the function of their injured students in the classroom. It will also serve as a vehicle to provide tailored rehabilitation services to injured students. Clinicians will be able to assess the recovery of their patients who have returned to school using this outcome measure. Finally, it will serve as a validated outcome measure for clinical trials in pediatric TBI. This work was carried out in three phases. First, qualitative research methodology was used to develop a measurement concept of school function after TBI. School function was defined as the observable traits and behavioural manifestations of multiple cognitive, psychosocial, and neurologic processes, as well as performance on in-classroom academic tasks that represent a child's ability to achieve expected academic and social milestones. The qualitative data informed the second phase of instrument development, in which items were generated and reduced to form a 95-item prototype questionnaire. In the third phase, field testing was performed in order to validate the concept of school function and further reduce items. Only 58 questionnaires were completed; much further work is necessary to achieve the goal of generating a valid and reliable instrument. When complete, it will fill a large gap in the outcome assessment of this vulnerable population.Ph.D