The Brain Injury Association of America states that traumatic brain injury (TBI) is the leading cause of disability and death in children and adolescents nationwide. The age groups most at risk for brain injury are newborns through age four and teens from 15 to 19 years of age. Every year, an average of 564,000 children are treated for brain injuries in the emergency room and 62,000 children with brain injuries are hospitalized. This is a staggering amount of children suffering with chronic symptoms that often do not have a definitive treatment in mainstream medicine.

Definition of TBI

There is a big difference between a bump on the head and a traumatic brain injury. TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. The severity of a TBI may range from "mild," i.e., a brief change in mental status or consciousness to "severe," i.e., an extended period of unconsciousness or amnesia after the injury. The majority of traumatic brain injuries that occur each year are concussions or other forms of mild TBI.

The results of a TBI can affect almost every aspect of the child's life. Ongoing issues arise through development, many times children appear to look okay and are assumed to be so, but it is not uncommon for educational, behavioral or social problems to emerge years after an injury. With the injury in the rear view, it is harder to make the connection between these issues and the past injury.

Developmental delays or issues in development may not be seen until years following the incident, although they were initially caused by the TBI. Unlike adults, children are still developing, making these injuries even more devastating and potentially crippling in the long term. Scientific research has indicated that TBI in childhood can be followed by a significant decrease in cognitive, social or behavioral skills at the time of injury and also by a later "stall" (possibly years later) during which failure to develop cognitive, behavioral or social skills affects learning and the ability to maintain friends, relationships and a career.

After the accident and initial diagnosis, the patient and family must consider a wide variety of treatment options. This has led many of the 5.3 million Americans living with disabilities resulting from traumatic brain injury to use complementary and alternative medicine.

Massage and TBI

Massage therapy has long been used to ease pain, provide comfort and address cognitive and neurological issues. Currently, there are many massage therapists who focus their practice solely on headaches, sports related concussions and other TBI related issues.

In addition to possible complications with a TBI, the practitioner has other concerns outside of simply following the typical known contraindications and precautions associated with pediatric massage therapy. Children are still developing and have not reached their full cognition levels. This can make communication challenging, until you learn how best to communicate with the individual patient. As always, the therapist should seek guidance from the parents and healthcare team on how to best to seek permission and proceed with safe communication.

A detailed health history and medical intake form should be completed by the parents and any questions should be answered before beginning the session. Physicians, other healthcare staff and parents will look to the massage therapists for careful scrutiny of a child's healthcare needs prior to providing massage therapy, and in devising an effective treatment plan. For a child with medical and healthcare related needs, communication with healthcare personnel provides massage therapists with essential information to develop an effective plan and approach for care.

It is best to understand the specific indications for which massage therapy has been sought, and discuss any concerns with the parents, patient and healthcare team prior to beginning the first session. Each session may not be the same as the last, and so it is best to see your patient as an individual that requires an individual treatment plan and approach at potentially each and every session. There is not one protocol that fits the mold for every child, but with a unique approach, there is great potential to make a beneficial difference.

As we continue to see the rates of traumatic brain injury, and head injury rise, it is important that massage and healthcare practitioners research safe and effective approaches for appropriate therapeutic care.