Direct clinician-delivered versus indirect family-supported rehabilitation of children with traumatic brain injury: A randomized controlled trial

Primary objectives: To explore the relative effectiveness of clinician-delivered vs family-supported interventions for children with chronic impairment after TBI. Research design: Randomized controlled clinical trial. Methods and procedures: Children aged 5-12 years in the chronic phase of their recovery were randomly assigned to the clinician-delivered or to the family-supported intervention group; both samples received intensive services for 1 year; physical outcome was measured by the SARAH scales, cognitive outcome by the WISC-III. Main outcomes and results: Parents in the family-supported intervention sample efficiently acquired the skills needed to deliver physical and cognitive interventions within the context of everyday routines of the child's life at home; family education level was not a factor. Although both groups demonstrated improvements, only the children in the family-supported intervention group demonstrated statistically significant - and clinically important - improvements on both outcome measures. Conclusions: This RCT provides compelling evidence for organizing cognitive and physical interventions and supports for children with TBI around the everyday routines of their lives, with intensive supports for their families.