Study designs of evaluations included in the review
All study designs were considered. For question 2, studies were excluded if they were published before 1971 and conducted outside the US, if they relied on selected samples, and if they were prospective studies with a design that may have influenced school placement..
Specific interventions included in the review
Early, intensive medical rehabilitation in the acute care hospital (no details were provided). The Neuro-Cognitive Educational Project provides one-on-one tutoring for each child, with instruction at home and/or in the school setting, and includes a component to assist families in understanding the child's new disabilities. The curriculum and protocol were individually designed for each child to meet that child's needs, based on his or her strengths and weaknesses. The duration of the intervention varied from 3 to 7 months, and from 19 to 68 hours of tutoring. Studies looking at instrument development or alcohol or drug abuse were excluded.
Participants included in the review
Children and adolescents with TBI occurring between the ages of 2 and 18 years, whose injury severity warranted admission to a hospital emergency department and subsequent transfer to acute care.
Outcomes assessed in the review
Numerous outcome measures were recorded for each of the review's five questions. These were as follows:
1. The presence or absence of complications (skin problems and pneumonia); health status at discharge from hospital (age-appropriate motor skills, activities of daily living, play skills, social interaction, behaviour, communication, and measures of cognitive function); long-term measures of impairment and disability (reintegration into school, family, and social groups; academic achievement, transitions through developmental stages); and measures of functional independence.
2. Placement patterns for children diagnosed with TBI; and characteristics of special education, such as (a) was the assessment appropriate to TBI, (b) was the assessment used to help create the programme, and (c) were the people who implemented the programme trained in caring for and educating children with TBI?
3. Academic achievement; activities of daily living; peer integration and social functioning; play skills; behaviour; communication and speech; motor skills; cognitive capabilities; functional capabilities; long-term disposition (i.e. do they remain in the school system or drop out; have they been referred to the mental health system; are they in the juvenile correction system?).
4. Predictability of the onset of deficits at specific ages or educational landmarks, measured by strength of the association between results of diagnostic or prognostic tests, and the actual manifestations of needs and deficits.
5. Measures of coping, adjustment, satisfaction, stress, and family and caregiver burden.
How were decisions on the relevance of primary studies made?
Two reviewers independently applied the predefined eligibility criteria for the selection of primary studies. The authors do not state how discrepancies were resolved.