Skip to main content

Advertisement

SpringerLink
Log in

Psychiatric Evaluation and Management in Pediatric Spinal Cord Injuries: a Review

  • Complex Medical-Psychiatric Issues (MB Riba, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To summarize current key recommendations in the evaluation and management of mental health disorders associated with spinal cord injuries (SCI) among pediatric patients, based on a review of recent evidence-based literature and clinical experience.

Recent Findings

Anticipating potential mental health risks among youth with SCI and implementing early multidisciplinary management improves physical and mental health outcomes. When caregivers of youth with SCI model healthy coping strategies, it promotes healthy coping strategies in patients themselves. Peer mentor programs can be instrumental in patient adjustment, improve mental health, and aid in recovery.

Summary

Pediatric SCI is particularly impactful on a child’s development and individuation. Early involvement of a mental health team while in the hospital can help with the initial adjustment period and address psychiatric concerns that might interfere with recovery. The transition from the hospital to home is a period of vulnerability for individuals with SCI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Piatt J, Imperato N. Epidemiology of spinal injury in childhood and adolescence in the United States: 1997–2012. J Neurosurg Pediatr. 2018;21(5):441–8. https://doi.org/10.3171/2017.10.PEDS17530.

    Article  PubMed  Google Scholar 

  2. Vitale MG, Goss JM, Matsumoto H, Roye DP. Epidemiology of pediatric spinal cord injury in the United States: years 1997 and 2000. J Pediatr Orthop. 2006;26(6):745–9. https://doi.org/10.1097/01.bpo.0000235400.49536.83.

    Article  PubMed  Google Scholar 

  3. Piatt JH. Pediatric spinal injury in the US: epidemiology and disparities. J Neurosurg Pediatr. 2015;16(4):463–71. https://doi.org/10.3171/2015.2.PEDS1515This study shares updated information about the epidemiology of pediatric SCI, broken down by region, race, and socioeconomic status. It also includes information about the interactions of these characteristics with mechanisms of injury and mortality.

    Article  PubMed  Google Scholar 

  4. Vogel LC, Hickey KJ, Klaas SJ, Anderson CJ. Unique issues in pediatric spinal cord injury. Orthop Nurs. 2004;23(5):300–8. https://doi.org/10.1097/00006416-200409000-00004This study provides a nice overview of the unique medical problems this patient population faces. It could also serve as a reference for providers who wish to provide guidance about topics that families may not bring up on their own such as sexuality/fertility.

    Article  PubMed  Google Scholar 

  5. Parent S, Mac-Thiong J-M, Roy-Beaudry M, Sosa JF, Labelle H. Spinal cord injury in the pediatric population: a systematic review of the literature. J Neurotrauma. 2011;28(8):1515–24. https://doi.org/10.1089/neu.2009.1153.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Lin W. Relieving anxiety among patients with tracheostomy in intensive care. Published online 2020. https://www.theseus.fi/bitstream/handle/10024/347574/Relieving%20anxiety%20among%20tracheotomy%20patient%20in%20intensive%20care.pdf?sequence=2&isAllowed=y.

  7. Al Taweel W, Seyam R. Neurogenic bladder in spinal cord injury patients. Res Rep Urol. 2015;85. https://doi.org/10.2147/RRU.S29644.

  8. Goetz LL, Hurvitz EA, Nelson VS, Waring W. Bowel management in children and adolescents with spinal cord injury. J Spinal Cord Med. 1998;21(4):335–41. https://doi.org/10.1080/10790268.1998.11719541.

    Article  CAS  PubMed  Google Scholar 

  9. Shem K, Wong J, Dirlikov B, Castillo K. Pharyngeal dysphagia in individuals with cervical spinal cord injury: a prospective observational cohort study. Top Spinal Cord Inj Rehabil. 2019;25(4):322–30. https://doi.org/10.1310/sci2504-322.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Martinsen B, Harder I, Biering-Sorensen F. The meaning of assisted feeding for people living with spinal cord injury: a phenomenological study. J Adv Nurs. 2008;62(5):533–40. https://doi.org/10.1111/j.1365-2648.2008.04637.x.

    Article  PubMed  Google Scholar 

  11. Kruger EA, Pires M, Ngann Y, Sterling M, Rubayi S. Comprehensive management of pressure ulcers in spinal cord injury: current concepts and future trends. J Spinal Cord Med. 2013;36(6):572–85. https://doi.org/10.1179/2045772313Y.0000000093.

    Article  PubMed  PubMed Central  Google Scholar 

  12. January AM, Zebracki K, Chlan KM, Vogel LC. Poor sleep in adults with pediatric-onset spinal cord injury: associations with pain, health, and activity. J Spinal Cord Med. 2017;40(5):560–6. https://doi.org/10.1080/10790268.2017.1308109This study highlights the need to address sleep issues in the pediatric SCI population.

    Article  PubMed  Google Scholar 

  13. January AM, Zebracki K, Chlan KM, Vogel LC. Sleep, well-being, and psychological symptoms in adults with pediatric-onset spinal cord injury. Rehabil Psychol. 2015;60(4):328–34. https://doi.org/10.1037/rep0000061.

    Article  PubMed  Google Scholar 

  14. Craig A, Guest R, Tran Y, Middleton J. Cognitive impairment and mood states after spinal cord injury. J Neurotrauma. 2017;34(6):1156–63. https://doi.org/10.1089/neu.2016.4632.

    Article  PubMed  Google Scholar 

  15. Chiaravalloti ND, Weber E, Wylie G, Dyson-Hudson T, Wecht JM. Patterns of cognitive deficits in persons with spinal cord injury as compared with both age-matched and older individuals without spinal cord injury. J Spinal Cord Med. 2020;43(1):88–97. https://doi.org/10.1080/10790268.2018.1543103.

    Article  PubMed  Google Scholar 

  16. Vova AJ, Palma P, McClanahan E. Dual diagnosis: the prevalence of brain injury and spinal cord injury in the pediatric population and its impact on length of stay. Int Phys Med Rehabil J. 2020;5(1):30–7. https://doi.org/10.15406/ipmrj.2020.05.00225.

    Article  Google Scholar 

  17. Watson WD, Suskauer SJ, Askin G, et al. Cognitive recovery during inpatient rehabilitation following pediatric traumatic brain injury: a pediatric brain injury consortium study. J Head Trauma Rehabil. 2021;Publish Ahead of Print. https://doi.org/10.1097/HTR.0000000000000650

  18. Patel AK, Bell MJ, Traube C. Delirium in pediatric critical care. Pediatr Clin N Am. 2017;64(5):1117–32. https://doi.org/10.1016/j.pcl.2017.06.009.

    Article  Google Scholar 

  19. Traube C, Silver G, Kearney J, et al. Cornell Assessment of pediatric delirium: a valid, rapid, observational tool for screening delirium in the PICU. Crit Care Med. 2014;42(3):656–63. https://doi.org/10.1097/CCM.0b013e3182a66b76Reference for CAPD screening tool.

    Article  PubMed  PubMed Central  Google Scholar 

  20. . Malas N, Brahmbhatt K, McDermott C, Smith A, Ortiz-Aguayo R, Turkel S. Pediatric delirium: evaluation, management, and special considerations. Curr Psychiatry Rep. 2017;19(9):65. https://doi.org/10.1007/s11920-017-0817-3This article summarizes evaluation and treatment of pediatric delirium.

    Article  PubMed  Google Scholar 

  21. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Association; 2013. doi:https://doi.org/10.1176/appi.books.9780890425596

  22. Boyer BA, Knolls ML, Kafkalas CM, Tollen LG, Swartz M. Prevalence and relationships of posttraumatic stress in families experiencing pediatric spinal cord injury. Rehabil Psychol. 2000;45(4):339–55. https://doi.org/10.1037/0090-5550.45.4.339.

    Article  Google Scholar 

  23. Horn SR, Feder A. Understanding resilience and preventing and treating PTSD. Harv Rev Psychiatry. 2018;26(3):158–74. https://doi.org/10.1097/HRP.0000000000000194.

    Article  PubMed  Google Scholar 

  24. Roberts NP, Kitchiner NJ, Kenardy J, Bisson JI. Early psychological interventions to treat acute traumatic stress symptoms. Cochrane Common Mental Disorders Group, ed. Cochrane Database Syst Rev. Published online March 17, 2010. doi:https://doi.org/10.1002/14651858.CD007944.pub2

  25. Richard YF, Swaine BR, Sylvestre M-P, Lesage A, Zhang X, Feldman DE. The association between traumatic brain injury and suicide: are kids at risk? Am J Epidemiol. 2015;182(2):177–84. https://doi.org/10.1093/aje/kwv014.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kelly EH, Riordan AL, Zebracki K, Thorpe S, Vogel LC. Relationships between caregiver characteristics and health-related quality of life among youth with spinal cord injury. Top Spinal Cord Inj Rehabil. 2016;22(2):149–57. https://doi.org/10.1310/sci2016-00012.

    Article  PubMed  PubMed Central  Google Scholar 

  27. DeMaso DR, Martini DR, Cahen LA. Practice parameter for the psychiatric assessment and management of physically ill children and adolescents. J Am Acad Child Adolesc Psychiatry. 2009;48(2):213–33. https://doi.org/10.1097/CHI.0b13e3181908bf4AACAP practice parameter for psychiatric assessment and management of medically ill pediatric patients.

    Article  PubMed  Google Scholar 

  28. Rabchevsky AG, Kitzman PH. Latest approaches for the treatment of spasticity and autonomic dysreflexia in chronic spinal cord injury. Neurotherapeutics. 2011;8(2):274–82. https://doi.org/10.1007/s13311-011-0025-5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. . Brouwer MA, ELM M, van der Heide A, Hein IM, Verhagen EAAE. Breaking bad news: what parents would like you to know. Arch Dis Child. 2021;106(3):276–81. https://doi.org/10.1136/archdischild-2019-318398Insightful publication about how to deliver bad medical news to parents of pediatric patients based on parent experience. They give concrete and practical guidance.

    Article  PubMed  Google Scholar 

  30. Augutis M, Levi R, Asplund K, Berg-Kelly K. Psychosocial aspects of traumatic spinal cord injury with onset during adolescence: a qualitative study. J Spinal Cord Med. 2007;30(sup1):S55–64. https://doi.org/10.1080/10790268.2007.11753970Insightful publication based on patient report of the most supportive networks that were formed for them after their injury. This paper highlights the importance of individuals outside of the health care team in the rehabilitation process.

    Article  PubMed  PubMed Central  Google Scholar 

  31. International perspectives on spinal cord injury. World Health Organization; 2013. https://apps.who.int/iris/bitstream/handle/10665/94190/9789241564663_eng.pdf?sequence=1250-page book produced by WHO about spinal cord injury globally. Chapter 5 highlights health systems strengthening. There is a great table about types of assistive devices. Quotes included throughout the book from patients with SCI are useful for practitioners to develop empathy.

  32. . Ljungberg I, Kroll T, Libin A, Gordon S. Using peer mentoring for people with spinal cord injury to enhance self-efficacy beliefs and prevent medical complications: enhance self-efficacy beliefs and prevent medical complications. J Clin Nurs. 2011;20(3–4):351–8. https://doi.org/10.1111/j.1365-2702.2010.03432.xThis study highlights how impactful a peer mentor can be for an individual with a newly diagnosed SCI.

    Article  PubMed  Google Scholar 

  33. O’Dell L, Earle S, Rixon A, Davies A. Role of peer support for people with a spinal cord injury. Nurs Stand. 2019;34(4):69–75. https://doi.org/10.7748/ns.2018.e10869.

    Article  PubMed  Google Scholar 

  34. Divanoglou A, Georgiou M. Perceived effectiveness and mechanisms of community peer-based programmes for spinal cord injuries—a systematic review of qualitative findings. Spinal Cord. 2017;55(3):225–34. https://doi.org/10.1038/sc.2016.147A strength of this study is that it looked at 4 different peer-based programs. They highlighted that peer programs helped participants uncover unmet needs and misperceptions about their potential.

    Article  CAS  PubMed  Google Scholar 

  35. Graham RJ, Amar-Dolan LR, Roussin CJ, Weinstock PH. Bridging the stressful gap between ICU and home: medical simulation for pediatric patients and their families. Pediatr Crit Care Med. 2019;20(4):e221–4. https://doi.org/10.1097/PCC.0000000000001869.

    Article  PubMed  Google Scholar 

  36. Osorio M, Reyes MR, Massagli TL. Pediatric spinal cord injury. Curr Phys Med Rehabil Rep. 2014;2(3):158–68. https://doi.org/10.1007/s40141-014-0054-1.

    Article  Google Scholar 

  37. Anderson CJ, Kelly EH, Klaas SJ, Russell H, Daharsh E, Vogel LC. Anxiety and depression in children and adolescents with spinal cord injuries. Dev Med Child Neurol. 2009;51(10):826–32. https://doi.org/10.1111/j.1469-8749.2009.03268.xThis study showed that levels of anxiety and depression in SCI youth are comparable to normal levels.

    Article  PubMed  Google Scholar 

  38. Kelly E, Mulcahey M, Klaas S, Russell H, Anderson C, Vogel L. Psychosocial outcomes among youth with spinal cord injury and their primary caregivers. Top Spinal Cord Inj Rehabil. 2012;18(1):67–72. https://doi.org/10.1310/sci1801-67.

    Article  PubMed  Google Scholar 

  39. Merikangas KR, He J, Burstein M, Swanson SA, Avenevoli S, Cui L, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49(10):980–9. https://doi.org/10.1016/j.jaac.2010.05.017.

    Article  PubMed  PubMed Central  Google Scholar 

  40. January AM, Zebracki K, Chlan KM, Vogel LC. Symptoms of depression over time in adults with pediatric-onset spinal cord injury. Arch Phys Med Rehabil. 2014;95(3):447–54. https://doi.org/10.1016/j.apmr.2013.11.011This study showed that levels of depression in the SCI population can change over time and preventing secondary health complications and facilitating community participation can help.

    Article  PubMed  Google Scholar 

  41. Hartkopp A, Brønnum-Hansen H, Seidenschnur A-M, Biering-Sorensen F. Suicide in a spinal cord injured population: its relation to functional status. Arch Phys Med Rehabil. 1998;79(11):1356–61. https://doi.org/10.1016/S0003-9993(98)90227-1.

    Article  CAS  PubMed  Google Scholar 

  42. Soden R, Walsh J, Middleton J, Craven M, Rutkowski S, Yeo J. Causes of death after spinal cord injury. Spinal Cord. 2000;38(10):604–10. https://doi.org/10.1038/sj.sc.3101080.

    Article  CAS  PubMed  Google Scholar 

  43. Giannini MJ, Bergmark B, Kreshover S, Elias E, Plummer C, O’Keefe E. Understanding suicide and disability through three major disabling conditions: intellectual disability, spinal cord injury, and multiple sclerosis. Disabil Health J. 2010;3(2):74–8. https://doi.org/10.1016/j.dhjo.2009.09.001.

    Article  PubMed  Google Scholar 

  44. Kriz J, Sediva K, Maly M. Causes of death after spinal cord injury in the Czech Republic. Spinal Cord Published online January 14, 2021. doi:https://doi.org/10.1038/s41393-020-00593-2.

  45. Kemp JB, Krause SJ. Depression and life satisfaction among people ageing with post-polio and spinal cord injury. Disabil Rehabil. 1999;21(5–6):241–9. https://doi.org/10.1080/096382899297666.

    Article  CAS  PubMed  Google Scholar 

  46. Qian J, McDonough DJ, Gao Z. The effectiveness of virtual reality exercise on individual’s physiological, psychological and rehabilitative outcomes: a systematic review. Int J Environ Res Public Health. 2020;17(11):4133. https://doi.org/10.3390/ijerph17114133.

    Article  PubMed Central  Google Scholar 

Download references

Acknowledgements

The editors would like to thank Dr. Harrison Levine and Dr. Victor Schwartz for taking the time to review this manuscript.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Michigan, Ann Arbor, USA

    Jane Harness

  2. Department of Psychiatry, Division of Child and Adolescent Psychiatry and Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan Hospital Systems, Ann Arbor, MI, USA

    Jessica Pierce & Nasuh Malas

  3. Department of Psychiatry and Pediatrics, C.S. Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, MI, USA

    Nasuh Malas

Authors
  1. Jane Harness
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jessica Pierce
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nasuh Malas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jane Harness.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Complex Medical-Psychiatric Issues

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harness, J., Pierce, J. & Malas, N. Psychiatric Evaluation and Management in Pediatric Spinal Cord Injuries: a Review. Curr Psychiatry Rep 23, 40 (2021). https://doi.org/10.1007/s11920-021-01256-6

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11920-021-01256-6

Keywords

Search

Navigation