Peer-reviewed article
Beyond rehabilitation: toward developmental and trans-sectoral systems of support for complex acquired brain injury in children.
Gmelig Meyling C, Bakker S, Reinders M, Voorman J, Oude Ophuis B et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001Children with acquired brain injury often face persistent difficulties that emerge long after initial rehabilitation ends, particularly as they move through different developmental stages and educational settings. Current healthcare systems typically provide time-limited, sector-specific services that leave many children without adequate ongoing support. This paper proposes a shift from traditional rehabilitation models toward integrated, developmental systems that connect healthcare, education, and community services across the child's lifespan. The Dutch Pediatric ABI Network is presented as an example of how coordinated, multi-sector support can better serve children with complex brain injury needs and their families.
Key points
- Persistent or emerging difficulties in children with acquired brain injury often become visible only after formal rehabilitation ends, particularly during developmental transitions in childhood and adolescence
- Current systems are fragmented across sectors (healthcare, education, children services), resulting in gaps in support for children with complex consequences of brain injury
- The paper introduces 'pediatric ABI with complex consequences' (ABI+) to describe a vulnerable population whose needs extend beyond acute and sub-acute rehabilitation
- The Dutch Pediatric ABI Network demonstrates an integrated national approach connecting community-based support, multidisciplinary expertise, research, policy, and lived experience
- Recovery and participation should be understood as ongoing processes shaped by interaction between neurological injury, child development, family functioning, and environmental factors
Limitations
This is a perspective paper that describes a proposed framework and one national network model rather than presenting empirical evidence of outcomes or effectiveness. The document does not provide comparative data on whether integrated systems achieve better results for children than current fragmented approaches.
Abstract
Pediatric acquired brain injury (ABI) can disrupt developmental trajectories across physical, cognitive, behavioral, emotional, and social domains. While rehabilitation pathways typically focus on recovery during the acute and subacute phases, many children and youth experience persistent or emerging difficulties long after formal rehabilitation treatment has ended. These difficulties may become more visible as developmental, educational, and social demands change, particularly during transitions across childhood and adolescence. Current systems, however, are often organized around sector-specific and time-limited models of service, resulting in fragmented support across healthcare, education, children and youth services, and settings. In this Perspective Paper, we introduce 'pediatric ABI with complex consequences' (ABI+) to draw specific attention to children and youth with ABI whose support needs in the community extend beyond acute care and sub-acute conventional rehabilitation pathways. ABI + is not proposed as a new diagnostic category, but as a vulnerable population as a result of ongoing dynamic interaction between neurological injury, child development, family functioning, and environmental factors over time. We argue that pediatric ABI rehabilitation should move from a phase-based, healthcare-centered model toward a developmental and trans-sectoral system of support. To illustrate this perspective, we describe the Dutch Pediatric ABI Network (Netwerk Kind & NAH), an integrated national network connecting community-based support, multidisciplinary expertise, research, policy, and lived-experience. Drawing on initial lessons learned from the development of this network, we aim to offer transferable insights that may inform the design of integrated systems supporting recovery, participation, and family functioning throughout the developmental course of children and youth with ABI.