When a child suffers a traumatic brain injury there are special considerations that must be reviewed in terms of setting up cognitive rehabilitation.

In terms of suffering a traumatic brain injury the youngest and oldest of the population are at a greater risk. Males 0-4 years old have the highest rates of TBI related emergency room visits. Teens and young adults have the highest rates of motor vehicle accident related TBIs. 71% of sports and recreation related TBI emergency room visits are among persons aged 10-19 years.

Consensus about children's outcomes following brain injury is that impairments and cognitive and behavioral skills impact educational and social functioning. This means impairments and difficulties in children suffering a traumatic brain injury are twofold:

• The initial cognitive impairments from the traumatic brain injury.
• Based upon the initial cognitive difficulties a child will not learn as quickly as his or her peers and will not participate in active social functioning creating a second severe impairment and continuing difficulties. This second impairment escalates as the child gets further and further behind in terms of not only school but also social functioning creating huge deficits. These problems can leave the child when he or she becomes an adult with an inability to fully function and support themselves.

Typically when a child is in recovery from a traumatic brain injury and undergoes initial medical care most of the child's recovery period is spent in school, a system that is becoming the long term rehabilitation program for children and youth. School systems focus on learning needs and this can differ from medical necessitated cognitive rehabilitation.

It is important when establishing cognitive rehabilitation for the recovery of a child with a traumatic brain injury that both education needs are met along with medical needs.

Some considerations are as follows:

• A holistic approach to cognitive rehabilitation should be undertaken that considers a child's education, wellbeing, social functioning, nutrition, sports and all aspects of the child's life.
• Injury adjustment is part of the process and as a child proceeds through recovery the changes in cognitive skills from the child's previous level of functioning should be taken into consideration.
• It is important when the child suffering from a TBI reenters school that an IEP (Individualized Education Program) be established and this is required under a Federal Law known as IDEA (Individuals with Disabilities Education Act). An IEP requires the school system to provide the disabled student with all education and counseling needs that are necessitated. It also requires the school system to pay for any outside help the disabled student may need.
• Maintaining any private medical therapy the child may need including counseling to help with adjustments that are necessitated.