Objectives: Participation is considerably restricted in children and adolescents with acquired
brain injury (ABI) as compared to their healthy peers. This systematic review aims to identify
which factors are associated with participation in children and adolescents with ABI.
Methods: A systematic search in Medline and various other electronic databases from January
2001–November 2014 was performed. All clinical studies describing determinants of participation
at least 1 year after the diagnosis of ABI by means of one or more pre-defined
instruments in patients up to 18 years of age were included. Extracted data included study
characteristics, patient characteristics, participation outcome and determinants of participation
(categorized into: health conditions (including characteristics of ABI), body functions and
structures, activities, personal factors and environmental factors). The methodological quality of
the studies was evaluated based on three quality aspects (selection, information and statistical
analysis bias) and scored as low, moderate or high.
Results: Eight studies using an explicit participation outcome measure were selected after
review, including a total of 1863 patients, with a follow-up ranging from 1 up to 288 months.
Three studies included patients with a traumatic or a non-traumatic brain injury (TBI or NTBI)
and five studies with only TBI patients. Factors consistently found to be associated with more
participation restrictions were: greater severity of ABI, impaired motor, cognitive, behavioural
and/or sensory functioning, limited accessibility of the physical environmentand worse family
functioning. Fewer participation problems were associated with a supportive/nurturing
parenting style, higher household income, acceptance and support in the community and
availability of special programmes. The overall methodological quality of the included studies
was high in two and moderate in six studies.
Conclusion: This systematic review shows that only a few, moderate quality, studies on the
determinants of participation after paediatric ABI using recommended explicit measurement
instruments are available. Various components of the ICF model: health condition,
body functions and structures and environmental factors were consistently found to
be associated with participation. More methodologically sound studies, using the recommended
explicit outcome measures, a standardized set of potential determinants and longterm
follow-up are suggested to increase the knowledge on participation in children and youth
with ABI.