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Ecology of development in children with brain impairment.

BACKGROUND
Many children with brain impairments develop well in spite of negative risk factors or prognoses. Most follow-up and review studies do not show uncontroversial effects of particular physiotherapy or activation programmes. Evidence is accumulating of environmental influence on brain plasticity, but it is not clear what exactly this means for human beings. This paper reports a qualitative study of the life histories of 20 children, with severe developmental disturbance of neurological origin, who showed marked functional improvements.


METHODS
Qualitative analysis of a group of 20 children, heterogeneous in aetiology or severity of brain impairments (hydrocephalus, porencephalic brain cysts, cerebral palsy, Rubinstein-Taybi, Down's or other genetic syndromes), in methods of rehabilitation as well as in outcome.


RESULTS
In these particular children, gross brain abnormalities apparent on initial imaging and early functional testing did not appear highly predictive of final outcome. There was no observed association between final functioning and any particular type of rehabilitation. The outcome rather seems to be the result of a complex process of interaction between the child and his/her human ecology; the way the child, as well as significant people in his/her environment, perceive problems and possible solutions; and the quality and quantity of activation and mediated learning experience.


CONCLUSION
Development in children with brain impairment does not seem to happen spontaneously. It is not a linear but an unpredictable process. Both outer (a stimulating environment with lots of activities) as well inner aspects (will and interactive processes) constitute a child's rehabilitative ecology. The findings are also suggestive for a brain plasticity influenced by the ecology of the child.