Top Lang Disorders Vol. 29, No. 3, pp. 207–223 Copyright c  2009 Wolters Kluwer Health | Lippincott Williams & Wilkins The Pediatric Test of Brain Injury Development and Interpretation Gillian A. Hotz, PhD; Nancy Helm-Estabrooks, ScD; Nickola Wolf Nelson, PhD; Elena Plante, PhD The Pediatric Test of Brain Injury (PTBI) is designed to assess neurocognitive, language, and liter- acy abilities that are relevant to the school curriculum of children and adolescents recovering from brain injury. The PTBI is intended to help clinicians establish baseline levels of cognitive–linguistic abilities in the acute stages of recovery, identify strengths and weaknesses for informing interven- tion, monitor functional changes and track recovery patterns, and guide decision making related to school reintegration and educational performance. This article describes the research version of the PTBI with regard to theoretical concerns guiding its development, selection of neurocognitive and language abilities that are relevant to the school curriculum and likely to be affected by brain injury, the rationale for tracking early recovery, and research being conducted on the PTBI to es- tablish criterion-referenced benchmarks for children and adolescents from age 6 through 16 years. Two case examples illustrate qualitative interpretations of results on each of the PTBI subtests, which are discussed with regard to implications for further curriculum-based language assessment and successful reintegration into school. Key words: brain injury recovery, early assessment, neurorehabilitation, pediatric, school reentry, traumatic brain injury E ACH YEAR, approximately 500,000 chil- dren in the United States are admitted to emergency departments for treatment of traumatic brain injury (TBI). Of these, more than 2,600 children die and another 37,000 are hospitalized (Langlois, Rutland-Brown, & Thomas, 2004). Residual neurological disabil- ities are said to occur in 30%–50% of children who have sustained severe head injury. The proportion of children experiencing dimin- ished learning capabilities is probably much Author Affiliations: Neurotrauma Outcome Research, Pediatric Brain & SCI Program, and Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida (Dr Hotz); University of North Carolina-Chapel Hill & Western Carolina University (Dr Helm-Estabrooks); Western Michigan University, Kalamazoo (Dr Nelson); and University of Arizona, Tucson (Dr Plante). Corresponding Author: Gillian A. Hotz, PhD, Univer- sity of Miami Miller School of Medicine, Miami, Florida (ghotz@med.miami.edu). higher (Lewis, Morris, Morris, Krawiecki, & Foster, 2000). The annual direct and indirect cost of TBI in the United States has been es- timated at $60 billion (Finkelstein, Corso, & Miller, 2006). Consistent with the World Health Organi- zation’s International Classification of Func- tioning, Disability, and Health (2001), the goal of rehabilitation following brain injury is to encourage maximal recovery, while supporting functional activity and participa- tion. In the case of pediatric TBI, rehabilita- tion goals include maintaining and/or recov- ering cognitive–linguistic processing abilities needed for academic functioning and partic- ipation in school. At the same time, practi- cal concerns influence the course of reha- bilitation. For example, insurance companies delimit authorization for inpatient hospitaliza- tion and outpatient visits. Given such con- straints, it is critical that clinicians have ef- ficient and effective standardized assessment tools for making decisions related to services 207