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Anderson V, Hearps SJC, Catroppa C, Beauchamp MH, Ryan NP. What predicts persisting social impairment following pediatric traumatic brain injury: contribution of a biopsychosocial approach. Psychol Med 2023; 53:3568-3579. [PMID: 35189999 PMCID: PMC10277758 DOI: 10.1017/s0033291722000186] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Psychosocial deficits, such as emotional, behavioral and social problems, reflect the most common and disabling consequences of pediatric traumatic brain injury (TBI). Their causes and recovery likely differ from physical and cognitive skills, due to disruption to developing brain networks and the influence of the child's environment. Despite increasing recognition of post-injury behavioral and social problems, there exists a paucity of research regarding the incidence of social impairment, and factors predicting risk and resilience in the social domain over time since injury. METHODS Using a prospective, longitudinal design, and a bio-psychosocial framework, we studied children with TBI (n = 107) at baseline (pre-injury function), 6 months, 1 and 2-years post-injury. We assessed intellectual ability, attention/executive function, social cognition, social communication and socio-emotional function. Children underwent structural magnetic resonance imaging (MRI) at 2-8 weeks post-injury. Parents rated their child's socio-emotional function and their own mental health, family function and perceived burden. RESULTS We distinguished five social recovery profiles, characterized by a complex interplay between environment and pre- and post-TBI factors, with injury factors playing a lesser role. Resilience in social competence was linked to intact family and parent function, intact pre-injury adaptive abilities, post-TBI cognition and social participation. Vulnerability in the social domain was related to poor pre- and post-injury adaptive abilities, greater behavioral concerns, and poorer pre- and post-injury parent health and family function. CONCLUSIONS We identified five distinct social recovery trajectories post-child-TBI, each characterized by a unique biopsychosocial profile, highlighting the importance of comprehensive social assessment and understanding of factors contributing to social impairment, to target resources and interventions to children at highest risk.
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Affiliation(s)
- Vicki Anderson
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
- Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
- University of Melbourne, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Stephen J. C. Hearps
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
- Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
- University of Melbourne, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Miriam H. Beauchamp
- University of Montreal, P.O. Box 6128, Center-ville branch, Montreal, QC, H3C 317, Canada
- St Justine Hospital, Avenue Ellendale, Montreal, QC, Canada
| | - Nicholas P. Ryan
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
- Deakin University, 221 Burwood Highway, Burwood, Australia
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Metabolism of Exogenous [2,4- 13C]β-Hydroxybutyrate following Traumatic Brain Injury in 21-22-Day-Old Rats: An Ex Vivo NMR Study. Metabolites 2022; 12:metabo12080710. [PMID: 36005582 PMCID: PMC9414923 DOI: 10.3390/metabo12080710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Traumatic brain injury (TBI) is leading cause of morbidity in young children. Acute dysregulation of oxidative glucose metabolism within the first hours after injury is a hallmark of TBI. The developing brain relies on ketones as well as glucose for energy. Thus, the aim of this study was to determine the metabolism of ketones early after TBI injury in the developing brain. Following the controlled cortical impact injury model of TBI, 21-22-day-old rats were infused with [2,4-13C]β-hydroxybutyrate during the acute (4 h) period after injury. Using ex vivo 13C-NMR spectroscopy, we determined that 13C-β-hydroxybutyrate (13C-BHB) metabolism was increased in both the ipsilateral and contralateral sides of the brain after TBI. Incorporation of the label was significantly higher in glutamate than glutamine, indicating that 13C-BHB metabolism was higher in neurons than astrocytes in both sham and injured brains. Our results show that (i) ketone metabolism was significantly higher in both the ipsilateral and contralateral sides of the injured brain after TBI; (ii) ketones were extensively metabolized by both astrocytes and neurons, albeit higher in neurons; (iii) the pyruvate recycling pathway determined by incorporation of the label from the metabolism of 13C-BHB into lactate was upregulated in the immature brain after TBI.
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Ionio C, Lista G, Veggiotti P, Colombo C, Ciuffo G, Daniele I, Landoni M, Scelsa B, Alfei E, Bova S. Cognitive, Behavioral and Socioemotional Development in a Cohort of Preterm Infants at School Age: A Cross-Sectional Study. Pediatr Rep 2022; 14:115-126. [PMID: 35324820 PMCID: PMC8948701 DOI: 10.3390/pediatric14010017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/26/2022] [Accepted: 03/01/2022] [Indexed: 12/10/2022] Open
Abstract
More than 50% of children who survive prematurity have an atypical course of development at school age, as environmental demands become more demanding. This study examines the effects of preterm birth on the cognitive, behavioral and socioemotional development of 185 children at ages five and seven years. Weaknesses were found in attention, working memory, processing speed and the ability to correctly interpret emotions at both ages five and seven. Significant correlations were found in regression and moderation models. These findings suggest that school-age children who were preterm infants are at increased risk of exhibiting impairments in several developmental domains that may affect their overall quality of life.
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Affiliation(s)
- Chiara Ionio
- CRIdee, Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, 20123 Milano, Italy; (G.C.); (M.L.)
- Correspondence: ; Tel.: +39-027-234-3642 or +39-338-442-5218; Fax: +39-027-234-2280
| | - Gianluca Lista
- Neonatologia, Patologia e Terapia Intensiva Neonatale, Ospedale dei Bambini “Vittore Buzzi”, ASST Fatebenefratelli Sacco, 20154 Milano, Italy; (G.L.); (C.C.); (I.D.)
| | - Pierangelo Veggiotti
- Neurologia Pediatrica, Ospedale dei Bambini “Vittore Buzzi”, ASST Fatebenefratelli Sacco, 20154 Milano, Italy; (P.V.); (B.S.); (E.A.); (S.B.)
| | - Caterina Colombo
- Neonatologia, Patologia e Terapia Intensiva Neonatale, Ospedale dei Bambini “Vittore Buzzi”, ASST Fatebenefratelli Sacco, 20154 Milano, Italy; (G.L.); (C.C.); (I.D.)
| | - Giulia Ciuffo
- CRIdee, Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, 20123 Milano, Italy; (G.C.); (M.L.)
| | - Irene Daniele
- Neonatologia, Patologia e Terapia Intensiva Neonatale, Ospedale dei Bambini “Vittore Buzzi”, ASST Fatebenefratelli Sacco, 20154 Milano, Italy; (G.L.); (C.C.); (I.D.)
| | - Marta Landoni
- CRIdee, Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, 20123 Milano, Italy; (G.C.); (M.L.)
| | - Barbara Scelsa
- Neurologia Pediatrica, Ospedale dei Bambini “Vittore Buzzi”, ASST Fatebenefratelli Sacco, 20154 Milano, Italy; (P.V.); (B.S.); (E.A.); (S.B.)
| | - Enrico Alfei
- Neurologia Pediatrica, Ospedale dei Bambini “Vittore Buzzi”, ASST Fatebenefratelli Sacco, 20154 Milano, Italy; (P.V.); (B.S.); (E.A.); (S.B.)
| | - Stefania Bova
- Neurologia Pediatrica, Ospedale dei Bambini “Vittore Buzzi”, ASST Fatebenefratelli Sacco, 20154 Milano, Italy; (P.V.); (B.S.); (E.A.); (S.B.)
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Genova HM, Haight A, Natsheh JY, DeLuca J, Lengenfelder J. The Relationship Between Social Communication and Social Functioning in Pediatric TBI: A Pilot Study. Front Neurol 2019; 10:850. [PMID: 31474925 PMCID: PMC6702270 DOI: 10.3389/fneur.2019.00850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/23/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: Social communication presents a significant difficulty for children with traumatic brain injury (TBI). Although several measures are used to examine social communication, there is no gold-standard assessment tool. The present pilot study examined the ability of the Social Communication Disorders Checklist (SCDC) to detect social communication difficulties in pediatric TBI. Further, we examined the relationship between social communication and social functioning as assessed by parental ratings of behavior and objective measures of social cognition. Methods: Sixteen children with pediatric TBI and 20 age, education and sex matched healthy controls (HCs) participated. All participants participated in a neuropsychological evaluation and parents filled out questionnaires. Parents rated their children's social communication abilities using the SCDC, as well as the Behavior Assessment System for Children, Second Edition (BASC-2). The pediatric subjects completed a task of social cognition, specifically Theory of Mind (ToM). Results: The pediatric TBI group had significantly lower scores on the SCDC compared to the HCs (p = 0.001). In the pediatric group, SCDC scores correlated significantly with scores on the BASC-2, as well as performance on the ToM task, indicating that children with lower parent-rated social communication abilities also had lower scores on the objective measure of social cognition. Conclusions: These data provide preliminary evidence that children with TBI have difficulties with social communication, as evidenced by lower scores on the SCDC, and that SCDC scores correlate with subjective and objective measures of social cognition and behavior in pediatric TBI.
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Affiliation(s)
- Helen M Genova
- Kessler Foundation, East Hanover, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, United States
| | | | - Joman Y Natsheh
- Kessler Foundation, East Hanover, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, United States.,Children's Specialized Hospital Research Center, New Brunswick, NJ, United States
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, United States
| | - Jean Lengenfelder
- Kessler Foundation, East Hanover, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, United States
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Wiseman-Hakes C, Saleem M, Poulin V, Nalder E, Balachandran P, Gan C, Colantonio A. The development of intimate relationships in adolescent girls and women with traumatic brain injury: a framework to guide gender specific rehabilitation and enhance positive social outcomes. Disabil Rehabil 2019; 42:3559-3565. [PMID: 30994020 DOI: 10.1080/09638288.2019.1597180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Traumatic brain injury is a neurological disorder of biopsychosocial nature influenced by sex and gender interactions across the lifespan. Traumatic brain injury sustained during adolescence can result in cognitive and social communication impairments that compromise the development and maintenance of intimate social relationships. This can increase both short and long-term vulnerability to poor mental health, social isolation, lack of meaningful friendships, exploitation, and abuse. Females with traumatic brain injury experience greater loss of confidence and have increased risk of victimization, sexual abuse, and violence. This paper aims to provide a framework to inform gender specific rehabilitation of social communication and intimacy, to enhance positive social outcomes for girls and women with Traumatic Brain Injury.Methods: The framework is developed through presentation of a conceptual, multi-dimensional model of intimacy and discussion of current evidence regarding trauma-related cognitive/social-communication impairments and considerations regarding social media.Results: Intimacy is strongly influenced by today's technology-informed "youth culture" and for those with Traumatic Brain Injury, is impacted by cognitive and social communication impairments. Females experience different challenges in recovery and experience of intimacy. There is a need to support girls and women with Traumatic Brain Injury as they develop intimate relationships.Conclusions: This framework can guide the development of female gender-specific rehabilitation and inform future research to promote positive social outcomes.Implications for rehabilitationIntimate relationships are a critical component of mental health and an important part of human development; however, the challenges faced by adolescent girls and woman with TBI in developing and maintaining intimate relationships are often overlooked in traditional rehabilitation programs.A multi-dimensional model of intimacy will help rehabilitation professionals understand the complexities of interventions needed to support healthy intimacy, as well as for harm prevention.Rehabilitation professionals play an important role in advocating for gender-specific supports and interventions.There is a need for early interventions, grounded in today's technological and social media culture, that will support healthy intimacy for adolescent girls and women with TBI.
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Affiliation(s)
- Catherine Wiseman-Hakes
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Speech Language Pathology, University of Toronto, Toronto, Canada.,Department of Speech Language Pathology, McMaster University, Hamilton, Canada
| | - Madiha Saleem
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Valérie Poulin
- Départment d'Ergothérapie, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Emily Nalder
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Peraveena Balachandran
- Department of Occupational Therapy, Saskatoon Health Region - Royal University Hospital, Saskatoon, Canada
| | - Caron Gan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital Toronto, Toronto, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Ciccia AH, Beekman L, Ditmars E. A clinically focused systematic review of social communication in pediatric TBI. NeuroRehabilitation 2018; 42:331-344. [DOI: 10.3233/nre-172384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Angela Hein Ciccia
- Department of Psychological Sciences, Communication Sciences Program, Case Western Reserve University, Cleveland, OH, USA
| | - Leah Beekman
- Department of Psychological Sciences, Communication Sciences Program, Case Western Reserve University, Cleveland, OH, USA
| | - Emily Ditmars
- Department of Psychological Sciences, Communication Sciences Program, Case Western Reserve University, Cleveland, OH, USA
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"Trying to Get a Grip": Language Competence and Self-Reported Satisfaction With Social Relationships Three Decades Post-Childhood Traumatic Brain Injury. J Head Trauma Rehabil 2018; 31:E30-40. [PMID: 26360001 DOI: 10.1097/htr.0000000000000182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE (1) To investigate outcomes in language competence and self-reported satisfaction with social relationships in long-term survivors of childhood traumatic brain injury (TBI); and (2) to establish whether language competence contributes to self-reported satisfaction with social relationships decades after sustaining childhood TBI. PARTICIPANTS Twelve females and 8 males aged 30 to 55 (mean = 39.80, standard deviation = 7.54) years who sustained a TBI during childhood and were on average 31 years postinjury (standard deviation = 9.69). An additional 20 participants matched for age, sex, handedness, years of education, and socioeconomic status constituted a control group. MAIN MEASURES Test of Language Competence-Expanded Edition and the Quality of Life in Brain Injury questionnaire. RESULTS Individuals with a history of childhood TBI performed significantly poorer than their non-injured peers on 2 (Ambiguous Sentences and Oral Expression: Recreating Sentences) out of the 4 Test of Language Competence-Expanded Edition subtests used and on the Quality of Life in Brain Injury subscale assessing satisfaction with social relationships. In the TBI group, scores obtained on the Ambiguous Sentences subtest were found to be a significant predictor of satisfaction with social relationships, explaining 25% of the variance observed. CONCLUSIONS The implication of high-level language skills to self-reported satisfaction with social relationships many decades post-childhood TBI suggests that ongoing monitoring of emerging language skills and support throughout the school years and into adulthood may be warranted if adult survivors of childhood TBI are to experience satisfying social relationships.
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8
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Ryan NP, Catroppa C, Godfrey C, Noble-Haeusslein LJ, Shultz SR, O'Brien TJ, Anderson V, Semple BD. Social dysfunction after pediatric traumatic brain injury: A translational perspective. Neurosci Biobehav Rev 2016; 64:196-214. [PMID: 26949224 PMCID: PMC5627971 DOI: 10.1016/j.neubiorev.2016.02.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 02/24/2016] [Accepted: 02/24/2016] [Indexed: 12/21/2022]
Abstract
Social dysfunction is common after traumatic brain injury (TBI), contributing to reduced quality of life for survivors. Factors which influence the development or persistence of social deficits after injury remain poorly understood, particularly in the context of ongoing brain maturation during childhood and adolescence. Aberrant social interactions have recently been modeled in adult and juvenile rodents after experimental TBI, providing an opportunity to gain new insights into the underlying neurobiology of these behaviors. Here, we review our current understanding of social dysfunction in both humans and rodent models of TBI, with a focus on brain injuries acquired during early development. Modulators of social outcomes are discussed, including injury-related and environmental risk and resilience factors. Disruption of social brain network connectivity and aberrant neuroendocrine function are identified as potential mechanisms of social impairments after pediatric TBI. Throughout, we highlight the overlap and disparities between outcome measures and findings from clinical and experimental approaches, and explore the translational potential of future research to prevent or ameliorate social dysfunction after childhood TBI.
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Affiliation(s)
- Nicholas P Ryan
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Cathy Catroppa
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia; Department of Psychology, Royal Children's Hospital, Parkville, VIC, Australia.
| | - Celia Godfrey
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Parkville, VIC, Australia.
| | - Linda J Noble-Haeusslein
- Departments of Neurological Surgery and Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, USA.
| | - Sandy R Shultz
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC, Australia.
| | - Terence J O'Brien
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC, Australia.
| | - Vicki Anderson
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia; Department of Psychology, Royal Children's Hospital, Parkville, VIC, Australia.
| | - Bridgette D Semple
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC, Australia.
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Mrazik M, Brooks BL, Jubinville A, Meeuwisse WH, Emery CA. Psychosocial Outcomes of Sport Concussions in Youth Hockey Players. Arch Clin Neuropsychol 2016; 31:297-304. [DOI: 10.1093/arclin/acw013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 11/14/2022] Open
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10
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Babikian T, Merkley T, Savage RC, Giza CC, Levin H. Chronic Aspects of Pediatric Traumatic Brain Injury: Review of the Literature. J Neurotrauma 2015; 32:1849-60. [DOI: 10.1089/neu.2015.3971] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Mattel Children's Hospital at UCLA, Los Angeles, California
| | - Tricia Merkley
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Christopher C. Giza
- Department of Pediatrics and Neurosurgery, David Geffen School of Medicine and Mattel Children's Hospital at UCLA, Los Angeles, California
| | - Harvey Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
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