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Gies LM, Narad M, Moscato EL, Sidol C, Makoroff K, Schmidt M, Rhine T, Wade SL. An open pilot of GROW, a responsive parenting intervention for young children with brain injuries: preliminary efficacy. Disabil Rehabil 2024:1-8. [PMID: 39397520 DOI: 10.1080/09638288.2024.2413177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 09/30/2024] [Accepted: 10/02/2024] [Indexed: 10/15/2024]
Abstract
PURPOSE Families experience stress and burden following their child's traumatic brain injury (TBI). Parenting styles are related to parent stress and child behavior problems and executive dysfunction. Parent-child interactions are shown to be a promising intervention target. We aimed to examine the preliminary efficacy of Gaining Real life skills Over the Web (GROW) in improving responsive parenting and reducing parent stress and depression in parents of children ages 0-4 who experienced TBI. METHOD Participants (n = 11) were parents of children four years old or younger, at the time of enrollment, and previously hospitalized overnight for TBI. Parent-reported measures included the Center for Epidemiologic Studies Depression Scale, Parenting Stress Inventory-Short Form, and Patient-Reported Outcomes Measurement Information System. Recordings of parent-child interactions were coded using the Play and Learning Strategies coding scheme. Study hypotheses were analyzed using independent samples t-tests, chi square analyses, and linear mixed models. RESULTS Parental warmth (t=-3.64, p = 0.001, d=.97), responsiveness (t=-2.09, p = 0.047, d = 0.70), and verbal stimulation (t=-2.30, p = 0.029, d = 0.75) increased significantly from pretreatment to posttreatment. Improvements in parental warmth were maintained 3 months posttreatment (t=-3.15, p = 0.004, d = 1.16). There were no significant changes in depression, parental stress, or quality of life. CONCLUSIONS Results provide preliminary support for the efficacy of GROW in improving responsive parenting for children following early TBI. Future directions include tailoring GROW to better fit the needs of families and testing the utility through a randomized control trial.
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Affiliation(s)
- Lisa M Gies
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Megan Narad
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Emily L Moscato
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Craig Sidol
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathi Makoroff
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Matthew Schmidt
- Department of Workforce Education and Instructional Technology, University of Georgia, Athens, GA, USA
| | - Tara Rhine
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Shari L Wade
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
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Chevignard M, Câmara-Costa H, Dellatolas G. Predicting and improving outcome in severe pediatric traumatic brain injury. Expert Rev Neurother 2024; 24:963-983. [PMID: 39140714 DOI: 10.1080/14737175.2024.2389921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 08/05/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Severe pediatric traumatic brain injury (spTBI), including abusive head trauma (AHT) in young children, is a major public health problem. Long-term consequences of spTBI include a large variety of physical, neurological, biological, cognitive, behavioral and social deficits and impairments. AREAS COVERED The present narrative review summarizes studies and reviews published from January 2019 to February 2024 on spTBI. Significant papers published before 2019 were also included. The article gives coverage to the causes of spTBI, its epidemiology and fatality rates; disparities, inequalities, and socioeconomic factors; critical care; outcomes; and interventions. EXPERT OPINION There are disparities between countries and according to socio-economic factors regarding causes, treatments and outcomes of spTBI. AHT has an overall poor outcome. Adherence to critical care guidelines is imperfect and the evidence-base of guidelines needs further investigations. Neuroimaging and biomarker predictors of outcomes is a rapidly evolving domain. Long-term cognitive, behavioral and psychosocial difficulties are the most prevalent and disabling. Their investigation should make a clear distinction between objective (clinical examination, cognitive tests, facts) and subjective measures (estimations using patient- and proxy-reported questionnaires), considering possible common source bias in reported difficulties. Family/caregiver-focused interventions, ecological approaches, and use of technology in delivery of interventions are recommended to improve long-term difficulties after spTBI.
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Affiliation(s)
- Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
- Sorbonne Université, GRC 24 Handicap Moteur Cognitif et Réadaptation (HaMCRe), AP-HP, Paris, France
| | - Hugo Câmara-Costa
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
- Sorbonne Université, GRC 24 Handicap Moteur Cognitif et Réadaptation (HaMCRe), AP-HP, Paris, France
| | - Georges Dellatolas
- Sorbonne Université, GRC 24 Handicap Moteur Cognitif et Réadaptation (HaMCRe), AP-HP, Paris, France
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Wolff B, Glasson EJ, Babikian T, Pestell CF. Self-Reported Traumatic Brain Injury and Its Biopsychosocial Risk Factors in Siblings of Individuals with Neurodevelopmental Conditions. Dev Neuropsychol 2024; 49:225-242. [PMID: 38994713 DOI: 10.1080/87565641.2024.2377689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/11/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
Siblings of individuals with neurodevelopmental conditions (NDCs) are situated within a complex system of risk and resilience factors for poor outcomes, many of which overlap with the risk of traumatic brain injury (TBI) and correlate with poorer recovery trajectories. This study used Bayesian analyses to characterize and compare TBI and biopsychosocial risk factors among 632 siblings (207 NDC, 425 controls; mean age 20.54 years, range 10-30, 78.48% female). NDC siblings had a higher self-reported lifetime history of TBI compared to controls (14.98% versus 6.35%), with most reporting more than one TBI, and at an earlier age. TBI history was associated with psychiatric diagnoses and subclinical NDC features. Family and structural factors related to TBI included poorer parent-child relationship, NDC diagnoses of autism or fetal alcohol spectrum disorder, minority ethnicity, and lower income. Findings have implications for health literacy, TBI education and screening, and implementation of family support.
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Affiliation(s)
- Brittany Wolff
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, and Jane & Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Emma J Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
- Discipline of Psychiatry, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences and UCLA Steve Tisch BrainSPORT Program, Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, California, US
| | - Carmela F Pestell
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
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McCusker C, Quinn C, Smyth B, Irwin M, McCavert ME, Raleigh N, McCrudden E. 'Family first' - feasibility and pilot outcomes of a community intervention for families of children in recovery following brain injury. Brain Inj 2024; 38:368-376. [PMID: 38317303 DOI: 10.1080/02699052.2024.2311347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Feasibility and pilot outcomes of a new community-based program for families of children with acquired brain injury (ABI) are presented. Interventions, delivered by home-visiting and teletherapy, were underpinned by problem-solving therapy, narrative meaning making, goal-directed interventions and community system psychoeducation. METHODS Eighty-three families of children, who had sustained an ABI before 12 years of age, had an average of 13 sessions of the 'Family First' (FF) intervention. A mixed-methods prospective design was employed. Feasibility was evaluated through measures of accessibility and acceptability. Goal attainment scaling and pre-post changes on standardized questionnaires assessed changes in psychosocial adjustment and quality of life. RESULTS Feasibility analyses suggested engagement and retention of often hard to reach families and children with high psychosocial needs. Qualitative analyses suggested themes related to the accessibility of a unique service ('Nothing else like this out there' and 'Accessible and flexible') which facilitated 'Empowerment' within a family context ('A family affair'). Promising changes on standardized scales of behavior problems, competencies and child and family quality of life were discerned. Increased goal attainment scores were observed. CONCLUSION The FF program showed feasibility and promise. It impacted positively on the lives of children and families and improved capacity in supporting systems.
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Affiliation(s)
- Chris McCusker
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Catherine Quinn
- Brain Injury Matters (NI) Castlereagh Business Park, Belfast, Northern Ireland
| | - Bridget Smyth
- Brain Injury Matters (NI) Castlereagh Business Park, Belfast, Northern Ireland
| | - Meg Irwin
- Brain Injury Matters (NI) Castlereagh Business Park, Belfast, Northern Ireland
| | | | - Niamh Raleigh
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Eunan McCrudden
- Department of Clinical Psychology, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
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Rivella C, Zanetti A, Bertamino M, Primavera L, Moretti P, Viterbori P. Emotional and social functioning after stroke in childhood: a systematic review. Disabil Rehabil 2023; 45:4175-4189. [PMID: 36384380 DOI: 10.1080/09638288.2022.2144490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To provide an overview of the effects of pediatric stroke on emotional and social functioning in childhood. METHODS A literature review was completed in accordance with the Preferred Reporting Items for Systematic Reviews. A systematic search of studies on internalizing problems and social functioning after pediatric stroke in PsycInfo, PsycArticles, and PubMed databases was conducted from inception to November 2021. A total of 583 studies were identified, and 32 met the inclusion criteria. RESULTS The review suggests that children after stroke are at risk of developing internalizing problems and a wide range of social difficulties. Internalizing problems are often associated with environmental factors such as family functioning and parents' mental health. In addition, a higher risk of developing psychosocial problems is associated with lower cognitive functioning and severe neurological impairment. CONCLUSIONS The assessment of psychological well-being and social functioning after pediatric stroke is helpful to provide adequate support to children and their families. Future studies are needed to better investigate these domains and to develop adequate methodologies for specific interventions.Implication for rehabilitationThis paper reviews research concerning emotional and social functioning following pediatric stroke in order to provide helpful information to clinicians and families and to improve rehabilitation pathways.Emotional and social functioning should be addressed during post-stroke evaluation and follow-up, even when physical and cognitive recovery is progressing well.Care in pediatric stroke should include volitional treatment and address emotional and social issues.
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Affiliation(s)
- Carlotta Rivella
- Department of Educational Science, University of Genoa, Genoa, Italy
| | - Alice Zanetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Bertamino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Paolo Moretti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Viterbori
- Department of Educational Science, University of Genoa, Genoa, Italy
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Karns CM, Wade SL, Slocumb J, Keating T, Gau JM, Slomine BS, Suskauer SJ, Glang A. Traumatic Brain Injury Positive Strategies for Families: A Pilot Randomized Controlled Trial of an Online Parent-Training Program. Arch Phys Med Rehabil 2023; 104:1026-1034. [PMID: 37142177 PMCID: PMC10330502 DOI: 10.1016/j.apmr.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/16/2023] [Accepted: 03/03/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To determine program satisfaction and preliminary efficacy of Traumatic Brain Injury Positive Strategies (TIPS), a web-based training for parenting strategies after child brain injury. DESIGN A randomized controlled trial with parallel assignment to TIPS intervention or usual-care control (TAU). The three testing time-points were pretest, posttest within 30 days of assignment, and 3-month follow-up. Reported in accordance with CONSORT extensions to randomized feasibility and pilot trials SETTING: Online. PARTICIPANTS Eighty-three volunteers recruited nationally who were 18 years of age or older, U.S. residents, English speaking and reading, had access to high-speed internet, and were living with and caring for a child who was hospitalized overnight with a brain injury (ages 3-18 years, able to follow simple commands; N=83). INTERVENTIONS Eight interactive behavioral training modules on parent strategies. The usual-care control was an informational website. MAIN OUTCOME MEASURES The proximal outcomes were User Satisfaction, Usefulness, Usability, Feature Preference, Strategy Utilization and Effectiveness, and Learning and Self-Efficacy for TIPS program participants. The primary outcomes were: Strategy Knowledge, Application, and Strategy-Application Confidence; Family Impact Module of Pediatric Quality of Life Inventory (PedsQL); and Caregiver Self-Efficacy Scale. The secondary outcomes were TIPS vs TCore PedsQL and Health Behavior Inventory (HBI) RESULTS: Pre- and posttest assessments were completed by 76 of 83 caregivers; 74 completed their 3-month follow-up. Linear growth models indicated that relative to TAU, TIPS yielded greater increases in Strategy Knowledge over the 3-month study (d=.61). Other comparisons did not reach significance. Outcomes were not moderated by child age, SES, or disability severity measured by Cognitive Function Module of PedsQL. All TIPS participants were satisfied with the program. CONCLUSIONS Of the 10 outcomes tested, only TBI knowledge significantly improved relative to TAU.
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Affiliation(s)
| | - Shari L Wade
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Jody Slocumb
- Department of Psychology, University of Oregon, Eugene, OR
| | | | - Jeff M Gau
- College of Education, University of Oregon, Eugene, OR
| | - Beth S Slomine
- Kennedy Krieger Institute, Baltimore, MD; Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stacy J Suskauer
- Kennedy Krieger Institute, Baltimore, MD; Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ann Glang
- Department of Psychology, University of Oregon, Eugene, OR
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Lundine JP, Chitwood KL, Wade SL. The Role of Speech-Language Pathologists in Expanding Delivery of Teen Online Problem Solving for Adolescents With Acquired Brain Injury: A Quality Improvement Project. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:989-998. [PMID: 37040320 DOI: 10.1044/2023_ajslp-22-00241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE Teen Online Problem Solving (TOPS) is an evidence-based teletherapy program designed to promote neurocognitive, behavioral, and psychosocial recovery following brain injury through family-centered training. To date, TOPS has been primarily administered by neuropsychologists and clinical psychologists. This clinical focus article discusses a quality improvement project to adapt the TOPS training and manual for use by speech-language pathologists (SLPs) and reports feedback from SLPs following TOPS training and after delivering the program with adolescents who experienced neurological insults. METHOD SLPs were invited to participate in TOPS training. Trainees were asked to complete posttraining surveys, active therapist questionnaires, and follow-up surveys directed to SLPs who had completed the intervention with at least one patient. RESULTS To date, a total of 38 SLPs completed TOPS training, 13 have implemented TOPS with at least one adolescent. Eight SLPs and 16 psychologists/trainees responded to follow-up surveys to share their perspectives on the program. Perceptions of clinicians delivering the program did not differ significantly in most respects. SLPs rated the ease of understanding nonverbal communication higher than psychologists. Seven SLPs responded to an SLP-specific survey about their experiences administering TOPS, noting a range of advantages and some limitations in their open-ended responses. CONCLUSION Training SLPs to deliver TOPS has the potential to increase service provision to adolescents with acquired brain injury who have cognitive communication difficulties and their families. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22357327.
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Affiliation(s)
- Jennifer P Lundine
- Department of Speech and Hearing Science, The Ohio State University, Columbus
- Division of Clinical Therapies and Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH
| | | | - Shari L Wade
- College of Medicine, University of Cincinnati, OH
- Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, OH
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Crook L, Riccardi JS, Ruddock HS, Ciccia A. Speech-Language Pathology Treatment of Cognitive-Communication Deficits in School-Aged Children With Traumatic Brain Injury: A Scoping Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1826-1841. [PMID: 37116307 DOI: 10.1044/2023_jslhr-22-00417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE The purpose of this scoping review was to synthesize the current evidence-based treatment practices used with school-aged children with any severity of traumatic brain injury (TBI) that could benefit the practice of speech-language pathologists (SLPs). METHOD A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Included studies were assigned thematic labels based on a modified version of the Rehabilitation Treatment Specification System. RESULTS A total of 27 articles that covered 16 different treatment approaches met inclusion criteria for this study. Most studies included adolescent or teenage participants with moderate-severe TBIs. Treatment targets included executive functioning (n = 15), social competence (n = 6), postconcussive symptoms (n = 5), behavior (n = 3), family functioning (n = 1), and health-related quality of life (n = 1). The majority of current interventions for school-aged children with TBI include a multidisciplinary approach and components of family involvement education. CONCLUSIONS Further research is needed on interventions that are specifically implemented by SLPs as well as protocols that include more heterogeneous samples (e.g., varied sociodemographic factors and injury severity) to allow for the development and testing of ecologically valid intervention practice. SLPs can use the results of this scoping review to individualize treatment based on the child's areas of need while considering individual characteristics and to provide person-centered intervention for children with school-aged TBI.
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Affiliation(s)
- Libby Crook
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Jessica S Riccardi
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Hannah S Ruddock
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Angela Ciccia
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
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Thamjamrassri T, Watanitanon A, Moore A, Chesnut RM, Vavilala MS, Lele AV. A Pilot Prospective Observational Study of Cerebral Autoregulation and 12-Month Outcomes in Children With Complex Mild Traumatic Brain Injury: The Argument for Sufficiency Conditions Affecting TBI Outcomes. J Neurosurg Anesthesiol 2022; 34:384-391. [PMID: 34009858 PMCID: PMC8563492 DOI: 10.1097/ana.0000000000000775] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The relationship between cerebral autoregulation and outcomes in pediatric complex mild traumatic brain injury (TBI) is unknown, and explored in this study. METHODS We conducted a prospective observational study of patients aged 0 to 18 years hospitalized with complex mild TBI (admission Glasgow Coma Scale score 13 to 15 with either abnormal computerized tomogram of the head or history of loss of consciousness). Cerebral autoregulation was tested using transcranial Doppler ultrasonography, and impaired autoregulation defined as autoregulation index<0.4. We collected Glasgow Outcome Scale Extended-Pediatrics score and health-related quality of life data at 3, 6, and 12 months after discharge. RESULTS Twenty-four patients aged 1.8 to 16.6 years (58.3% male) with complete 12-month outcome data were included in the analysis. Median admission Glasgow Coma Scale score was 15 (range: 13 to 15), median injury severity score was 12 (range: 4 to 29) and 23 patients (96%) had isolated TBI. Overall, 10 (41.7%) patients had impaired cerebral autoregulation. Complete recovery was observed in 6 of 21 (28.6%) children at 3 months, in 4 of 16 (25%) children at 6 months, and in 8 of 24 (33.3%) children at 12 months. There was no difference in median (interquartile range) Glasgow Outcome Scale Extended-Pediatrics score (2 [2.3] vs. 2 [interquartile range 1.3]) or health-related quality of life scores (91.5 [21.1] vs. 90.8 [21.6]) at 12 months between those with intact and impaired autoregulation, respectively. Age-adjusted hypotension occurred in 2/24 (8.3%) patients. CONCLUSION Two-thirds of children with complex mild TBI experienced incomplete functional recovery at 1 year. The co-occurrence of hypotension and cerebral autoregulation may be a sufficiency condition needed to affect TBI outcomes.
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Affiliation(s)
| | | | - Anne Moore
- Department of Neurological Surgery, University of Washington, Harborview Medical Center
| | - Randall M. Chesnut
- Department of Neurological Surgery, University of Washington, Harborview Medical Center
- Orthopedics and Sport Medicine, Seattle, WA
| | - Monica S. Vavilala
- Harborview Injury Prevention and Research Center
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| | - Abhijit V. Lele
- Harborview Injury Prevention and Research Center
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
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Cermak CA, McCabe SA, Kuchurean B, Schaefer J, Tendera A, Beal DS. Parent Interventions Improve Behavior After Pediatric Traumatic Brain Injury: A Systematic Review and Meta-analysis. J Head Trauma Rehabil 2022; 37:293-302. [PMID: 35125430 DOI: 10.1097/htr.0000000000000766] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine child behavior change scores from randomized controlled trials (RCTs) of parent interventions for pediatric traumatic brain injury (TBI). METHODS MEDLINE, EMBASE, PsycINFO, and CINAHL were searched to identify studies that examined parent interventions for pediatric TBI. Inclusion criteria included (i) a parent intervention for children with TBI; (ii) an RCT study design; (iii) statistical data for child behavior outcome(s); and (iv) studies that were published in English. RESULTS Seven studies met inclusion criteria. All interventions reported improved child behavior after pediatric TBI; however, child and parent factors contributed to behavior change scores in some interventions. Factors found to contribute to the level of benefit included age of child, baseline behavior levels, sociodemographics (eg, parent income, parent education), and parent mental health. CONCLUSION Improved child behavior outcomes resulting from parent interventions for pediatric TBI are well supported by the evidence in the peer-reviewed literature. Clinicians are encouraged to consider child and parent factors as they relate to child behavior outcomes.
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Affiliation(s)
- Carly A Cermak
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada (Drs Cermak, Tendera, and Beal and Mss McCabe, Kuchurean, and Schaefer); Rehabilitation Sciences Institute (Drs Cermak and Beal), and Department of Speech-Language Pathology, Faculty of Medicine (Ms Kuchurean and Dr Beal), University of Toronto, Toronto, Ontario, Canada
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Feasibility and Acceptability of a Complex Telerehabilitation Intervention for Pediatric Acquired Brain Injury: The Child in Context Intervention (CICI). J Clin Med 2022; 11:jcm11092564. [PMID: 35566690 PMCID: PMC9103299 DOI: 10.3390/jcm11092564] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/23/2022] [Accepted: 04/30/2022] [Indexed: 12/14/2022] Open
Abstract
The current study is a feasibility study of a randomized controlled trial (RCT): the Child in Context Intervention (CICI). The CICI study is an individualized, goal-oriented and home-based intervention conducted mainly through videoconference. It targets children with ongoing challenges (physical, cognitive, behavioral, social and/or psychological) after acquired brain injury (ABI) and their families at least one year post injury. The CICI feasibility study included six children aged 11–16 years with verified ABI-diagnosis, their families and their schools. The aim was to evaluate the feasibility of the intervention components, child and parent perceptions of usefulness and relevance of the intervention as well as the assessment protocol through a priori defined criteria. Overall, the families and therapists rated the intervention as feasible and acceptable, including the videoconference treatment delivery. However, the burden of assessment was too high. The SMART-goal approach was rated as useful, and goal attainment was high. The parents’ ratings of acceptability of the intervention were somewhat higher than the children’s. In conclusion, the CICI protocol proved feasible and acceptable to families, schools and therapists. The assessment burden was reduced, and adjustments in primary outcomes were made for the definitive RCT.
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A Review of Family Environment and Neurobehavioral Outcomes Following Pediatric Traumatic Brain Injury: Implications of Early Adverse Experiences, Family Stress, and Limbic Development. Biol Psychiatry 2022; 91:488-497. [PMID: 34772505 DOI: 10.1016/j.biopsych.2021.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/21/2021] [Accepted: 08/11/2021] [Indexed: 12/30/2022]
Abstract
Pediatric traumatic brain injury (TBI) is a public health crisis, with neurobehavioral morbidity observed years after an injury associated with changes in related brain structures. A substantial literature base has established family environment as a significant predictor of neurobehavioral outcomes following pediatric TBI. The neural mechanisms linking family environment to neurobehavioral outcomes have, however, received less empiric study in this population. In contrast, limbic structural differences as well as challenges with emotional adjustment and behavioral regulation in non-TBI populations have been linked to a multitude of family environmental factors, including family stress, parenting style, and adverse childhood experiences. In this article, we systematically review the more comprehensive literature on family environment and neurobehavioral outcomes in pediatric TBI and leverage the work in both TBI and non-TBI populations to expand our understanding of the underlying neural mechanisms. Thus, we summarize the extant literature on the family environment's role in neurobehavioral sequelae in children with TBI and explore potential neural correlates by synthesizing the wealth of literature on family environment and limbic development, specifically related to the amygdala. This review underscores the critical role of environmental factors, especially those predating the injury, in modeling recovery outcomes post-TBI in childhood, and discusses clinical and research implications across pediatric populations. Given the public health crisis of pediatric TBI, along with the context of sparse available medical interventions, a broader understanding of factors contributing to outcomes is warranted to expand the range of intervention targets.
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Miley AE, Elleman CB, Chiu RY, Moscato EL, Fisher AP, Slomine BS, Kirkwood MW, Baum KT, Walsh KE, Wade SL. Professional stakeholders' perceptions of barriers to behavioral health care following pediatric traumatic brain injury. Brain Inj 2022; 36:536-543. [PMID: 35113744 DOI: 10.1080/02699052.2022.2034956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To examine professional stakeholders' perspectives of barriers to behavioral health care (BHC) follow-up and telepsychology after pediatric traumatic brain injury (TBI). METHODS Twenty-nine professionals participated in a focus group (FG) or key informant interview (KII) between January and March 2020. Professionals answered questions about facilitators and barriers to BHC follow-up and telepsychology. Given widespread telepsychology implementation since COVID-19, a follow-up survey assessing telehealth perceptions since the pandemic was sent out in December 2020. Nineteen professionals completed the survey. RESULTS Professionals identified individual (e.g., family factors, insurance coverage/finances, transportation/distance, availability, planning follow-up care) and system-level (e.g., lack of access to BHC providers) barriers to BHC post-injury. Possible solutions, like collaborative follow-up care, were also identified. Generally, clinical professionals have favorable impressions of telepsychology and utilized services as a delivery modality for clinical care. Though telepsychology could reduce barriers to care, professionals also expressed concerns (e.g., technology issues, security/safety) and challenges (e.g., funding, accessibility, training/licensure for clinicians) with implementing telepsychology. CONCLUSION Barriers identified highlight the need for context-specific solutions to increase BHC access, with telepsychology generally recognized as a beneficial modality for BHC. Future work should continue to focus on understanding barriers to BHC and potential solutions after pediatric TBI.
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Affiliation(s)
- Aimee E Miley
- Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Chloe B Elleman
- Department of Undergraduate Education- Medical Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Rachel Y Chiu
- Department of Psychology, Northwestern University, Evanston, Indiana, USA
| | - Emily L Moscato
- Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Allison P Fisher
- Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Beth S Slomine
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael W Kirkwood
- Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine, Aurora, Illinois, USA.,Department of Rehabilitation Medicine, Children's Hospital Colorado, Aurora, Illinois, USA
| | - Katherine T Baum
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathleen E Walsh
- Department of Pediatrics, Harvard Medical School, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Shari L Wade
- Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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14
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Parent- and Adolescent-reported Executive Functioning in the Context of Randomized Controlled Trials of Online Family Problem-Solving Therapy. J Int Neuropsychol Soc 2022; 28:123-129. [PMID: 33896436 DOI: 10.1017/s1355617721000308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We examined parent- and adolescent-reported executive functioning (EF) behaviors following pediatric traumatic brain injury (TBI) in the context of Online Family Problem-Solving Therapy (OFPST) and moderators of change in EF behaviors. METHOD In total, 274 families were randomized to OFPST or an internet resource comparison group. Parents and adolescents completed the Behavior Rating Inventory of Executive Function at four time points. Mixed models were used to examine EF behaviors, assessing the effects of visit, treatment group, rater, TBI severity, age, socioeconomic status, and family functioning. RESULTS Parents rated their adolescents' EF as poorer (F(3,1156) = 220.15, p < .001; M = 58.11, SE = 0.73) than adolescents rated themselves (M = 51.81, SE = 0.73). Across raters, EF behaviors were poorer for adolescents whose parents had less education (F(3,1156) = 8.60, p = .003; M = 56.76, SE = 0.98) than for those with more education (M = 53.16, SE = 0.88). Age at baseline interacted with visit (F(3,1156) = 5.05, p = .002), such that families of older adolescents reported improvement in EF behaviors over time. Family functioning also interacted with visit (F(3, 1156) = 2.61, p = .049), indicating more improvement in EF behaviors over time in higher functioning families. There were no effects of treatment or TBI severity. CONCLUSION We identified a discrepancy between parent- and adolescent-reported EF, suggesting reduced awareness of deficits in adolescents with TBI. We also found that poorer family functioning and younger age were associated with poorer recovery after TBI, whereas adolescents of parents with less education were reported as having greater EF deficits across time points.
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15
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Wade SL, Jones KM, Corti C, Adlam AR, Limond J, Bardoni A, Gies LM. Adapting intervention approaches to new contexts: Three case studies of international adaptation of the Teen Online Problem Solving (TOPS) program. Rehabil Psychol 2021; 66:356-365. [PMID: 34871027 DOI: 10.1037/rep0000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE To describe the process of adapting the evidence-based Teen Online Problem Solving (TOPS) program, a telehealth problem-solving treatment addressing executive function and behavior regulation challenges in adolescents with traumatic brain injury, in Italy, New Zealand, and the United Kingdom. Research Method/Design: We describe the process of adapting and translating the TOPS program in 3 case studies with unique methods and samples. In Italy, 14 parents of adolescents with TBI participated in focus groups, and 2 adolescents with TBI and their parents and 2 physicians provided input on the resulting translation. In New Zealand, an independent Māori cultural advisor reviewed the content, and 6 adolescent-parent dyads and 2 health professionals completed the 10 modules independently over a five-week period to inform adaptation. In the United Kingdom, a team of neuropsychologists and a parent of an adolescent with ABI reviewed and adapted the content through successive iterations. RESULTS In Italy, suggested changes included greater emphasis on nonverbal communication and clearer examples of inappropriate problem-solving responses. In New Zealand, parents and adolescents rated the program as acceptable and helpful. Suggestions included incorporating familiar Māori settings, integrating religion, and developing videos with New Zealand adolescents. In the United Kingdom, iterative refinements focused on adapting TOPS for other acquired brain injuries and reflecting cross-national differences (e.g., drinking age). CONCLUSIONS/IMPLICATIONS These 3 case studies suggest that programs such as TOPS developed in 1 cultural context can be broadly acceptable in other contexts, with adaptations focusing on tailoring to reflect the unique cultural and linguistic setting. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Shari L Wade
- Department of Pediatrics, Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center
| | - Kelly M Jones
- National Institute for Stroke and Applied Neurosciences
| | | | | | | | | | - Lisa M Gies
- Department of Pediatrics, Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center
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16
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de Boer K, Muir SD, Silva SSM, Nedeljkovic M, Seabrook E, Thomas N, Meyer D. Videoconferencing psychotherapy for couples and families: A systematic review. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:259-288. [PMID: 33837968 DOI: 10.1111/jmft.12518] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 06/12/2023]
Abstract
The delivery of videoconferencing psychotherapy (VCP) has been found to be an efficacious, acceptable and feasible treatment modality for individual therapy. However, less is known about the use of VCP for couple and family therapy (CFT). The focus of this systematic review was to examine the efficacy, feasibility and acceptability of using VCP as a treatment delivery modality for CFT. A systematic search was conducted, data relating to efficacy, feasibility and acceptability were extracted from included studies. The search returned 7,112 abstracts, with 37 papers (0.005%) included. The methods of the review were pre-registered (PROSPERO; CRD42018106137). VCP for CFT was demonstrated to be feasible and acceptable. A meta-analysis was not conducted; however, results from the included studies indicate that VCP is an efficacious delivery method for CFT. Recommendations for future research and implications regarding clinical practice are made, which may be of interest to practitioners given the COVID-19 pandemic.
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Affiliation(s)
- Kathleen de Boer
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Samuel D Muir
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - S Sandun M Silva
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Maja Nedeljkovic
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Elizabeth Seabrook
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Neil Thomas
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Denny Meyer
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
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17
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Poor Parental Supervision Associated With Traumatic Brain Injury and Reactive Aggression in Young Offenders. J Head Trauma Rehabil 2021; 37:E65-E70. [PMID: 33782348 DOI: 10.1097/htr.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To establish whether poor parental supervision is associated with head injury and self-reported reactive aggression (ie, aggression in response to perceived provocation or threat) in adolescents in a Young Offender's Institute, by examining correlations between these variables. Understanding this population is important, as they are at a key pivotal age for intervention to prevent lifelong reoffending. METHODS Ninety-six male participants aged 16 to 18 years were recruited from a UK Young Offender's Institute. Self-report measures of remembered parenting, reactive aggression, and head injury history were administered during individual interviews. RESULTS Seventy-four percent of participants reported having experienced a lifetime traumatic brain injury (TBI), and 46% of participants reported experiencing at least 1 TBI leading to a loss of consciousness (LOC). We found that poor parental supervision, length of LOC following TBI, and self-reported reactive aggression were all positively correlated. CONCLUSIONS Findings show that there are correlational relationships between poor parental supervision, length of LOC following lifetime TBI, and higher levels of self-reported reactive aggression. This suggests there may be pathways resulting from poor parental supervision leading to both TBI with LOC, and reactive aggression. We advocate for future research with longitudinal designs and larger samples to examine the nature of these interactions, and to establish whether poor parental supervision is a prospective risk factor for more TBIs leading to LOC, and reactive aggression. This is key to understanding whether parenting interventions could help to reduce the disabling effects of TBI in adolescents, and help to prevent contact with the law.
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18
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Caregiver and Child Behavioral Health Service Utilization Following Pediatric Traumatic Brain Injury. Res Child Adolesc Psychopathol 2021; 49:491-501. [PMID: 33404944 DOI: 10.1007/s10802-020-00737-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
Given sparse literature examining receipt of behavioral health service in children and caregivers following traumatic brain injury (TBI), we sought to identify predictors of unmet need. We performed an individual participant data meta-analysis using generalized linear mixed-effect models to examine predictors of behavioral health service use and unmet need. We included 572 children, ages 3 to 18, who were hospitalized overnight following complicated mild to severe TBI between 2002 and 2015. Caregivers completed ratings of depression and distress, child behavior problems, family functioning, and behavioral health service utilization. For children, unmet behavioral health service need was defined as an elevation on one or more child behavior problem scales without receipt of behavioral health services. For caregivers, unmet need was defined as an elevation on either a depression or distress scale without behavioral health service utilization. Among those with behavioral health needs, rates of unmet need were high for both children (77.8%) and caregivers (71.4%). Poorer family functioning was related to more unmet need in children (F(1, 497) = 6.57, p = 0.01; OR = 1.8) and caregivers (F(1, 492) = 17.54, p < 0.001; OR = 2.7). Children with unmarried caregivers also had more unmet behavioral health service need than those with married caregivers (F(1, 497) = 12.14, p < 0.001; OR = 2.2). In conclusion, unmet needs are common after pediatric TBI and relate to family factors. The findings underscore the importance of monitoring service needs following pediatric TBI and point to disparities in service use.
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19
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Chevignard M, Câmara-Costa H, Dellatolas G. Pediatric traumatic brain injury and abusive head trauma. HANDBOOK OF CLINICAL NEUROLOGY 2020; 173:451-484. [PMID: 32958191 DOI: 10.1016/b978-0-444-64150-2.00032-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Childhood traumatic brain injury (TBI) commonly occurs during brain development and can have direct, immediately observable neurologic, cognitive, and behavioral consequences. However, it can also disrupt subsequent brain development, and long-term outcomes are a combination of preinjury development and abilities, consequences of brain injury, as well as delayed impaired development of skills that were immature at the time of injury. There is a growing number of studies on mild TBI/sport-related concussions, describing initial symptoms and their evolution over time and providing guidelines for effective management of symptoms and return to activity/school/sports. Mild TBI usually does not lead to long-term cognitive or academic consequences, despite reports of behavioral/psychologic issues postinjury. Regarding moderate to severe TBI, injury to the brain is more severe, with evidence of a number of detrimental consequences in various domains. Patients can display neurologic impairments (e.g., motor deficits, signs of cerebellar disorder, posttraumatic epilepsy), medical problems (e.g., endocrine pituitary deficits, sleep-wake abnormalities), or sensory deficits (e.g., visual, olfactory deficits). The most commonly reported deficits are in the cognitive-behavioral field, which tend to be significantly disabling in the long-term, impacting the development of autonomy, socialization and academic achievement, participation, quality of life, and later, independence and ability to enter the workforce (e.g., intellectual deficits, slow processing speed, attention, memory, executive functions deficits, impulsivity, intolerance to frustration). A number of factors influence outcomes following pediatric TBI, including preinjury stage of development and abilities, brain injury severity, age at injury (with younger age at injury most often associated with worse outcomes), and a number of family/environment factors (e.g., parental education and occupation, family functioning, parenting style, warmth and responsiveness, access to rehabilitation and care). Interventions should identify and target these specific factors, given their major role in postinjury outcomes. Abusive head trauma (AHT) occurs in very young children (most often <6 months) and is a form of severe TBI, usually associated with delay before appropriate care is sought. Outcomes are systematically worse following AHT than following accidental TBI, even when controlling for age at injury and injury severity. Children with moderate to severe TBI and AHT usually require specific, coordinated, multidisciplinary, and long-term rehabilitation interventions and school adaptations, until transition to adult services. Interventions should be patient- and family-centered, focusing on specific goals, comprising education about TBI, and promoting optimal parenting, communication, and collaborative problem-solving.
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Affiliation(s)
- Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Neurological Injury and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France; GRC 24, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France.
| | - Hugo Câmara-Costa
- GRC 24, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France; Centre d'Etudes en Santé des Populations, INSERM U1018, Paris, France
| | - Georges Dellatolas
- GRC 24, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France
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20
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Wade SL, Gies LM, Fisher AP, Moscato EL, Adlam AR, Bardoni A, Corti C, Limond J, Modi AC, Williams T. Telepsychotherapy With Children and Families: Lessons Gleaned From Two Decades of Translational Research. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2020; 30:332-347. [PMID: 34295136 DOI: 10.1037/int0000215] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The novel coronavirus, COVID-19, has led to sweeping changes in psychological practice and the concomitant rapid uptake of telepsychotherapy. Although telepsychotherapy is new to many clinical psychologists, there is considerable research on telepsychotherapy treatments. Nearly 2 decades of clinical research on telepsychotherapy treatments with children with neurological conditions has the potential to inform emerging clinical practice in the age of COVID-19. Toward that end, we synthesized findings from 14 clinical trials of telepsychotherapy problem-solving and parent-training interventions involving more than 800 children and families with diverse diagnoses, including traumatic brain injury, epilepsy, brain tumors, congenital heart disease, and perinatal stroke. We summarize efficacy across studies and clinical populations and report feasibility and acceptability data from the perspectives of parents, children, and psychotherapists. We describe adaptation for international contexts and strategies for troubleshooting technological challenges and working with families of varying socioeconomic strata. The extensive research literature reviewed and synthesized provides considerable support for the utility of telepsychotherapy with children with neurological conditions and their families and underscores its high level of acceptability with both diverse clinical populations and providers. During this period of heightened vulnerability and stress and reduced access to usual supports and services, telepsychotherapy approaches such as online family problem-solving treatment and online parenting skills training may allow psychologists to deliver traditional evidence-based treatments virtually while preserving fidelity and efficacy.
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Affiliation(s)
- Shari L Wade
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, and Department of Psychology and Department of Pediatrics, College of Medicine, University of Cincinnati
| | - Lisa M Gies
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, and Department of Psychology, University of Cincinnati
| | - Allison P Fisher
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, and Department of Psychology, University of Cincinnati
| | - Emily L Moscato
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, and Department of Psychology, University of Cincinnati
| | | | - Alessandra Bardoni
- Neuro-oncological and Neuropsychological Rehabilitation Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Claudia Corti
- Neuro-oncological and Neuropsychological Rehabilitation Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | | | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, College of Medicine, University of Cincinnati
| | - Tricia Williams
- Psychology Department, Hospital for Sick Children, Toronto, Ontario, Canada
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21
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Stubberud J, Holthe IL, Løvstad M, Schanke AK, Brandt A, Finnanger T. The feasibility and acceptability of goal management training of executive functions in children with spina bifida and acquired brain injury. Neuropsychol Rehabil 2020; 31:601-620. [PMID: 32065032 DOI: 10.1080/09602011.2020.1723649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Executive dysfunction causes significant real-life disability for children with spina bifida (SB) and acquired brain injury (ABI), and efficient interventions are needed. Goal Management Training (GMT) is a cognitive rehabilitation intervention for improving executive function (EF) that has received empirical support in studies of adults with SB and ABI. The purpose of this study was to determine the feasibility and acceptability of a newly developed pediatric GMT protocol (pGMT). Thirteen children (7 boys, 10-16 years) with SB (n = 4), traumatic brain injury (n = 8), and encephalitis (n = 1) were included, based upon the presence of EF problems as described by parents. The participants received 21 h of pGMT, using inpatient intervention periods, followed by 4 h of pGMT outpatient guidance over 8 weeks. Notably, pGMT was found to be both feasible and acceptable, with satisfactory compliance for the children, parents and teachers, in addition to being considered acceptable by all participants. Furthermore, a reliable change in daily life EF was reported by the parents for 2 children. And, some children obtained scores below clinical cut-off on a measure of parent reported real-life EF after intervention. Hence, findings suggest that a randomized controlled trial of pGMT, with a larger sample size, should be conducted.
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Affiliation(s)
- Jan Stubberud
- TRS National Resource Centre for Rare Disorders, Nesoddtangen, Norway.,Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Ingvil L Holthe
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Marianne Løvstad
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Anne-Kristine Schanke
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Anne Brandt
- Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torun Finnanger
- Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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