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So M, Dziuban EJ, Pedati CS, Holbrook JR, Claussen AH, O'Masta B, Maher B, Cerles AA, Mahmooth Z, MacMillan L, Kaminski JW, Rush M. Childhood Physical Health and Attention Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Modifiable Factors. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:316-336. [PMID: 35947281 PMCID: PMC10032176 DOI: 10.1007/s11121-022-01398-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 10/15/2022]
Abstract
Although neurobiologic and genetic factors figure prominently in the development of attention deficit/hyperactivity disorder (ADHD), adverse physical health experiences and conditions encountered during childhood may also play a role. Poor health is known to impact the developing brain with potential lifelong implications for behavioral issues. In attempt to better understand the relationship between childhood physical health and the onset and presence of ADHD symptoms, we summarized international peer-reviewed articles documenting relationships between a select group of childhood diseases or health events (e.g., illnesses, injuries, syndromes) and subsequent ADHD outcomes among children ages 0-17 years. Drawing on a larger two-phase systematic review, 57 longitudinal or retrospective observational studies (1978-2021) of childhood allergies, asthma, eczema, head injury, infection, or sleep problems and later ADHD diagnosis or symptomatology were identified and subjected to meta-analysis. Significant associations were documented between childhood head injuries, infections, and sleep problems with both dichotomous and continuous measures of ADHD, and between allergies with dichotomous measures of ADHD. We did not observe significant associations between asthma or eczema with ADHD outcomes. Heterogeneity detected for multiple associations, primarily among continuously measured outcomes, underscores the potential value of future subgroup analyses and individual studies. Collectively, these findings shed light on the importance of physical health in understanding childhood ADHD. Possible etiologic links between physical health factors and ADHD are discussed, as are implications for prevention efforts by providers, systems, and communities.
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Affiliation(s)
- Marvin So
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-E88, Atlanta, GA, 30341, USA.
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
| | - Eric J Dziuban
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Caitlin S Pedati
- Virginia Beach Department of Public Health, Virginia Beach, VA, USA
| | - Joseph R Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-E88, Atlanta, GA, 30341, USA
| | - Angelika H Claussen
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-E88, Atlanta, GA, 30341, USA
| | | | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Jennifer W Kaminski
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-E88, Atlanta, GA, 30341, USA
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Valdivia-Tangarife ER, Morlett-Paredes A, Rizo-Curiel G, Jiménez-Maldonado ME, Ruiz-Sandoval JL, Barba AR, López-Enríquez A, Avilés-Martínez KI, Villaseñor-Cabrera T. Incidence, and factors associated with moderate/severe pediatric traumatic brain injury in children aged 5-15 years in western, Mexico. Eur J Paediatr Neurol 2024; 49:6-12. [PMID: 38278011 DOI: 10.1016/j.ejpn.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE The study objectives were to estimate the standardized incidence and evaluate factors associated with moderate/severe pediatric traumatic brain injury (p-TBI) in children aged 5-15 years in Western, Mexico. METHODS The study was cross-sectional in design. We estimated the standardized incidence of moderate/severe p-TBI using the direct methods of the World Health Organization (WHO) standard populations. We utilized the Glasgow Coma Scale (GCS) to identify moderate/severe p-TBI patients (GCS ≤ 13). Logistic regression analysis was applied to evaluate variables associated with moderate/severe p-TBI. RESULTS The standardized incidence of patients diagnosed with moderate/severe p-TBI was 31.0/100,000 person-years (95 % CI 28.7-33.4). According to age, the moderate/severe TBI group was included. A total of 254 (38.5 %) patients were aged 5-9 years, 343 (52.0 %) were aged 10-14 years, and 62 (9.5 %) were aged 15 years. Factors associated with moderate/severe TBI in the crude analysis were male sex (OR 5.50, 95 % CI 4.16-7.39, p < 0.001), primary school (OR 2.15, 95 % CI 1.62-2.84, p < 0.001), and falls (OR 1.34, 95 % CI 1.02-1.77, p = 0.035). Factors associated with moderate/severe p-TBI in the adjusted analysis were male sex (OR 6.12, 95 % CI 4.53-8.29, p < 0.001), primary school (OR 3.25, 95 % CI 2.31-4.55, p < 0.001), and falls (OR 1.78, 95 % CI 1.28-2.47, p < 0.001). CONCLUSION The incidence of moderate/severe p-TBI in children aged 5-15 years in western Mexico in this study was higher than that in other studies. One of the biggest factors associated with moderate/severe p-TBI was male sex, specifically those with lower education levels and those who were prone to falls.
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Affiliation(s)
| | | | - Genoveva Rizo-Curiel
- Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico
| | - Miriam E Jiménez-Maldonado
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; Departamento de Neurociencias, Universidad de California San Diego, La Jolla, CA, USA; Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; O.P.D Hospital Civil Fray Antonio Alcalde, Guadalajara, Mexico
| | | | | | | | | | - Teresita Villaseñor-Cabrera
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; Departamento de Neurociencias, Universidad de California San Diego, La Jolla, CA, USA; Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; O.P.D Hospital Civil Fray Antonio Alcalde, Guadalajara, Mexico.
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Brandt AE, Rø TB, Finnanger TG, Hypher RE, Lien E, Lund B, Catroppa C, Andersson S, Risnes K, Stubberud J. Intelligence and executive function are associated with age at insult, time post-insult, and disability following chronic pediatric acquired brain injury. Front Neurol 2024; 14:1192623. [PMID: 38249741 PMCID: PMC10796693 DOI: 10.3389/fneur.2023.1192623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
Background Pediatric acquired brain injury (pABI) profoundly affects cognitive functions, encompassing IQ and executive functions (EFs). Particularly, young age at insult may lead to persistent and debilitating deficits, affecting daily-life functioning negatively. This study delves into the intricate interplay of age at insult, time post-insult, and their associations with IQ and EFs during chronic (>1 year) pABI. Additionally, we investigate cognitive performance across different levels of global function, recognizing the multifaceted nature of developmental factors influencing outcomes. Methods Drawing upon insult data and baseline information analyzing secondary outcomes from a multicenter RCT, including comprehensive medical and neuropsychological assessments of participants aged 10 to 17 years with pABI and parent-reported executive dysfunctions. The study examined associations between age at insult (early, EI; ≤7y vs. late, LI; > 7y) and time post-insult with IQ and EFs (updating, shifting, inhibition, and executive attention). Additionally, utilizing the Pediatric Glasgow Outcome Scale-Extended, we explored cognitive performance across levels of global functioning. Results Seventy-six participants, median 8 years at insult and 5 years post-insult, predominantly exhibiting moderate disability (n = 38), were included. Notably, participants with LI demonstrated superior IQ, executive attention, and shifting compared to EI, [adjusted mean differences with 95% Confidence Intervals (CIs); 7.9 (1.4, 14.4), 2.48 (0.71, 4.24) and 1.73 (0.03, 3.43), respectively]. Conversely, extended post-insult duration was associated with diminished performances, evident in mean differences with 95% CIs for IQ, updating, shifting, and executive attention compared to 1-2 years post-insult [-11.1 (-20.4, -1.7), -8.4 (-16.7, -0.1), -2.6 (-4.4, -0.7), -2.9 (-4.5, -1.2), -3.8 (-6.4, -1.3), -2.6 (-5.0, -0.3), and -3.2 (-5.7, -0.8)]. Global function exhibited a robust relationship with IQ and EFs. Conclusion Early insults and prolonged post-insult durations impose lasting tribulations in chronic pABI. While confirmation through larger studies is needed, these findings carry clinical implications, underscoring the importance of vigilance regarding early insults. Moreover, they dispel the notion that children fully recover from pABI; instead, they advocate equitable rehabilitation offerings for pABI, tailored to address cognitive functions, recognizing their pivotal role in achieving independence and participation in society. Incorporating disability screening in long-term follow-up assessments may prove beneficial.
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Affiliation(s)
- Anne Elisabeth Brandt
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torstein B. Rø
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torun G. Finnanger
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ruth E. Hypher
- Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Espen Lien
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bendik Lund
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cathy Catroppa
- Brain and Mind, Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Psychology, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | | | - Kari Risnes
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jan Stubberud
- Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
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Corti C, Oldrati V, Papini M, Strazzer S, Poggi G, Romaniello R, Borgatti R, Urgesi C, Bardoni A. Randomized clinical trial on the effects of a computerized cognitive training for pediatric patients with acquired brain injury or congenital malformation. Sci Rep 2023; 13:14559. [PMID: 37666983 PMCID: PMC10477344 DOI: 10.1038/s41598-023-41810-1] [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: 04/28/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023] Open
Abstract
Both acquired injuries and congenital malformations often cause lifelong disabilities in children, with a significant impact on cognitive abilities. Remote computerized cognitive training (CCT) may be delivered in ecological settings to favour rehabilitation continuity. This randomized clinical trial (RCT) evaluated the efficacy of an 8-week multi-domain, home-based CCT in a sample of patients aged 11-16 years with non-progressive acquired brain injury (ABI), brain tumor (BT) and congenital brain malformation (CBM). Following a stepped-wedge research design, patients were randomized into two groups: Training-first group, which started the CCT immediately after baseline assessment and Waiting-first group, which started the CCT after a period of time comparable to that required by the training (8 weeks). Post-training and long-term (6 months) changes were assessed. Both groups improved on visual-spatial working memory after the CCT, with benefits maintained after 6 months, while no other changes in cognitive or psychological measures were found. These findings suggest that a multi-domain CCT can generate benefits in visual-spatial working memory, in accordance with data from extant literature reporting that computer games heavily engage visuo-spatial abilities. We speculate that is tapping on the same cognitive ability with a prolonged training that may generate the greatest change after a CCT.
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Affiliation(s)
- Claudia Corti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Viola Oldrati
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy.
| | - Marta Papini
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Sandra Strazzer
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Geraldina Poggi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | | | - Renato Borgatti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Cosimo Urgesi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
- Laboratory of Cognitive Neuroscience, Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
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Villalonga-Olives E, Majercak KR, Almansa J, Khambaty T. Longitudinal impact of volunteering on the cognitive functioning of older adults: A secondary analysis from the US Health and Retirement Study. Int J Nurs Sci 2023; 10:373-382. [PMID: 37545782 PMCID: PMC10401338 DOI: 10.1016/j.ijnss.2023.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 05/30/2023] [Accepted: 06/23/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives To examine the relationship of volunteering with cognitive activity, social activity, and physical activity among older adults and, ultimately, with later cognitive functioning across different time periods. Methods We used individual responding to three waves of the US Health and Retirement Study panel data from 2008, 2012, and 2016 (n = 2,862). Self-reported questionnaires were used to assess annual volunteering frequency (non volunteering, volunteering <100 h and ≥100 h), and an adapted version of the Telephone Interview for Cognitive Status (TICS) was used to assess memory, mental processing, knowledge, language, and orientation. A structural equation model was estimated to assess effects on cognitive functioning throughout waves. Results Those participants that were part of volunteering activities in 2012 showed an increase between 2008 and 2012 in moderate physical activity (β = 0.19, P < 0.001 for those volunteering less than 100 h and β = 0.21, P < 0.001 for those volunteering at least 100 h), increase in social activity (β = 0.10, P = 0.052 for those volunteering less than 100 h and β = 0.12, P = 0.018 for those volunteering at least 100 h) and increase in higher cognitive activity (β = 0.13, P < 0.001 for those volunteering at least 100 h), compared to participants who did not volunteer. Higher levels of cognitive activity in 2008 and 2012 were associated with higher cognitive functioning on the following waves (β = 0.66 and β = 0.60, P < 0.001, respectively). Discussion Volunteering is a modifiable activity that can be increased to bolster cognitive functioning in older adulthood, primarily mediated by increased cognitive activity.
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Affiliation(s)
- Ester Villalonga-Olives
- Sciences and Health Outcomes Research Department, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Kayleigh R. Majercak
- Sciences and Health Outcomes Research Department, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Josue Almansa
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center, University of Groningen, the Netherlands
| | - Tasneem Khambaty
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, USA
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Steiner M, Lidzba K, Bigi S. Processing Speed in Children with Traumatic Brain Injury. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2023. [DOI: 10.1024/1016-264x/a000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Abstract: Traumatic brain injury (TBI) is a common cause of childhood morbidity and mortality. Information processing speed (IPS) is a central construct of neuropsychology and a mediator for a range of cognitive functions. In adults, the negative effects of TBI on IPS are well documented. This review qualitatively describes the impact of TBI on IPS in children and adolescents and examines various influencing factors. We included a total of 37 studies in the review that explored IPS using various clinical assessments. These clinical assessments often examine other neuropsychological functions besides IPS. In 29 of these studies, we found a negative effect of TBI on IPS. While injury severity has small but consistent effects on IPS, the effects of age at injury, time since injury, and gender were less evident. Because it is a central construct of neuropsychological functions, IPS should be assessed after TBI.
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Affiliation(s)
- Michelle Steiner
- Department of Pediatrics, Division of Neuropediatrics, Development, and Rehabilitation, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Karen Lidzba
- Department of Pediatrics, Division of Neuropediatrics, Development, and Rehabilitation, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sandra Bigi
- Department of Pediatrics, Division of Neuropediatrics, Development, and Rehabilitation, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Neurology, Bern University Hospital, University of Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
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Proceedings of the First Pediatric Coma and Disorders of Consciousness Symposium by the Curing Coma Campaign, Pediatric Neurocritical Care Research Group, and NINDS: Gearing for Success in Coma Advancements for Children and Neonates. Neurocrit Care 2023; 38:447-469. [PMID: 36759418 PMCID: PMC9910782 DOI: 10.1007/s12028-023-01673-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023]
Abstract
This proceedings article presents the scope of pediatric coma and disorders of consciousness based on presentations and discussions at the First Pediatric Disorders of Consciousness Care and Research symposium held on September 14th, 2021. Herein we review the current state of pediatric coma care and research opportunities as well as shared experiences from seasoned researchers and clinicians. Salient current challenges and opportunities in pediatric and neonatal coma care and research were identified through the contributions of the presenters, who were Jose I. Suarez, MD, Nina F. Schor, MD, PhD, Beth S. Slomine, PhD Erika Molteni, PhD, and Jan-Marino Ramirez, PhD, and moderated by Varina L. Boerwinkle, MD, with overview by Mark Wainwright, MD, and subsequent audience discussion. The program, executively planned by Varina L. Boerwinkle, MD, Mark Wainwright, MD, and Michelle Elena Schober, MD, drove the identification and development of priorities for the pediatric neurocritical care community.
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Hagan AJ, Verity SJ. Translating methylphenidate's efficacy on selective and sustained attentional deficits to those reported in childhood cancer survivors: A qualitative review. APPLIED NEUROPSYCHOLOGY. CHILD 2023; 12:74-87. [PMID: 35108133 DOI: 10.1080/21622965.2022.2025538] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Whilst an increasing number of children survive previously incurable cancers of the central nervous system (CNS), associated treatments often result in significant neurocognitive late effects. Methylphenidate provides some signs of alleviating cognitive difficulties in different pediatric groups; however, a minimal amount of systematic work has explored its effectiveness isolated to vulnerable attentional domains. The current review aimed to explore the effectiveness of methylphenidate isolated to two attentional domains (sustained and selective attention)-with an aim to substantiate its utility in childhood cancer survivors. Five databases were comprehensively searched for relevant articles. A purpose-developed tool was used to assess each study's robustness and research quality. Eleven out of 1,865 identified articles were included within the review. Studies drew upon five clinical populations. Individual attentional domains demonstrate variation in their response to methylphenidate. Sustained attention demonstrated the most consistent benefit of methylphenidate, reported largely in attention-deficit/hyperactivity disorder (ADHD) groups. Gains in selective attention and higher-order cognitive functions appeared to follow initial gains in sustained attention. Childhood cancer survivors report greater gains in selective attention compared to sustained attention. Higher doses may yield greater benefit for children with more diffuse attentional deficits. There is a need to improve the validity of current attentional measures before further methylphenidate trials are conducted.
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Affiliation(s)
- Alexander J Hagan
- Department of Paediatric Health Psychology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Sarah J Verity
- Department of Paediatric Health Psychology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK.,Newcastle University Centre for Cancer, Newcastle University, Newcastle Upon Tyne, UK
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Fisher AP, Gies LM, Chapman L, Aguilar JM, Yeates KO, Taylor HG, Wade SL. The clinical utility of the Children's Communication Checklist-2 in children with early childhood traumatic brain injury. Clin Neuropsychol 2022; 36:1728-1745. [PMID: 33375912 PMCID: PMC9204558 DOI: 10.1080/13854046.2020.1866675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/15/2020] [Indexed: 01/27/2023]
Abstract
ObjectivePediatric traumatic brain injury (TBI) is associated with long-term cognitive and behavioral deficits. Social communication impairments are common and impact functional outcomes, such as social engagement and academic performance. There are many barriers to identifying social communication deficits following TBI, including the absence of a standardized parent-reported communication measure for use in this population. The Children's Communication Checklist-Second Edition (CCC-2) has demonstrated utility in identifying communication deficits in diagnoses other than TBI. This study investigated the clinical utility of the CCC-2's social communication scales in children with TBI. Method: 203 children who sustained TBI or orthopedic injuries between the ages of 36 and 83 months were recruited as part of a larger, longitudinal study. We analyzed social communication subscale scores from the CCC-2 an average of 3.5 years postinjury. We used binary logistic regression analyses to examine the measure's accuracy in classifying children with and without social communication deficits on other measures of pragmatic language and social competence. Correlation analyses and linear mixed models were used to examine the construct validity of the CCC-2. Results: The CCC-2 was able to accurately classify those with and without pragmatic language impairments on the Comprehensive Assessment of Spoken Language 92% of the time (sensitivity = 55%) and 96% of the time on the Home and Community Social Behavior scale (sensitivity = 72%). The CCC-2 demonstrated strong correlations with and predictive validity for measures of social communication and competence. Conclusions: The findings offer support for the clinical utility of the CCC-2 in the pediatric TBI population.
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Affiliation(s)
- Allison P. Fisher
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, phone: 513-803-7404, fax: 513-636-7360
- University of Cincinnati, Cincinnati, OH
| | - Lisa M. Gies
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, phone: 513-803-7404, fax: 513-636-7360
- University of Cincinnati, Cincinnati, OH
| | - Leah Chapman
- Department of Neurology, Wake Forest Baptist Health, Winston-Salem, NC
| | - Jessica M. Aguilar
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, phone: 513-803-7404, fax: 513-636-7360
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children’s Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary
| | - H. Gerry Taylor
- Professor, Abigail Wexner Research Institute at Nationwide Children’s Hospital, and Department of Pediatrics, The Ohio State University, Nationwide Children’s Hospital
| | - Shari L. Wade
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, phone: 513-803-7404, fax: 513-636-7360
- University of Cincinnati, Cincinnati, OH
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Hagan AJ, Verity SJ. The influence of methylphenidate on sustained attention in paediatric acquired brain injury: a meta-analytical review. Child Neuropsychol 2022:1-32. [PMID: 36000579 DOI: 10.1080/09297049.2022.2112559] [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: 10/15/2022]
Abstract
Impairment in sustained attention is a common consequence of childhood Acquired Brain Injury (ABI). Whilst methylphenidate provides promise in enhancing "attention" as a unitary construct, little work has explored its effectiveness upon individual attentional domains. The current systematic review and meta-analysis evaluates the utility of methylphenidate on sustained attentional performance across childhood ABI groups. Five databases (PsycINFO, MEDLINE, Embase, Scopus & Cochrane Library) were searched for relevant articles from their inception to March 2022. A purpose-developed evaluation tool was used to assess each study's research quality (QuEST:MAP). Nine of the 1600 identified articles were included within this review (n = 259). Meta-analytical findings reported an overall significant benefit of methylphenidate on sustained attention in childhood ABI (g = -0.33, 95% CI: -0.62 to -0.04). Associated summary effect sizes were relatively small, particularly when adjusting for outlier cases. Subgroup analyses identified a significantly greater benefit of methylphenidate in clinical subgroups with comorbid ADHD diagnoses (p < .01). The current evidence base is characterized by small-scale clinical trials with variable research quality and low generalizability. Further robust research is needed to quantify methylphenidate utility upon individual attentional domains in larger and more representative ABI samples.
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Affiliation(s)
- Alexander J Hagan
- Department of Paediatric Health Psychology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-Upon-Tyne, UK
| | - Sarah J Verity
- Department of Paediatric Health Psychology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-Upon-Tyne, UK.,Newcastle University Centre for Cancer, Newcastle University, Newcastle Upon Tyne, UK
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Holthe IL, Dahl HM, Rohrer-Baumgartner N, Eichler S, Elseth MF, Holthe Ø, Berntsen T, Yeates KO, Andelic N, Løvstad M. Neuropsychological Impairment, Brain Injury Symptoms, and Health-Related Quality of Life After Pediatric TBI in Oslo. Front Neurol 2022; 12:719915. [PMID: 35153967 PMCID: PMC8831895 DOI: 10.3389/fneur.2021.719915] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022] Open
Abstract
Descriptions of clinical outcomes in pediatric traumatic brain injury (pTBI) in Scandinavia are sparse. The Oslo site of the European CENTER-TBI study has performed a pTBI outcome study in a hospitalized population. The main objective was to investigate neuropsychological outcomes, self- and parent-reported symptoms associated with brain injury, and quality of life in children aged 1–15 years, 5–8 months after injury. Fifty-two children were included, and 45 completed the assessments. The sample consisted of 15.4% severe, 21.2% moderate, and 63.4% mild TBI. Subjectively experienced problems with concentration and fatigue were reported by the parents of nearly half of the children. Higher brain injury symptom load was associated with lower quality of life, but was unrelated to injury severity. Group average scores of the sample on neuropsychological testing appeared unimpaired relative to normative means aside from lower performance in working memory. However, based on an impairment index (i.e., 2 or more tests being >1.5 SD below the normative mean), the presence of weak cognitive performance was evident in as many as 45.4% of the sample. Two-thirds of the sample also showed abnormally large intraindividual variability in cognitive functioning (i.e., significant WISC-IV index discrepancies). The findings highlight the need to look beyond group averages on neuropsychological testing. Utilizing an impairment index and considering intraindividual performance variability conveyed deficits that may warrant clinical follow-up. The association of brain injury symptoms with quality of life but not injury severity emphasizes the need to consider symptoms after TBI within a biopsychosocial framework. Clinical Trial Registration:ClinicalTrials.gov; identifier: NCT02210221.
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Affiliation(s)
- Ingvil Laberg Holthe
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
- *Correspondence: Ingvil Laberg Holthe
| | - Hilde Margrete Dahl
- Section for Child Neurology, Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | | | - Sandra Eichler
- Department of Traumatic Brain Injury, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | | | - Øyvor Holthe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Torhild Berntsen
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
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12
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Moser A, Wirt SZ, Niedzwecki C. Determining school reintegration needs of acquired brain injury patient through the use of a novel school simulation rubric. J Pediatr Rehabil Med 2022; 15:523-527. [PMID: 35723124 DOI: 10.3233/prm-210052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Determining when a child returns to school after an acquired brain injury is difficult to assess. Many factors affect a successful hospital-to-school reintegration. The hospital school simulation allowed the Acute Pediatric Inpatient Rehabilitation Unit (IRU) interdisciplinary team to assess how the patient was functioning at specific stages of the patient healing process to target goals that explicitly helped the patient safely reintegrate into school. A patient with an acquired brain injury (ABI) participated in a hospital school simulation where a novel school simulation rubric (SSR) tool was used to evaluate completion of specific activities the patient would experience in a traditional classroom. Results were shared with the IRU team so accommodations and modifications could be made to the IRU school recommendations letter based on the results of the final SSR. Preliminary results were found to benefit the patient as they reintegrated back to school. This study highlights the need for ongoing communication between hospital providers and educational personnel to provide patients with academic supports for school reintegration.
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Affiliation(s)
- Alana Moser
- Child Life, Texas Children's Hospital, Houston, TX, USA
| | - Stephen Z Wirt
- Physical Medicine and Rehabilitation, Texas Children's Hospital, Houston, TX, USA
| | - Christian Niedzwecki
- Physical Medicine and Rehabilitation, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
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13
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Stojanovski S, Scratch SE, Dunkley BT, Schachar R, Wheeler AL. A Systematic Scoping Review of New Attention Problems Following Traumatic Brain Injury in Children. Front Neurol 2021; 12:751736. [PMID: 34858314 PMCID: PMC8631327 DOI: 10.3389/fneur.2021.751736] [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: 08/01/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: To summarize existing knowledge about the characteristics of attention problems secondary to traumatic brain injuries (TBI) of all severities in children. Methods: Computerized databases PubMed and PsychINFO and gray literature sources were used to identify relevant studies. Search terms were selected to identify original research examining new ADHD diagnosis or attention problems after TBI in children. Studies were included if they investigated any severity of TBI, assessed attention or ADHD after brain injury, investigated children as a primary or sub-analysis, and controlled for or excluded participants with preinjury ADHD or attention problems. Results: Thirty-nine studies were included in the review. Studies examined the prevalence of and risk factors for new attention problems and ADHD following TBI in children as well as behavioral and neuropsychological factors associated with these attention problems. Studies report a wide range of prevalence rates of new ADHD diagnosis or attention problems after TBI. Evidence indicates that more severe injury, injury in early childhood, or preinjury adaptive functioning problems, increases the risk for new ADHD and attention problems after TBI and both sexes appear to be equally vulnerable. Further, literature suggests that cases of new ADHD often co-occurs with neuropsychiatric impairment in other domains. Identified gaps in our understanding of new attention problems and ADHD include if mild TBI, the most common type of injury, increases risk and what brain abnormalities are associated with the emergence of these problems. Conclusion: This scoping review describes existing studies of new attention problems and ADHD following TBI in children and highlights important risk factors and comorbidities. Important future research directions are identified that will inform the extent of this outcome across TBI severities, its neural basis and points of intervention to minimize its impact.
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Affiliation(s)
- Sonja Stojanovski
- SickKids Research Institute, Program in Neuroscience and Mental Health, Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, ON, Canada.,Physiology Department, University of Toronto, Toronto, ON, Canada
| | - Shannon E Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Benjamin T Dunkley
- SickKids Research Institute, Program in Neuroscience and Mental Health, Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Russell Schachar
- SickKids Research Institute, Program in Neuroscience and Mental Health, Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, ON, Canada.,Psychiatry Department, University of Toronto, Toronto, ON, Canada
| | - Anne L Wheeler
- SickKids Research Institute, Program in Neuroscience and Mental Health, Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, ON, Canada.,Physiology Department, University of Toronto, Toronto, ON, Canada
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14
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Hall A, Lundine JP, McCauley RJ. Nonstandardized Assessment of Cognitive-Communication Abilities Following Pediatric Traumatic Brain Injury: A Scoping Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2296-2317. [PMID: 34351823 DOI: 10.1044/2021_ajslp-20-00231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The purpose of this study is to describe and synthesize existing research on nonstandardized assessment of cognitive-communication abilities in children with traumatic brain injury (TBI) in order to improve the detection, diagnosis, and tracking of injury sequelae and guide appropriate service provision. Materials and Method A search of peer-reviewed journal databases revealed 504 unique articles published between January 2000 and August 2019. For full inclusion, articles had to report on empirical studies examining variables related to the nonstandardized assessment of cognitive-communication skills following TBI in children. Review articles, expert opinion pieces, and non-English language articles were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guided this process. Results Results were tabulated for each of the 14 articles that met full inclusion criteria. Included studies presented five different types of nonstandardized assessment: discourse analysis (n = 3), systematic observation of child's performance during an instrumental activity of daily living (n = 4), virtual reality tasks (n = 3), structured cognitive tasks (n = 2), and functional rating scales (n = 2). The majority of included studies compared the outcomes of nonstandardized assessment against subtest scores and checklists drawn from a variety of existing standardized and criterion-referenced assessments. Targeted cognitive-communication skills included attention, working memory, self-regulation, planning, multitasking, social problem-solving, inferencing, and macrolevel discourse. Conclusions Preliminary research suggests that a well-designed and systematically implemented nonstandardized assessment can yield essential information about children's cognitive-communication abilities in real-world contexts. Further research is needed to validate these assessments and to determine in which settings and situations they may prove most effective. Supplemental Material https://doi.org/10.23641/asha.15079026.
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Affiliation(s)
- Audrey Hall
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Jennifer P Lundine
- Department of Speech and Hearing Science, The Ohio State University, Columbus
- Division of Clinical Therapies & Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH
| | - Rebecca J McCauley
- Department of Speech and Hearing Science, The Ohio State University, Columbus
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15
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Evaluating the feasibility and efficacy of the Amsterdam memory and attention training for children (Amat-c) following acquired brain injury (ABI): protocol for a pilot study with online clinician support. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background:
Attention and memory deficits are common following paediatric acquired brain injury (ABI). However, there are few evidence-based interventions to improve these domains and benefit the everyday life of children post-injury. The Amsterdam Memory and Attention Training for children (Amat-c) has been translated from Dutch to English and shown to improve attention and memory skills in children following ABI. This protocol describes a study to expand accessibility of the program by using online, clinician-supported delivery with children post-ABI.
Method/design:
The study is a randomized controlled trial. Participants will be 40 children aged 8–16 a minimum of one-year post-ABI. Participants in the treatment group will complete 18 weekly sessions of the Amat-c program with weekly online clinician support. Participants in the active-control group will be administered ABI psychoeducation via a booklet for parents, with weekly online clinician contact. Attention and memory will be assessed at three time points up to six months post-intervention.
Results:
Analysis will be repeated measures multivariate planned comparisons; using the Statistical Package for the Social Sciences (IBM SPSS Statistics) General Linear Model procedure will compare pre- and post-intervention and six-month follow-up outcomes.
Discussion:
If shown efficacious in improving attention and memory, our team will then take a key role in implementing Amat-c into clinical care.
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16
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Watson WD, Suskauer SJ, Askin G, Nowak S, Baum KT, Gerber LM, Blackwell LS, Koterba CH, Hoskinson KR, Kurowski BG, Mclaughlin MJ, Tlustos SJ, Zimmerman KO, Shah SA. Cognitive Recovery During Inpatient Rehabilitation Following Pediatric Traumatic Brain Injury: A Pediatric Brain Injury Consortium Study. J Head Trauma Rehabil 2021; 36:253-263. [PMID: 33656473 DOI: 10.1097/htr.0000000000000650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To characterize the demographics, clinical course, and predictors of cognitive recovery among children and young adults receiving inpatient rehabilitation following pediatric traumatic brain injury (TBI). DESIGN Retrospective observational, multicenter study. SETTING Eight acute pediatric inpatient rehabilitation facilities in the United States with specialized programs for treating patients with TBI. PARTICIPANTS Children and young adults (0-21 years) with TBI (n = 234) receiving inpatient rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Admission and discharge status assessed by the WeeFIM Cognitive Developmental Functional Quotient (DFQ) and Cognitive and Linguistic Scale (CALS). RESULTS Patients admitted to pediatric inpatient rehabilitation are diverse in cognitive functioning. While the majority of patients make improvements, cognitive recovery is constrained for those admitted with the most severe cognitive impairments. Age, time since injury to rehabilitation admission, and admission WeeFIM Cognitive DFQ are significant predictors of cognitive functioning at discharge from inpatient rehabilitation. CONCLUSIONS This work establishes a multicenter Pediatric Brain Injury Consortium and characterized the demographics and clinical course of cognitive recovery during inpatient rehabilitation of pediatric patients with TBI to aid in prospective study design.
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Affiliation(s)
- William D Watson
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York (Dr Watson); Blythedale Children's Hospital, Valhalla, New York (Drs Watson and Shah and Ms Nowak); Kennedy Krieger Institute, and Departments of Physical Medicine and Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Suskauer); Departments of Population Health Sciences (Ms Askin and Dr Gerber) and Rehabilitation Medicine (Dr Shah), Weill Cornell Medicine, New York, New York; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Baum); Department of Neuropsychology, Children's Hospital of Atlanta, Atlanta, Georgia (Dr Blackwell); Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio (Drs Koterba and Hoskinson); Department of Pediatrics, The Ohio State University College of Medicine, Columbus (Dr Hoskinson); Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, and Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Ohio (Dr Kurowski); Division of Pediatric Rehabilitation Medicine, Children's Mercy-Kansas City, Kansas City, Missouri, and Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri (Dr Mclaughlin); Department of Rehabilitation, Children's Hospital Colorado, and Department of Physical Medicine and Rehabilitation, University of Colorado Anshutz Medical Campus, Aurora (Dr Tlustos); and Division of Critical Care Medicine, Department of Pediatrics, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina (Dr Zimmerman)
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17
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Maddux AB, Sevick C, Cox-Martin M, Bennett TD. Novel Claims-Based Outcome Phenotypes in Survivors of Pediatric Traumatic Brain Injury. J Head Trauma Rehabil 2021; 36:242-252. [PMID: 33656469 PMCID: PMC8249306 DOI: 10.1097/htr.0000000000000646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE For children hospitalized with acute traumatic brain injury (TBI), to use postdischarge insurance claims to identify: (1) healthcare utilization patterns representative of functional outcome phenotypes and (2) patient and hospitalization characteristics that predict outcome phenotype. SETTING Two pediatric trauma centers and a state-level insurance claim aggregator. PATIENTS A total of 289 children, who survived a hospitalization after TBI between 2009 and 2014, were in the hospital trauma registry, and had postdischarge insurance eligibility. DESIGN Retrospective cohort study. MAIN MEASURES Unsupervised machine learning to identify phenotypes based on postdischarge insurance claims. Regression analyses to identify predictors of phenotype. RESULTS Median age 5 years (interquartile range 2-12), 29% (84/289) female. TBI severity: 30% severe, 14% moderate, and 60% mild. We identified 4 functional outcome phenotypes. Phenotypes 3 and 4 were the highest utilizers of resources. Morbidity burden was highest during the first 4 postdischarge months and subsequently decreased in all domains except respiratory. Severity and mechanism of injury, intracranial pressure monitor placement, seizures, and hospital and intensive care unit lengths of stay were phenotype predictors. CONCLUSIONS Unsupervised machine learning identified postdischarge phenotypes at high risk for morbidities. Most phenotype predictors are available early in the hospitalization and can be used for prognostic enrichment of clinical trials targeting mitigation or treatment of domain-specific morbidities.
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Affiliation(s)
- Aline B. Maddux
- Assistant Professor of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO
| | - Carter Sevick
- Data Analyst, Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Matthew Cox-Martin
- Data Analyst, Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Tellen D. Bennett
- Associate Professor and Section Head, Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO
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18
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Miley AE, Fisher AP, Moscato EL, Culp A, Mitchell MJ, Hindert KC, Makoroff KL, Rhine TD, Wade SL. A mixed-methods analysis examining child and family needs following early brain injury. Disabil Rehabil 2021; 44:3566-3576. [PMID: 33459078 DOI: 10.1080/09638288.2020.1870757] [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] [Indexed: 10/22/2022]
Abstract
Purpose:To understand child and family needs following TBI in early childhood, 22 caregivers of children who were hospitalized for a moderate to severe TBI between the ages of 0 and 4 within the past 10 years (M = 3.27 years; Range = 3 months to 8 years) participated in a needs assessment.Methods: Through a convergent study design, including focus groups (FG), key informant interviews (KII), and standardized questionnaires, caregivers discussed challenges and changes in their child's behaviors and functioning in addition to resources that would be helpful post-injury. Standardized questionnaires assessing current psychological distress and parenting stress in addition to open-ended questions about their general experience were completed.Results: Results indicated some families continue to experience unresolved concerns relating to the child's injury, caregiver wellbeing, and the family system after early TBI, including notable variation in caregiver reported psychological distress and parenting stress. Caregivers noted unmet needs post-injury, such as child behavior management and caregiver stress and coping.Conclusion: Early TBI can have a long-term impact on the child, caregivers, and family system. Addressing the needs of the whole family system in intervention and rehabilitation efforts may optimize outcomes following early TBI. Study results will inform intervention development to facilitate post-injury coping and positive parenting.IMPLICATIONS FOR REHABILITATIONEarly TBI can result in unmet needs that have a lingering impact on the child, caregiver, and family.Caregivers need information and resources that address their own distress and stressors related to changes in the child post-injury.Our study suggests that stress management and self-care skills are possible targets of intervention for caregivers of children who experienced an early TBI.
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Affiliation(s)
- Aimee E Miley
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Allison P Fisher
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA
| | - Emily L Moscato
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA
| | - Aubrey Culp
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Monica J Mitchell
- Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kellana C Hindert
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathi L Makoroff
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tara D Rhine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 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 College of Arts and Science, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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19
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White matter changes following experimental pediatric traumatic brain injury: an advanced diffusion-weighted imaging investigation. Brain Imaging Behav 2021; 15:2766-2774. [PMID: 33411159 DOI: 10.1007/s11682-020-00433-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/24/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022]
Abstract
Pediatric traumatic brain injury (pTBI) is a major community health concern. Due to ongoing maturation, injury to the brain at a young age can have devastating consequences in later life. However, how pTBI affects brain development, including white matter maturation, is still poorly understood. Here, we used advanced diffusion weighted imaging (DWI) to assess chronic white matter changes after experimental pTBI. Mice at post-natal day 21 sustained a TBI using the controlled cortical impact model and magnetic resonance imaging (MRI) was performed at 6 months post-injury using a 4.7 T Bruker scanner. Four diffusion shells with 81 directions and b-values of 1000, 3000, 5000, and 7000s/mm2 were acquired and analyzed using MRtrix3 software. Advanced DWI metrics, including fiber density, fiber cross-section and a combined fiber density and cross-section measure, were investigated together with three track-weighted images (TWI): the average pathlength map, mean curvature and the track density image. These advanced metrics were compared to traditional diffusion tensor imaging (DTI) metrics which indicated that TBI injured mice had reduced fractional anisotropy and increased radial diffusivity in the white matter when compared to age-matched sham controls. Consistent with previous findings, fiber density and TWI metrics appeared to be more sensitive to white matter changes than DTI metrics, revealing widespread reductions in fiber density and TWI metrics in pTBI mice compared to sham controls. These results provide additional support for the use of advanced DWI metrics in assessing white matter degeneration following injury and highlight the chronic outcomes that can follow pTBI.
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20
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Injury during adolescence leads to sex-specific executive function deficits in adulthood in a pre-clinical model of mild traumatic brain injury. Behav Brain Res 2020; 402:113067. [PMID: 33333110 DOI: 10.1016/j.bbr.2020.113067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022]
Abstract
Adolescents are more likely than adults to develop chronic symptoms, such as impulsivity and difficulty concentrating, following a mild traumatic brain injury (mTBI) which may relate to disruption of pre-frontal cortex (PFC development). During adolescence the PFC is undergoing extensive remodelling, driving maturation of executive functions incorporating attention, motivation and impulse control. In part maturation of the PFC is driven by outgrowth of dopaminergic neurons to the PFC under the guidance of specific axonal targeting cues, including netrin-1. How a mTBI in adolescence may alter the expression of these axonal targeting cues, and the influence on PFC development is not yet known. As such the effects of mTBI in mid-adolescence on executive functioning in adulthood (12 weeks) were examined via the 5-choice serial reaction task in both male and female Sprague Dawley rats. Animals at p35 (n = 12-16 per group) were injured via weight drop (100 g from 0.75 m) and injury confirmed by a significant increase in righting reflex. Interestingly, while a mid-adolescence mTBI in females led to significantly higher omissions and decreased accuracy when task difficulty was high (stimulus duration 1 s), males had significantly increased premature response rate when the intertrial interval was varied. Examination of levels of TH, as a reflection of dopaminergic innervation, found no difference in either gender post-TBI in the PFC, but a significant increase in the limbic system (nucleus accumbens) in males, but not females, chronically post-TBI, suggesting an imbalance between the regions. The increase in TH was accompanied by a chronic reduction in netrin-1 within the nucleus accumbens in males only. Taken together, these results indicate that mTBI in adolescence leads to sex specific effects in different domains of PFC function in adulthood, which may relate to subtle alterations in the developmental trajectory of the mesocortical limbic pathway in males only.
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21
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Botchway EN, Godfrey C, Ryan NP, Hearps S, Nicholas CL, Anderson VA, Catroppa C. Sleep Disturbances in Young Adults with Childhood Traumatic Brain Injury: Relationship with Fatigue, Depression, and Quality of Life. Brain Inj 2020; 34:1579-1589. [PMID: 33054410 DOI: 10.1080/02699052.2020.1832704] [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: 10/23/2022]
Abstract
OBJECTIVE This study assessed the consequences of childhood traumatic brain injury (TBI) on sleep, fatigue, depression, and quality of life (QoL) outcomes and explored the relationships between these variables at 20 years following childhood TBI. PARTICIPANTS We followed up 54 young adults with mild, moderate, and severe TBI, and 13 typically developing control (TDC) participants, recruited at the time of TBI. METHODS Sleep was assessed with the Pittsburgh Sleep Quality Index and actigraphy. RESULTS At 20 years postinjury, results showed no significant difference between whole TBI group and TDC participants on subjective sleep quality; however, the moderate TBI group reported significantly poorer subjective sleep quality compared to those with severe TBI. Poorer subjective sleep was associated with increased symptoms of fatigue, depression, and poorer perceptions of General Health in the TBI group. Actigraphic sleep efficiency, fatigue, depression, and QoL outcomes were not significantly different between TBI and TDC or among TBI severity groups. CONCLUSIONS These preliminary findings underscore associations between subjective sleep disturbance, fatigue, depression, and QoL in this TBI sample, and mostly comparable outcomes in sleep, fatigue, depression, and QoL between the TBI and TDC groups. Further research is required to clarify these findings.
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Affiliation(s)
- Edith N Botchway
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne , Melbourne, Australia
| | - Celia Godfrey
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne , Melbourne, Australia
| | - Nicholas P Ryan
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne , Melbourne, Australia.,Cognitive Neuroscience Unit, Deakin University , Geelong, Victoria, Australia
| | - Stephen Hearps
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia
| | - Christian L Nicholas
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Melbourne School of Psychological Sciences, University of Melbourne , Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health , Heidelberg, Victoria, Australia
| | - Vicki A Anderson
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne , Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne , Melbourne, Australia
| | - Cathy Catroppa
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne , Melbourne, Australia
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22
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Linden MA, O’Rourke C, Lohan M. Traumatic brain injury and social competence among young male offenders. Disabil Rehabil 2020; 42:2422-2429. [DOI: 10.1080/09638288.2019.1629699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Mark A. Linden
- School of Nursing & Midwifery, Queen’s University Belfast, Belfast, UK
| | - Conall O’Rourke
- School of Nursing & Midwifery, Queen’s University Belfast, Belfast, UK
| | - Maria Lohan
- School of Nursing & Midwifery, Queen’s University Belfast, Belfast, UK
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23
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O'Brien AM, Bartlett AN, Frost N, Casey JE. Inflated scaled scores on the digital WISC-V coding subtest in a Canadian sample. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:150-157. [PMID: 32515226 DOI: 10.1080/21622965.2020.1773270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined performance differences in the traditional paper-and-pencil and new digital versions of the Coding subtest from the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) using a cross-sectional sample. A total of 212 school-aged children between 6 and 14 years old were included in the sample, with 116 completing the paper version and 96 completing the digital version administered on a tablet in 2017-2018. One-way ANOVA revealed a significant difference with large effect size between mean scaled scores, with the digital version resulting in higher scaled scores than the paper version, F (1, 210) = 67.57, p < 0.001, d = 1.14, ηp2 = 0.24. That is, normed digital scores appear inflated as compared to paper scores. No difference in raw scores was observed when controlling for age, F (1, 209) = 0.54, p > 0.05. Post-hoc analyses were performed to account for potential confounds in demographic differences and to maximize group equivalence, with the same pattern of results. Findings have important implications for clinical interpretation of Coding scores when administering the digital version of the task. Clinicians, including psychologists and neuropsychologists, should be aware of the limitations of the new digital version of this subtest, including differences in standardized performance and task requirements. Future studies using random assignment and/or repeated-measures design are needed to replicate these findings.
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Affiliation(s)
- Amanda M O'Brien
- Department of Psychology, University of Windsor, Windsor, Canada
| | | | - Natalie Frost
- Department of Psychology, University of Windsor, Windsor, Canada
| | - Joseph E Casey
- Department of Psychology, University of Windsor, Windsor, Canada
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Yehene E, Golan S, Brezner A, Gerner M, Landa J. Exploring the role of perceived vs. observed behavioral outcomes in parental grief reaction following pediatric acquired brain injury. NeuroRehabilitation 2019; 45:11-18. [PMID: 31403959 DOI: 10.3233/nre-192751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pediatric acquired brain injury may result in a significant gap between the "pre" and "post-injury" child. OBJECTIVE We aimed to quantitatively explore the mechanism underlying parents' loss experience by examining the mediating role of behavioral outcomes (observed-problems and perceived-change) in the relationship between injury severity and grief. METHOD The study employed a cross-sectional retrospective design and comprised 40 parents of children (aged 3-18 years) with moderate-severe brain injury. Data for each parent included an adapted version of the Two-Track Bereavement Questionnaire and Socio-demographics; Data for each child included the child's Information Processing Speed Index; the Child Behavioral Checklist and Parental Perception of Behavioral Changes scale. RESULTS Slowed information processing speed was significantly associated with elevated ratings on both measures of behavioral outcomes and with intensified grief. Mediation analyses revealed that parental perceived behavioral change, significantly mediate the relationship between information processing speed and grief; the Child Behavioral Checklist total score also mediated the same relationship but only in 90% confidence interval. CONCLUSIONS Findings reveal the adverse impact of behavioral outcomes on grief and suggest parents' loss experience to be stemming primarily from their subjective perception over their "changed-child", rather than the observed problems. Implications for clinical practice are discussed.
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Affiliation(s)
- Einat Yehene
- School of Behavioral Sciences, The Academic College of Tel Aviv - Yaffo, Israel.,Department of Pediatric Rehabilitation, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel
| | - Sapir Golan
- School of Behavioral Sciences, The Academic College of Tel Aviv - Yaffo, Israel
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel
| | - Maya Gerner
- Department of Pediatric Rehabilitation, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel
| | - Janna Landa
- Department of Pediatric Rehabilitation, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv - Yaffo, Israel
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Executive functions and attention 7years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l'Enfant (TGE) cohort. Ann Phys Rehabil Med 2019; 63:270-279. [PMID: 31605766 DOI: 10.1016/j.rehab.2019.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/11/2019] [Accepted: 09/14/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Severe childhood traumatic brain injury (TBI) leads to long-standing executive function and attention deficits, with negative consequences for participation, academic outcome and independence. This study aimed to assess executive function and attention 7 years after severe childhood TBI in comparison with a matched control group and to investigate associated factors. METHODS Children (<15years) with severe accidental TBI consecutively admitted in a single trauma center over 3years were included in the Traumatisme Grave de l'Enfant (TGE) prospective longitudinal study. Of the 81children initially included, 65survived. At 7years post-TBI, executive functions and attention were assessed in 27participants (42 % of the 65 survivors) by using a combination of computerized tasks from the Test of Attentional Performance (TAP) and the Behavioral Rating of Executive Functions (BRIEF) questionnaire. Patients were compared to a group of 27typically developing controls who were matched for sex, age and parental education level. RESULTS Among the 27participants, mean (SD) age at injury was 7.7 (4.6)years, and mean length of coma 5.6 (4.6) days. Regarding the TAP, the number of errors was significantly higher (P=0.003) and reaction time marginally slower (P=0.08) in the TBI than control group. The BRIEF questionnaire completed by parents indicated significantly more executive difficulties in the TBI than control group (Behavior Regulation Index, P=0.005; Metacognitive index, P=0.02; Global Executive Composite, P=0.012). Correlations between BRIEF and TAP scores did not reach statistical significance. BRIEF total score was correlated moderately with length of coma (r=0.40, P=0.037), and TAP scores were correlated with the Full-Scale Intellectual Quotient (total number of errors: r=-0.48; P=0.01; mean reaction time: r=-0.51; P=0.009). CONCLUSIONS Executive and attention deficits were evident 7 years after severe childhood TBI. Computerized tasks and questionnaires provide complementary and non-redundant information. Systematic long-term follow-up should be provided until the transition to adulthood, to assess ongoing development and to implement timely tailored interventions.
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Self- and parent-reported Quality of Life 7 years after severe childhood traumatic brain injury in the Traumatisme Grave de l'Enfant cohort: associations with objective and subjective factors and outcomes. Qual Life Res 2019; 29:515-528. [PMID: 31549364 DOI: 10.1007/s11136-019-02305-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate self- and parent-reported Health-Related Quality-of-Life (HRQoL) and their associations after severe childhood traumatic brain injury (TBI) in the Traumatisme Grave de l'Enfant (TGE) cohort. METHODS Self- (n = 34) and/or parent-reports (n = 25) of HRQoL were collected for 38 participants (age 7-22 years) 7 years after severe childhood TBI. The collected data included sociodemographic characteristics, injury severity indices, and overall disability and functional outcome at 3-months, 1- and 2-years post-injury. At 7-years post-injury, data were collected in the TBI group and in a control group (n = 33): overall disability (Glasgow Outcome Scale Extended), intellectual ability (IQ), and questionnaires assessing HRQoL (Pediatric Quality of Life Inventory), executive functions (Behavior Rating Inventory of Executive Functions), behavior (Child Behavior Checklist), fatigue (Multidimensional Fatigue Scale) and participation (Child and Adolescent Scale of Participation). RESULTS Parent- and self-reports of HRQoL were significantly lower in the TBI group than in the control group. Parent-rated HRQoL was not associated with objectively assessed factors, whereas self-reported HRQoL was associated with gender (worse in females) and initial functional outcome. All questionnaire scores completed by the same informant (self or parent) were strongly inter-correlated. CONCLUSIONS Reported HRQoL 7-years after severe childhood TBI is low compared to controls, weakly or not-related to objective factors, such as injury severity indices, clinically assessed functional outcomes, or IQ, but strongly related to reports by the same informant of executive deficits, behavior problems, fatigue, and participation.
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Haarbauer-Krupa J, Haileyesus T, Gilchrist J, Mack KA, Law CS, Joseph A. Fall-related traumatic brain injury in children ages 0-4 years. JOURNAL OF SAFETY RESEARCH 2019; 70:127-133. [PMID: 31847987 PMCID: PMC6927527 DOI: 10.1016/j.jsr.2019.06.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/24/2019] [Accepted: 06/11/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Falls are the leading cause of traumatic brain injury (TBI) for children in the 0-4 year age group. There is limited literature pertaining to fall-related TBIs in children age 4 and under and the circumstances surrounding these TBIs. This study provides a national estimate and describes actions and products associated with fall-related TBI in this age group. METHOD Data analyzed were from the 2001-2013 National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), a nationally representative sample of emergency departments (ED). Case narratives were coded for actions associated with the fall, and product codes were abstracted to determine fall location and product type. All estimates were weighted. RESULTS An estimated 139,001 children younger than 5 years were treated annually in EDs for nonfatal, unintentional fall-related TBI injuries (total = 1,807,019 during 2001-2013). Overall, child actions (e.g., running) accounted for the greatest proportion of injuries and actions by others (e.g., carrying) was highest for children younger than 1 year. The majority of falls occurred in the home, and involved surfaces, fixtures, furniture, and baby products. CONCLUSIONS Fall-related TBI in young children represents a significant public health burden. The majority of children seen for TBI assessment in EDs were released to home. Prevention efforts that target parent supervision practices and the home environment are indicated. Practical applications: Professionals in contact with parents of young children can remind them to establish a safe home and be attentive to the environment when carrying young children to prevent falls.
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Affiliation(s)
- Juliet Haarbauer-Krupa
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
| | - Tadesse Haileyesus
- Division of Analysis, Research and Practice Integration, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Julie Gilchrist
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Karin A Mack
- Division of Analysis, Research and Practice Integration, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Caitlin S Law
- Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Andrew Joseph
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America
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Fadida Y, Shapira-Vadler O, Spasser R, Frenkel-Toledo S. Reproducibility and smallest real differences of walking and Energy Expenditure Index in children and adolescents with an acquired brain injury. NeuroRehabilitation 2019; 45:19-24. [PMID: 31403952 DOI: 10.3233/nre-192716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reliable evaluation is of utmost importance to the therapist and the patient. There is no data about the test-retest reproducibility of 6-Minute Walk Test (6MWT) and Energy Expenditure Index (EEI) for children and adolescents with an Acquired Brain Injury (ABI) in the sub-acute phase. OBJECTIVE To determine test-retest reproducibility and smallest real differences (SRDs) of the 6MWT and EEI in children and adolescents with an ABI during rehabilitation in the sub-acute phase. Our second aim was to assess the correlation between the objective measure, the EEI, and the subjective perception of physical exertion obtained by using the pictorial children's effort rating scale (PCERT). METHODS Twenty eight participants (12.5±4.3 years; 10 females) with an ABI in the sub-acute phase were asked to perform the 6MWT twice during their hospitalization. Heart rate was monitored during rest and throughout the 6MWT to calculate the EEI. Intra-class correlation coefficients (ICCs) and SRDs of the 6MWT and EEI were determined. RESULTS Test-retest reproducibility was excellent for the 6MWT (ICC = 0.98, SRD = 65.73 m) and EEI tests (ICC = 0.99, SRD = 0.65 beats/m). Excluding one participant who walked extremely slowly resulted in ICC = 0.97, SRD = 67.01 m for the 6MWT, and ICC = 0.91, SRD = 0.25 beats/m for the EEI. No significant correlations were found between the EEI and PCERT. CONCLUSIONS 6MWT and EEI are reliable measures in children and adolescents with an ABI during hospitalization in the sub-acute phase.
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Affiliation(s)
- Yahaloma Fadida
- Department of Physical Therapy, Loewenstein Rehabilitation Hospital, Raanana, Israel.,Department of Pediatric and Youth Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Orit Shapira-Vadler
- Department of Physical Therapy, Loewenstein Rehabilitation Hospital, Raanana, Israel.,Department of Pediatric and Youth Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Raluca Spasser
- Department of Pediatric and Youth Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel.,Department of Physical Therapy, Loewenstein Rehabilitation Hospital, Raanana, Israel
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Hypher RE, Brandt AE, Risnes K, Rø TB, Skovlund E, Andersson S, Finnanger TG, Stubberud J. Paediatric goal management training in patients with acquired brain injury: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e029273. [PMID: 31375619 PMCID: PMC6688684 DOI: 10.1136/bmjopen-2019-029273] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/27/2019] [Accepted: 07/08/2019] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Compromised integrity of the brain due to paediatric acquired brain injury (pABI) has been associated with cognitive impairment, particularly executive dysfunction, in addition to somatic and emotional symptoms and reduced everyday function. Goal Management Training (GMT) is a cognitive rehabilitation intervention for improving executive function (EF) that has received empirical support in studies of adults with ABI. The purpose of the present study is to determine the efficacy of a recently developed paediatric version of GMT (pGMT) for children and adolescents with ABI and reported executive dysfunction. METHODS AND ANALYSIS This study protocol describes a parallel randomised controlled trial including allocation concealment and assessor blinding. Eighty survivors after pABI, aged 10-17 years at the time of intervention, will be recruited. Participants will be randomly allocated to either pGMT (n=40) or a psychoeducative control intervention (n=40; paediatric Brain Health Workshop). Both interventions consist of seven group sessions for participants and parents, followed by external cueing and telephone counselling. The study also includes involvement of teachers. Assessments will be performed at baseline, immediately postintervention and at 6 months' follow-up. Primary outcome measure will be changes in daily life EF as reported by parents (The Behavior Rating Inventory of Executive Function). Secondary outcomes include other assessments of EF (neuropsychological tests and questionnaires). Furthermore, we aim to assess generalisation effects of pGMT on other cognitive functions, as well as emotional, behavioural, adaptive and family function, academic performance, fatigue and quality of life. ETHICS AND DISSEMINATION Results from this study will be disseminated to relevant research, clinical, health service and patient communities through publications in peer-reviewed and popular science journals, in addition to presentations at scientific conferences. The study will be conducted in accordance with the Helsinki declaration and the Ethical Research Involving Children (ChildWatch International and Unicef). In accordance to Good Clinical Practice our study includes safety and quality monitoring guarantees in compliance with research ethics and safety. The trial will be reported in accordance with the Consolidated Standards of Reporting Trials 2010 statement and Standard Protocol Items for Reporting in Trials recommendations, in addition to being registered at ClinicalTrials.gov. The study has been approved by the Regional Committees for Medical and Health Research Ethics Norway (2017/772). TRIAL REGISTRATION NUMBER NCT03215342.
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Affiliation(s)
- Ruth Elizabeth Hypher
- Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent Medicine, Oslo Universitetssykehus, Oslo, Norway
| | - Anne Elisabeth Brandt
- Children's Clinic, St Olavs's Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Kari Risnes
- Children's Clinic, St Olavs's Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Torstein Baade Rø
- Children's Clinic, St Olavs's Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Stein Andersson
- Department of Psychology, Universitetet i Oslo, Oslo, Norway
| | | | - Jan Stubberud
- Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent Medicine, Oslo Universitetssykehus, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
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Galicia-Alvarado M, Alducin-Castillo J, Ramírez-Flores MJ, Sánchez Quezada AL, Yáñez-Suárez O, Flores-Ávalos B. Cognitive and spectral coherence of EEG alterations in resting state in children with chronic TBI. SALUD MENTAL 2019. [DOI: 10.17711/sm.0185-3325.2019.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. TBI is associated with alterations in cortico-subcortical connectivity. However, little attention has been paid to its clinical characteristics and functional connectivity in pediatric patients with chronic TBI. Objective. To evaluate the cognitive performance and spectral coherence of a group of children with TBI in non-acute phase. Method. Cross-sectional study of 15 children with chronic TBI and 17 healthy children. The Neuropsychological Assessment of Children (Evaluación Neuropsicológica Infantil, ENI) was used and the resting activity of the EEG with eyes-closed was recorded. Offline, two-second epochs of the EEG of each participant were chosen and the spectral coherence was estimated in a range of 1.6 to 30 Hz. The cognitive performance between groups was compared with T-test/Mann-Whitney U Test and MANOVA for the coherence values. Results. The TBI group showed a lower performance (p ≤ 0.05) in metalinguistic, visuospatial skills, attention, memory, non-verbal flexibility, planning, and organization. Differences (p ≤ 0.000) were found both inter and intrahemispherically in the spectral coherence between the groups, particularly on F1-F3 (95% CI: 0.543 - 0.557) over the whole frequency range and F3-C3 (95% CI: 0.503 - 0.515) in delta, theta, alpha2, and beta frequencies. Discussion and conclusión. Our findings suggest alterations of hypo and hyper functional connectivity, particularly on the frontal and parietal lobes of both hemispheres, even after several years of a TBI. It is possible that a subtle difference in the degree of connectivity is crucial in the genesis or successful development of attentional, mnesic, executive, and visuospatial processes.
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Affiliation(s)
- Marlene Galicia-Alvarado
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico
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Dooley B, Stagnitti K, Galvin J. An investigation of the pretend play abilities of children with an acquired brain injury. Br J Occup Ther 2019. [DOI: 10.1177/0308022619836941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bridget Dooley
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Karen Stagnitti
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Jane Galvin
- Victorian Paediatric Rehabilitation Service, Melbourne, Victoria, Australia
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Botchway EN, Godfrey C, Anderson V, Nicholas CL, Catroppa C. Outcomes of Subjective Sleep–Wake Disturbances Twenty Years after Traumatic Brain Injury in Childhood. J Neurotrauma 2019; 36:669-678. [DOI: 10.1089/neu.2018.5743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Edith N. Botchway
- Murdoch Children's Research Institute, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Celia Godfrey
- Murdoch Children's Research Institute, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Christian L. Nicholas
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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Chea RE, Munro N, Drevensek S, Brady C, Docking K. Vocabulary skills of school-age children with acquired brain injury: an exploration of tiered word knowledge and naming errors. Brain Inj 2019; 33:657-669. [PMID: 30702947 DOI: 10.1080/02699052.2019.1567939] [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: 10/27/2022]
Abstract
BACKGROUND Vocabulary deficits are the most frequently documented communication difficulty following childhood acquired brain injury (ABI). Given the adverse consequences of limited vocabulary on academic success, it is critical to identify the presence and nature of vocabulary impairments to provide effective intervention for children with ABI. METHOD Eleven children (7;6-11;11) with moderate/severe ABI (>12 months post-injury) and individually matched typically developing (TD) controls completed an Australian adaptation of a vocabulary assessment based on a three-tiered framework: tier 1 (basic words), tier 2 (high-frequency, cross-curricular words), and tier 3 (curriculum-based words). Overall scores and tiered accuracy were compared at individual and group level. Type and frequency of expressive naming errors were also coded. RESULTS In this pilot study, children with ABI demonstrated poorer overall scores than TD children. Equivalent accuracy was noted for tier 1 words and tier 2 receptive words. However, significantly poorer accuracy was noted in the ABI group for tier 2 expressive words and all tier 3 words. The majority of naming errors were semantic across both groups although TD participants showed a wider distribution of error types. CONCLUSIONS Findings support the use of tier 2 and 3 vocabulary as intervention targets in this population within education contexts and speech pathology settings.
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Affiliation(s)
- Ruei Ern Chea
- a Discipline of Speech Pathology, Faculty of Health Sciences , University of Sydney , Lidcombe , Australia
| | - Natalie Munro
- a Discipline of Speech Pathology, Faculty of Health Sciences , University of Sydney , Lidcombe , Australia
| | - Suzi Drevensek
- b Brain Injury Service, Kids Rehab , The Children's Hospital at Westmead, Sydney Children's Hospital Network , Westmead , Australia
| | - Candice Brady
- b Brain Injury Service, Kids Rehab , The Children's Hospital at Westmead, Sydney Children's Hospital Network , Westmead , Australia
| | - Kimberley Docking
- a Discipline of Speech Pathology, Faculty of Health Sciences , University of Sydney , Lidcombe , Australia
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Molteni E, Slomine BS, Castelli E, Zasler N, Schnakers C, Estraneo A. International survey on diagnostic and prognostic procedures in pediatric disorders of consciousness. Brain Inj 2019; 33:517-528. [PMID: 30663416 DOI: 10.1080/02699052.2019.1565899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS 1. to investigate diagnostic and prognostic procedures routinely used by international professionals to assess children with disorders of consciousness (DoC); 2. to explore use and availability of internal and national guidelines for pediatric DoC; 3. to identify international differences in diagnostic/prognostic protocols. METHODS The International Brain Injury Association DoC Special Interest Group emailed a survey link to 43,469 professionals. The survey included questions on diagnostic/prognostic procedures and guidelines for children with DoC. RESULTS Data on 82 respondents [(50% physicians) primarily from Europe (43.9%)and North America (37.8%)] were analyzed. Common diagnostic tools included the Glasgow Coma Scale for clinical assessment (94%), the Coma Recovery Scale-Revised for outcome measurement (57%), and cerebral MRI (94%). Clinical features used most frequently to inform prognosis varied with patient age. Few respondents used national (28%) admission protocols for children with DoC, and most were unaware of published national guidelines for diagnostic (72%) and prognostic (85%) procedures. Compared to North American respondents, more European respondents were physicians and used neurophysiological data for prognosis. CONCLUSIONS This international survey provides useful information about diagnostic and prognostic procedures currently used for children with DoC and highlights the need for guidelines to promote best practices for diagnosis/prognosis in pediatric DoC.
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Affiliation(s)
- Erika Molteni
- a Acquired Brain Injury Unit, IRCCS E. Medea , Scientific Institute , Lecco , Italy.,b School of Biomedical Engineering and Imaging Sciences , King's College London , UK
| | - Beth S Slomine
- c Department of Neuropsychology , Kennedy Krieger Institute, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Enrico Castelli
- d Paediatric Neurorehabilitation Units, Neuroscience and Neurorehabilitation Department , Bambino Gesù Children's Hospital , Rome , Italy
| | - Nathan Zasler
- e Concussion Care Centre of Virginia, Ltd., Tree of Life Services, Inc., Department of Physical Medicine and Rehabilitation , Virginia Commonwealth University , Richmond , Virginia , USA.,f Department of Physical Medicine and Rehabilitation , University of Virginia , Charlottesville , Virginia , USA
| | - Caroline Schnakers
- g Research Institute , Casa Colina Hospital and Centers for Healthcare , Pomona , CA , USA
| | - Anna Estraneo
- h DOC Research Laboratory and Neurorehabilitation Unit for DOC patients , Maugeri Clinical Scientific Institutes, IRCCS , Telese Terme , Italy
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Linden MA, Glang AE, McKinlay A. A systematic review and meta-analysis of educational interventions for children and adolescents with acquired brain injury. NeuroRehabilitation 2018; 42:311-323. [DOI: 10.3233/nre-172357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mark A. Linden
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland, UK
| | - Ann E. Glang
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland, UK
- Center on Brain Injury Research and Training, University of Oregon, Eugene, OR, USA
| | - Audrey McKinlay
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland, UK
- Department of Psychology, University of Canterbury, Canterbury, New Zealand
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Sorek G, Shaklai S, Meyer S, Katz-Leurer M. Autonomic cardiac control response to walking and executive cognitive task in adolescents with acquired brain injury and typically developed controls. Brain Inj 2018. [PMID: 29533099 DOI: 10.1080/02699052.2018.1450993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Adolescents with acquired brain injury (ABI) present a range of physical and cognitive as well as cardiac autonomic control system (CACS) dysfunctions. AIM To examine the CACS response to an executive task, a physical task and a combined physical and executive task, in adolescents with ABI and typically developed (TD) controls. METHODS Included were two groups: The first group consisted of 17 adolescents (11-18 years) with ABI, during the in-patient or out-patient rehabilitation period. All were independent walkers. The second group consisted of 18-year-olds age and gender-matched TD adolescents. A Polar RS800CX device was used to assess heart rate (HR) and heart rate variability (HRV). Walking velocity was assessed by average speed on the 6-Minute Walk Test, and executive cognitive function was assessed by the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire. The physical task was walking for 5 minutes on a treadmill. The cognitive task was the Digit Span Backward test. The study included four stages divided into rest state with and without cognitive task and walking state with and without cognitive task. RESULTS Adolescents with ABI presented higher HR and lower HRV measures at rest (p-value < 0.01). A significant 'group' and 'activity' interaction effect on HRV was found; change in the activity level had significantly smaller effects on HRV parameters in adolescents with ABI as compared to controls. An interaction effect of 'cognitive' and 'activity' on HR and HRV was noted, with no significant difference between groups; at rest, performing a cognitive task was associated with reduced HRV, while during walking HRV increased. CONCLUSIONS While ABI was associated with a reduced HRV at rest and less adaptive cardiac autonomic system to activity, ABI adolescent's response to a cognitive demand during an activity task such as walking was similar to the response of TD adolescents. Accordingly, we may say that adding a cognitive task to a walking task can improve the CACS function of ABI adolescents.
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Affiliation(s)
- Gilad Sorek
- a Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,b Physiotherapy Department, Alyn Children's Hospital and Rehabilitation Center , Jerusalem , Israel
| | - Sharon Shaklai
- c Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel.,d Children Rehabilitation Department , Loewenshtein Rehabilitation Center , Raanana , Israel
| | - Shirley Meyer
- b Physiotherapy Department, Alyn Children's Hospital and Rehabilitation Center , Jerusalem , Israel
| | - Michal Katz-Leurer
- a Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Influence of Catechol-O-methyltransferase on Executive Functioning Longitudinally After Early Childhood Traumatic Brain Injury: Preliminary Findings. J Head Trauma Rehabil 2018; 31:E1-9. [PMID: 26394291 DOI: 10.1097/htr.0000000000000162] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To elucidate the association of a functional catechol-O-methyltransferase (COMT) genotype (rs4680) with recovery of executive functions up to 18 months after early childhood traumatic brain injury (TBI) compared with an orthopedic injury (OI) group. SETTING Outpatient. PARTICIPANTS A total of 134 children with a moderate to severe TBI (n = 63) or OI (n = 71) between the ages of 3 and 6 years who were followed 18 months postinjury. DESIGN Case-comparison, longitudinal cohort MAIN MEASURES : The Behavior Rating Inventory of Executive Function, developmental NEuroPSYchological Assessment (NEPSY) of Verbal Fluency, and a modified Stroop Test for young children (Shape School). RESULTS The low-activity COMT enzyme genotype (AA) was associated with better scores on the developmental NEPSY of Verbal Fluency (F = 3.80; P = .02) and the Shape School (F = 2.89; P = .06) in all participants when controlling for injury type (TBI vs OI) over the first 18 months after injury. Injury type (TBI vs OI) did not significantly moderate the effect of the COMT genotypes on executive function recovery. CONCLUSION This study provides preliminary evidence for a role of COMT genotypes in long-term recovery of executive function after pediatric TBI and OI. Larger studies are needed to determine the exact link between genetic variation in the COMT gene and TBI recovery in children.
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McKinlay A, Buck K. Misconceptions about traumatic brain injury among educators: has anything changed over the last 20 years? Disabil Rehabil 2018; 41:1419-1426. [DOI: 10.1080/09638288.2018.1429500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Audrey McKinlay
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Kimberly Buck
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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Suskauer SJ, Rane S, Reesman J, Slomine BS. Caregiver-report of symptoms following traumatic brain injury in a small clinical sample of preschool-aged children. J Pediatr Rehabil Med 2018; 11:7-14. [PMID: 29630559 DOI: 10.3233/prm-160424] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Preschool-aged children have a high rate of traumatic brain injuries (TBI). Anecdotally, caregivers of young children describe symptoms not typically associated with TBI. The objective of this study was to preliminarily describe symptoms reported following TBI in an outpatient sample of preschool-aged children. METHODS Retrospective chart review was completed of the first specialty clinic visit by 28 children ages 3 through 5 years with TBI (32% mild, 50% moderate, 18% severe) to identify post-injury symptoms elicited by caregiver interview including querying of symptoms listed on the Acute Concussion Evaluation (ACE) plus an open-ended request to describe any other symptoms. RESULTS Visits occurred on average 38 days post-injury. Caregivers endorsed typical post-concussive symptoms, with headache being most common. In addition, caregivers described other symptoms not captured by the ACE which were grouped into the following categories: Appetite Changes, Behavioral Dysregulation, Decreased Engagement, Disrupted Sleep, Enuresis, Increased Dependence, and Stomachaches. CONCLUSIONS Caregivers of preschool-aged children with TBI endorse that young children experience many typical post-concussive symptoms but also a range of other symptoms which may not be typically associated with TBI. Additional work is needed to determine whether specialized evaluation tools and educational materials may be useful for this age group.
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Affiliation(s)
- Stacy J Suskauer
- Kennedy Krieger Institute, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shruti Rane
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jennifer Reesman
- Kennedy Krieger Institute, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Beth S Slomine
- Kennedy Krieger Institute, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lah S, Black C, Gascoigne MB, Gott C, Epps A, Parry L. Accelerated Long-Term Forgetting Is Not Epilepsy Specific: Evidence from Childhood Traumatic Brain Injury. J Neurotrauma 2017; 34:2536-2544. [DOI: 10.1089/neu.2016.4872] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Suncica Lah
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, New South Wales, Australia
| | - Carly Black
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael B. Gascoigne
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, New South Wales, Australia
| | - Chloe Gott
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Epps
- Brain Injury Rehabilitation Program, Rehab2Kids, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Louise Parry
- Brain Injury Rehabilitation Program, Rehab2Kids, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Beauchamp MH, Landry-Roy C, Gravel J, Beaudoin C, Bernier A. Should Young Children with Traumatic Brain Injury Be Compared with Community or Orthopedic Control Participants? J Neurotrauma 2017; 34:2545-2552. [PMID: 28398160 DOI: 10.1089/neu.2016.4868] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pediatric traumatic brain injury (TBI) research depends on comparisons of profiles and outcomes between brain-injured individuals and groups consisting either of injured controls (e.g., orthopedic injuries, OI) or uninjured, typically developing children recruited from the community (community controls, CC). Children with OI are thought to provide optimal comparisons for individuals with TBI because they share injury-related experiences and pre-morbid characteristics; however, a study by Mathias and colleagues (2013) 1 in adults has called into question the added value of injury control groups in TBI research. The comparability of these control groups has not been established in young children. Seventy-two children with OI and 84 CC aged between 18 and 60 months were compared on a range of demographic variables, developmental and medical history, pre-injury behavioral and adaptive profiles, as well as on measures of adaptive functioning, behavior, family functioning, post-concussive symptoms, and cognition (intellectual functioning, verbal abilities, executive functioning, social cognition) 6 months after the OI. There were no statistically significant differences between the OI and CC groups on any of the variables tested, whether they related to pre-injury or post-injury characteristics. The findings are applicable to studies seeking to identify appropriate control groups in the context of preschool TBI research, and suggest no clear advantage in recruiting OI controls based on the variables studied and the methodology used. However, further work is necessary to verify additional factors and outcomes relevant to pediatric TBI research, as well as to compare outcomes between these two groups at more acute stages (i.e., prior to 6 months post-injury).
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Affiliation(s)
- Miriam H Beauchamp
- 1 Department of Psychology, University of Montreal , Montreal, Quebec, Canada .,2 Ste-Justine Hospital Research Center , Montreal, Montreal, Quebec, Canada
| | - Catherine Landry-Roy
- 1 Department of Psychology, University of Montreal , Montreal, Quebec, Canada .,2 Ste-Justine Hospital Research Center , Montreal, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- 2 Ste-Justine Hospital Research Center , Montreal, Montreal, Quebec, Canada
| | - Cindy Beaudoin
- 1 Department of Psychology, University of Montreal , Montreal, Quebec, Canada .,2 Ste-Justine Hospital Research Center , Montreal, Montreal, Quebec, Canada
| | - Annie Bernier
- 1 Department of Psychology, University of Montreal , Montreal, Quebec, Canada
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Long-Term Neuropsychological Outcomes of Childhood Onset Acute Disseminated Encephalomyelitis (ADEM): a Meta-Analysis. Neuropsychol Rev 2017; 27:124-133. [DOI: 10.1007/s11065-017-9343-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
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Faber J, Wilde EA, Hanten G, Ewing-Cobbs L, Aitken ME, Yallampalli R, MacLeod MC, Mullins SH, Chu ZD, Li X, Hunter JV, Noble-Haeusslein L, Levin HS. Ten-year outcome of early childhood traumatic brain injury: Diffusion tensor imaging of the ventral striatum in relation to executive functioning. Brain Inj 2016; 30:1635-1641. [PMID: 27680309 DOI: 10.1080/02699052.2016.1199910] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVE The long-term effects of TBI on verbal fluency and related structures, as well as the relation between cognition and structural integrity, were evaluated. It was hypothesized that the group with TBI would evidence poorer performance on cognitive measures and a decrease in structural integrity. RESEARCH DESIGN Between a paediatric group with TBI and a group of typically-developing children, the long-term effects of traumatic brain injury were investigated in relation to both structural integrity and cognition. Common metrics for diffusion tensor imaging (DTI) were used as indicators of white matter integrity. METHODS AND PROCEDURES Using DTI, this study examined ventral striatum (VS) integrity in 21 patients aged 10-18 years sustaining moderate-to-severe traumatic brain injury (TBI) 5-15 years earlier and 16 demographically comparable subjects. All participants completed Delis-Kaplan Executive Functioning System (D-KEFS) sub-tests. MAIN OUTCOMES AND RESULTS The group with TBI exhibited lower fractional anisotropy (FA) and executive functioning performance and higher apparent diffusion coefficient (ADC). DTI metrics correlated with D-KEFS performance (right VS FA with Inhibition errors, right VS ADC with Letter Fluency, left VS FA and ADC with Category Switching). CONCLUSIONS TBI affects VS integrity, even in a chronic phase, and may contribute to executive functioning deficits.
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Affiliation(s)
- J Faber
- a Rice University , Houston , TX , USA.,b Department of Physical Medicine and Rehabilitation
| | - E A Wilde
- b Department of Physical Medicine and Rehabilitation.,c Department of Neurology.,d Department of Radiology , Baylor College of Medicine , Houston , TX , USA.,e Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
| | - G Hanten
- b Department of Physical Medicine and Rehabilitation
| | - L Ewing-Cobbs
- f Children's Learning Institute and Department of Pediatrics , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - M E Aitken
- g Department of Pediatrics , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - R Yallampalli
- b Department of Physical Medicine and Rehabilitation.,e Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
| | - M C MacLeod
- b Department of Physical Medicine and Rehabilitation
| | - S H Mullins
- g Department of Pediatrics , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Z D Chu
- d Department of Radiology , Baylor College of Medicine , Houston , TX , USA.,h Department of Pediatric Radiology , Texas Children's Hospital , Houston , TX , USA
| | - X Li
- b Department of Physical Medicine and Rehabilitation
| | - J V Hunter
- b Department of Physical Medicine and Rehabilitation.,d Department of Radiology , Baylor College of Medicine , Houston , TX , USA.,h Department of Pediatric Radiology , Texas Children's Hospital , Houston , TX , USA
| | - L Noble-Haeusslein
- i Departments of Neurosurgical Surgery and Physical Therapy and Rehabilitation Science , University of California , San Francisco , CA , USA
| | - H S Levin
- b Department of Physical Medicine and Rehabilitation.,c Department of Neurology.,e Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
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Abstract
BACKGROUND Childhood mild traumatic brain injury (mTBI) has been associated with negative adult outcomes. Effective interventions require identification of the injury event. There is currently little information regarding the accuracy of adult recall of childhood mTBI. METHOD Prospectively collected information from a large birth cohort was used to examine adult recall accuracy at age 25 for 161 childhood mTBI events occurring before age 10. RESULTS At age 25 cohort members recalled 11 outpatient injuries and 16 inpatient injuries. Recall accuracy increased with age. Logistic regression analysis distinguished between respondents who reported and did not report a childhood mTBI event correctly classifying 84.5% of cases. Age at injury, injury severity and loss of consciousness (LoC) made a unique statistically significant contribution to the model. CONCLUSIONS Most childhood mTBI events are not recalled in adulthood. Age at injury, injury severity and LoC significantly increase likelihood of recall and should be used in measures that evaluate whether injury has occurred. Implications for rehabilitation Traumatic brain injury occurs frequently and often results in ongoing deficits in attention, concentration, executive function and later mental health problems. Identification of a history of traumatic brain injury is essential to ensure that appropriate rehabilitative input is provided. Rehabilitation professionals need to be aware that mental health problems may be secondary to a prior traumatic brain injury. It is important for rehabilitation professionals elicit an accurate history of traumatic brain injury to ensure that their treatment plans are tailored to the needs of this group.
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Affiliation(s)
- Audrey McKinlay
- a Melbourne School of Psychological Science , The University of Melbourne , Melbourne , Australia
| | - L John Horwood
- b Christchurch Health and Development Study , University of Otago , Christchurch , New Zealand
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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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Gilboa Y, Kerrouche B, Longaud-Vales A, Kieffer V, Tiberghien A, Aligon D, Mariller A, Mintegui A, Canizares C, Abada G, Paule Chevignard M. Describing the attention profile of children and adolescents with acquired brain injury using the Virtual Classroom. Brain Inj 2015; 29:1691-700. [PMID: 26399584 DOI: 10.3109/02699052.2015.1075148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The objectives of the study were: (1) to describe the attention deficits profile of children with significant acquired brain injury (ABI) in comparison to matched controls, using the virtual classroom (VC); (2) to assess the utility of the VC in detecting attention deficits in children with ABI, as compared to classical neuropsychological tests and questionnaire-based assessment of attention; and (3) to determine how performance in the VC is affected by demographic and injury severity variables. METHODS Forty-one children with ABI and 35 age- and gender-matched controls, aged 8-16, were assessed with the VC. The results of the VC were compared to sub-tests of the Test of Everyday Attention for Children (TEA-Ch), the Conners' Parent Rating Scales-Revised: Short (CPRS-R:S) questionnaire and analysed according to demographic and injury severity variables. RESULTS Significant differences were found between the groups regarding the number of targets correctly identified in the VC. Significant inter-correlations were obtained between the VC variables. Significant correlations were found between the VC variables, the sub-tests of TEA-Ch and the CPRS-R:S and the demographic characteristics of the sample. CONCLUSION The VC appears to be a sensitive and ecologically valid assessment tool for use in the diagnosis of attention deficits among children with ABI.
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Affiliation(s)
- Yafit Gilboa
- a School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem , Jerusalem , Israel .,b Sorbonne Universités, UPMC Univ Paris, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB) , Paris , France
| | - Bernadette Kerrouche
- c Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals , Saint Maurice , France
| | | | - Virginie Kieffer
- d Pediatric Oncology Department , Gustave Roussy , Villejuif , France , and
| | - Anne Tiberghien
- c Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals , Saint Maurice , France
| | - Delphine Aligon
- c Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals , Saint Maurice , France
| | - Aude Mariller
- e Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals , Saint Maurice , France
| | - Amaia Mintegui
- e Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals , Saint Maurice , France
| | - Céline Canizares
- c Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals , Saint Maurice , France
| | - Geneviève Abada
- e Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals , Saint Maurice , France
| | - Mathilde Paule Chevignard
- b Sorbonne Universités, UPMC Univ Paris, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB) , Paris , France .,e Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals , Saint Maurice , France
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Catroppa C, Stone K, Hearps SJC, Soo C, Anderson V, Rosema S. Evaluation of an attention and memory intervention post-childhood acquired brain injury: Preliminary efficacy, immediate and 6 months post-intervention. Brain Inj 2015; 29:1317-24. [PMID: 26186037 DOI: 10.3109/02699052.2015.1043345] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Impairments in attention and memory are common sequelae following paediatric acquired brain injury (ABI). While it has been established that such impairments are long-term and, therefore, affect quality-of-life, there is a scarcity of evidence-based interventions to treat these difficulties. The current study aimed to pilot the efficacy of the Amsterdam Memory and Attention Training for Children (Amat-c: English version) using both neuropsychological and ecologically sensitive measures. It was expected that children with attention and memory difficulties post-ABI would show improved performance post-intervention on cognitive and ecological measures, with maintenance at 6 months post-intervention. METHODS AND PROCEDURES Ten children with an ABI, between the ages of 8-13 years at the time of recruitment were identified through audits of presentations to a metropolitan paediatric hospital. Each child underwent screening, the 18 week intervention programme, pre-intervention, immediate and 6 month post-intervention assessments. OUTCOMES/RESULTS Findings supported the hypothesis that children would show post-intervention (immediate and 6 month) improvement in areas of attention and memory, with generalization to everyday life. CONCLUSIONS/IMPLICATIONS Preliminary results provide support for the efficacy of the Amat-c post-childhood ABI. A larger study is needed to confirm these findings, as a reduction in attention and memory difficulties will enhance everyday functioning.
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Affiliation(s)
- Cathy Catroppa
- a Murdoch Children's Research Institute .,b Royal Children's Hospital , and.,c University of Melbourne , Parkville , Victoria , Australia
| | | | | | - Cheryl Soo
- a Murdoch Children's Research Institute .,c University of Melbourne , Parkville , Victoria , Australia
| | - Vicki Anderson
- a Murdoch Children's Research Institute .,b Royal Children's Hospital , and.,c University of Melbourne , Parkville , Victoria , Australia
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Dennis M, Cirino PT, Simic N, Juranek J, Taylor WP, Fletcher JM. White and grey matter relations to simple, choice, and cognitive reaction time in spina bifida. Brain Imaging Behav 2015; 10:238-51. [DOI: 10.1007/s11682-015-9388-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Predicting Adult Offending Behavior for Individuals Who Experienced a Traumatic Brain Injury During Childhood. J Head Trauma Rehabil 2014; 29:507-13. [DOI: 10.1097/htr.0000000000000000] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Garcia D, Hungerford GM, Bagner DM. Topical review: negative behavioral and cognitive outcomes following traumatic brain injury in early childhood. J Pediatr Psychol 2014; 40:391-7. [PMID: 25342645 DOI: 10.1093/jpepsy/jsu093] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 09/24/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To summarize recent research on negative behavioral and cognitive outcomes following early childhood traumatic brain injury (TBI). METHODS Topical review of the literature published since the year 2000 examining behavioral and cognitive difficulties following TBI in early childhood. RESULTS Research findings from the reviewed studies demonstrate a variety of negative behavioral and cognitive outcomes following TBI in childhood, particularly for children <5 years of age. Negative outcomes include problems with externalizing behaviors, attention, language, and cognitive functioning (e.g., IQ, executive functioning). Furthermore, negative outcomes have been shown to persist up to 16 years following the injury. CONCLUSIONS The empirical studies reviewed demonstrate the increased risk for negative behavioral and cognitive outcomes following early childhood TBI. Furthermore, the review highlights current strengths and limitations of TBI research with young children and the need for multidisciplinary work examining outcomes for this vulnerable pediatric population.
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