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Chevignard M, Câmara-Costa H, Dellatolas G. Predicting and improving outcome in severe pediatric traumatic brain injury. Expert Rev Neurother 2024:1-21. [PMID: 39140714 DOI: 10.1080/14737175.2024.2389921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 08/05/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Severe pediatric traumatic brain injury (spTBI), including abusive head trauma (AHT) in young children, is a major public health problem. Long-term consequences of spTBI include a large variety of physical, neurological, biological, cognitive, behavioral and social deficits and impairments. AREAS COVERED The present narrative review summarizes studies and reviews published from January 2019 to February 2024 on spTBI. Significant papers published before 2019 were also included. The article gives coverage to the causes of spTBI, its epidemiology and fatality rates; disparities, inequalities, and socioeconomic factors; critical care; outcomes; and interventions. EXPERT OPINION There are disparities between countries and according to socio-economic factors regarding causes, treatments and outcomes of spTBI. AHT has an overall poor outcome. Adherence to critical care guidelines is imperfect and the evidence-base of guidelines needs further investigations. Neuroimaging and biomarker predictors of outcomes is a rapidly evolving domain. Long-term cognitive, behavioral and psychosocial difficulties are the most prevalent and disabling. Their investigation should make a clear distinction between objective (clinical examination, cognitive tests, facts) and subjective measures (estimations using patient- and proxy-reported questionnaires), considering possible common source bias in reported difficulties. Family/caregiver-focused interventions, ecological approaches, and use of technology in delivery of interventions are recommended to improve long-term difficulties after spTBI.
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Affiliation(s)
- Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
- Sorbonne Université, GRC 24 Handicap Moteur Cognitif et Réadaptation (HaMCRe), AP-HP, Paris, France
| | - Hugo Câmara-Costa
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
- Sorbonne Université, GRC 24 Handicap Moteur Cognitif et Réadaptation (HaMCRe), AP-HP, Paris, France
| | - Georges Dellatolas
- Sorbonne Université, GRC 24 Handicap Moteur Cognitif et Réadaptation (HaMCRe), AP-HP, Paris, France
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Riccardi JS, Viola N, Lundine JP, Ciccia AH. Fatigue, Fogginess, and Sleep Complaints: Presence and Impact on Functioning After Childhood Traumatic Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-11. [PMID: 39083509 DOI: 10.1044/2024_ajslp-24-00108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
PURPOSE The purpose of this study was to examine the occurrence and impact of fatigue, fogginess, and sleep complaints on functioning at 3, 6, 10, and 16 months after childhood traumatic brain injury (TBI). METHOD Eighty-eight caregivers completed online surveys regarding their children with TBI, with 17 participants included at the final time point. Measures included questions related to demographic and injury characteristics, executive functioning, social relations, health-related quality of life, and fatigue, fogginess, and sleep complaints. RESULTS Fatigue, fogginess, and sleep complaints were persistent and ultimately increased at 16 months postinjury. Over half of the participants were experiencing each symptom at 16 months postinjury (i.e., 52.94% fatigue and fogginess, 58.82% sleep complaints). At 16 months postinjury, fatigue was significantly associated with female sex, and fatigue and sleep complaints were significantly associated with lower physical quality of life, but no other differences were found with symptoms and current functioning. CONCLUSIONS The results of this study support that fatigue, fogginess, and sleep complaints can persist (from baseline, from postinjury, and in fluctuation) chronically for about half of the children with TBI but little association or impact on other domains of functioning. The present study supports the continued investigation of fatigue, fogginess, and sleep complaints after childhood brain injury, but further investigation with a larger sample size is necessary to inform clinical practices for assessment and management, particularly for speech-language pathologists in rehabilitation and educational settings.
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Affiliation(s)
| | - Nicole Viola
- 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 and Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH
| | - Angela H Ciccia
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
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Botchway-Commey E, Ryan NP, Anderson V, Catroppa C. Exploring emotional distress symptom clusters in young adults with childhood traumatic brain injury. Neuropsychol Rehabil 2024:1-25. [PMID: 39031777 DOI: 10.1080/09602011.2024.2375803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 06/28/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Depression, anxiety, and stress are persistent and co-occurring symptoms in survivors of childhood traumatic brain injury (TBI), and often impact on health-related quality of life (HRQoL). This paper explored emotional distress symptom clusters and associated factors in young adults with childhood TBI. METHODS We included 54 young adults who sustained mild (n = 14), moderate (n = 27), and severe (n = 13) childhood TBI, at 20 years post-injury. The Depression Anxiety Stress Scale was administered. Cluster group membership was identified using two-step clustering and hierarchical clustering methods, and associated factors were assessed with multiple regression models. RESULTS Two symptom cluster groups were identified, including a No Distress (n = 66%) and an Elevated Distress (n = 33%) group, with the latter showing significantly higher symptoms of depression, anxiety, and stress (all p < .001). Elevated Distress group membership was linked to tobacco use and poor sleep quality, while poor HRQoL was associated with younger age at injury and Elevated Distress group membership. CONCLUSIONS Using cluster methodology, we showed that one-third of young adults with childhood TBI had elevated emotional distress symptoms. This underscores the complex emotional profile of this subgroup and the need for assessment, analysis, and treatment methods that target a range of symptoms rather than relying on single-diagnostic protocols. ABBREVIATIONS ANOVA: Analysis of Variance; CT: Computed Tomography; DASS: Depression Anxiety Stress Scale; GCS: Glasgow Coma Scale; HREC: Human Research Ethics Committee; HRQoL: Health-Related Quality of Life; IBM: International Business Machines Corporation; MRI: Magnetic Resonance Imaging; PTA: Post-Traumatic Amnesia; QoL: Quality of Life; QOLIBRI: Quality of Life after Brain Injury Scale; REDCap: Research Electronic Data Capture; SES: Socioeconomic Status; SPSS: Statistical Package for the Social Sciences; TBI: Traumatic Brain Injury.
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Affiliation(s)
- Edith Botchway-Commey
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Psychology, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Nicholas P Ryan
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Psychology, Royal Children's Hospital, Melbourne, Australia
- Cognitive Neuroscience Unit, Deakin University, Geelong, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Psychology, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Psychology, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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Lee Marmol N, Ryan NP, Sood N, Morrison E, Botchway-Commey E, Anderson V, Catroppa C. Biopsychosocial correlates of fatigue in young adult survivors of childhood traumatic brain injury: A prospective cohort study. Neuropsychol Rehabil 2024:1-18. [PMID: 38380887 DOI: 10.1080/09602011.2024.2319910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024]
Abstract
This prospective cohort study aimed to evaluate the potential role of injury, socio-demographic and individual psychological factors in predicting long-term fatigue outcomes in young adult survivors of childhood TBI at 16-years post-injury. The study included 51 young adults diagnosed with childhood TBI from 2-12 years of age. Twenty age-and-sex-matched controls were included for comparison. Findings showed that almost one-in-four TBI participants (24%) endorsed clinically elevated fatigue at 16-years post-injury. Despite the relatively large proportion of TBI participants endorsing clinically significant fatigue, group comparisons revealed that the TBI and control groups did not significantly differ on fatigue symptom severity or rates of clinically elevated fatigue. For the TBI group, post-injury fatigue was significantly associated with socio-demographic and psychological factors, including lower educational level, higher depression symptom severity, and more frequent substance use. Higher fatigue was also associated with lower self-reported quality of life (QoL) in the physical, psychological, and environmental domains, even after controlling for depressive symptom severity, socio-demographic, and injury-related factors. Overall, findings show that a substantial proportion of young adults with a history of childhood TBI experience clinically elevated fatigue at 16-years post-injury. Identification and treatment of modifiable risk-factors (e.g. depression symptoms, substance use) has potential to reduce fatigue.
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Affiliation(s)
- Nohely Lee Marmol
- Brain and Mind Research, Murdoch Children's Research Institute, Parkville, Australia
| | - Nicholas P Ryan
- Brain and Mind Research, Murdoch Children's Research Institute, Parkville, Australia
- School of Psychology, Deakin University, Geelong, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Nikita Sood
- Brain and Mind Research, Murdoch Children's Research Institute, Parkville, Australia
| | - Elle Morrison
- Brain and Mind Research, Murdoch Children's Research Institute, Parkville, Australia
| | - Edith Botchway-Commey
- Brain and Mind Research, Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Brain and Mind Research, Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- Psychology Service, The Royal Children's Hospital, Melbourne, Australia
| | - Cathy Catroppa
- Brain and Mind Research, Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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Jarvis JM, Fink EL. More than a feeling: understanding function and health related quality of life after pediatric neurocritical illness. Neurocrit Care 2021; 35:308-310. [PMID: 34286460 PMCID: PMC9558587 DOI: 10.1007/s12028-021-01270-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/04/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Jessica M Jarvis
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ericka L Fink
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
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