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Ewing-Cobbs L, Clark A, Keenan H. Long-term Participation and Functional Status in Children Who Experience Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:E162-E171. [PMID: 38032836 DOI: 10.1097/htr.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To evaluate the effect of child and family factors on children's participation outcomes 2 to 3 years following traumatic brain injury (TBI). SETTING Two level 1 pediatric trauma centers. PARTICIPANTS Children aged 0 to 15 years with TBI at all severity levels or an orthopedic injury. DESIGN Prospective cohort. MAIN MEASURES Caregivers completed the Child and Adolescent Scale of Participation (CASP) at 2- and 3-year follow-ups. The CASP was categorized as more than 90 or 90 or less on a 100-point scale, with 90 or less representing the 10th percentile and below in this sample. Modified Poisson regression models were used to describe relative risk of the CASP at 90 or less at 2 to 3 years postinjury, adjusting for preinjury family environment variables and injury group. A secondary analysis only included children who were 31 months or older at injury ( n = 441) to determine whether changes in functional outcome (Pediatric Injury Functional Outcome Scale, PIFOS) and executive functions (Behavior Rating Inventory of Executive Function, BRIEF) from preinjury to 1 year after injury predicted CASP scores at the 2- or 3-year follow-up. RESULTS Seventy-eight percent (596/769) of children who had a completed preinjury survey had a completed CASP. In the adjusted model, children with severe TBI had a nearly 3 times higher risk (RR = 2.90; 95% CI, 1.43-5.87) of reduced participation than children with an orthopedic injury. In the secondary analysis, lower functional skills (5-point increase in 1-year postinjury PIFOS score) (RR = 1.36; 95% CI, 1.18-1.57) and less favorable family function (RR = 1.46; 95% CI, 1.02-2.10) were associated with reduced participation in both girls and boys. CONCLUSION Participation in home, school, and community activities after TBI is related to multiple biopsychosocial factors. Participation-focused interventions are needed to reduce barriers to involvement and assist children and families to close the participation gap across settings.
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Affiliation(s)
- Linda Ewing-Cobbs
- Department of Pediatrics and Children's Learning Institute, McGovern Medical School, University of Texas Health Science Center at Houston (Dr Ewing-Cobbs); and Division of Critical Care, Department of Pediatrics, University of Utah (Ms Clark and Dr Keenan)
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McAdams RJ, Acevedo-Fontánez AI, Arcury-Quandt AE, Heberger JR. Head Injuries Among Children Treated in US Emergency Departments, 2015-2019. Clin Pediatr (Phila) 2024; 63:659-668. [PMID: 37553815 PMCID: PMC11403468 DOI: 10.1177/00099228231191942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
This study evaluates the epidemiology of nonfatal head injuries among children aged 1 to 4 years associated with consumer products and identifies the specific consumer products associated with these injuries. Data for children aged 1 to 4 years who presented to emergency departments (EDs) from 2015 to 2019 for a nonfatal head injury were extracted from the National Electronic Injury Surveillance System. An estimated 1 032 429 (95% confidence interval [CI]: 675 822-1 389 063) children presented to US EDs for head injuries, averaging 566 injuries daily. The average rate of head injury did not change over the 5-year study period (slope = -0.003; P = .852); it was highest among children aged 1 year (2.06 per 100 children aged 1 year), which was nearly 3 times that of children aged 4 years (rate ratio = 2.75; 95% CI: 2.73-2.77). Most injuries occurred at home (80.4%) and occurred from interacting with home furnishings (45.1%). This study underscores the need for increased head injury mitigation efforts among young children.
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Affiliation(s)
- Rebecca J McAdams
- Center for Injury Research and Policy, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Alice E Arcury-Quandt
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - John R Heberger
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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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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Gao S, Treble-Barna A, Fabio A, Beers SR, Kelly MK, Rosario BL, Bell MJ, Wisniewski SR. Effects of inpatient rehabilitation after acute care on motor, neuropsychological and behavioral outcomes in children with severe traumatic brain injury. Disabil Rehabil 2024:1-10. [PMID: 38166467 DOI: 10.1080/09638288.2023.2297920] [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: 03/26/2023] [Accepted: 12/16/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE An observational study of children with severe traumatic brain injury (TBI) (Approaches and Decisions in Acute Pediatric TBI [ADAPT] Trial) demonstrated the benefits of inpatient rehabilitation on functional outcomes for those with more severely impaired consciousness when medically stable. We conducted a secondary analysis to assess whether using an inpatient rehabilitation or skilled nursing facility after acute hospitalization was associated with better motor, neuropsychological, and behavioral outcomes compared to receiving only non-inpatient rehabilitation among children with severe TBI. MATERIALS AND METHODS We included 180 children who used an inpatient rehabilitation or skilled nursing facility and 74 children who only received non-inpatient rehabilitation from the ADAPT trial. At 12 months post-injury, children underwent tests of motor skills, intellectual functioning, verbal learning, memory, processing speed, and cognitive flexibility. Parents/guardians rated children's executive function and behaviors. We performed inverse probability weighting to adjust for potential confounders. RESULTS No significant differences were found in any motor, neuropsychological, or behavioral measures between children receiving inpatient rehabilitation and children receiving only non-inpatient rehabilitation. CONCLUSIONS Analyses of comprehensive outcomes did not show differences between children receiving inpatient rehabilitation and children receiving only non-inpatient rehabilitation, suggesting a need for more research on specific components of the rehabilitation process.
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Affiliation(s)
- Shiyao Gao
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amery Treble-Barna
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anthony Fabio
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sue R Beers
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Kathleen Kelly
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bedda L Rosario
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael J Bell
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital, WA, DC, USA
| | - Stephen R Wisniewski
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA
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Esterov D, Hines E, Neumann AA, Mara KC, Weaver AL. The Association of Adverse Childhood Experiences with Long-term Mood and Anxiety Disorders After Childhood Traumatic Brain Injury: A Population-based Case-Control Study. Arch Phys Med Rehabil 2023; 104:2075-2083. [PMID: 37467935 PMCID: PMC10792097 DOI: 10.1016/j.apmr.2023.07.002] [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: 04/18/2023] [Revised: 05/31/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To assess the association between ACEs and the development of psychiatric disorders by age 25 among individuals who sustained TBI prior to age 10. DESIGN Population-based case-control study. SETTING Olmsted County, Minnesota. PARTICIPANTS 566 individuals (N=566) who sustained a TBI prior to age 10 were identified and classified using a validated TBI classification system. Among these individuals, cases with a subsequent mood or anxiety disorder prior to age 25 were identified through clinical diagnostic codes and manual record review. For each case, a 1:1 matched control was randomly selected from individuals with a pediatric TBI who did not have a mood/anxiety disorder prior to the matched case's mood/anxiety disorder. INTERVENTIONS Not applicable MAIN OUTCOME MEASURES: Development of a mood/anxiety disorder. RESULTS Among the 114 matched pairs of individuals with a TBI prior to age 10, a subsequent mood/anxiety diagnosis was significantly associated with a history of 10 of 14 ACE categories and with having an ACE score ≥1 (odds ratio 5.17; 95% confidence interval 2.78-9.59). CONCLUSIONS This is the first population-based study to the authors' knowledge showing that among children who sustained a TBI prior to age 10, those who experienced ACEs are at increased risk of developing a mood or anxiety disorder.
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Affiliation(s)
- Dmitry Esterov
- Department of Physical Medicine and Rehabilitation Mayo Clinic, Rochester MN.
| | - Emily Hines
- Department of Physical Medicine and Rehabilitation Mayo Clinic, Rochester MN
| | - Alyssa A Neumann
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Kristin C Mara
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Amy L Weaver
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Killien EY, Watson RS, Banks RK, Reeder RW, Meert KL, Zimmerman JJ. Predicting functional and quality-of-life outcomes following pediatric sepsis: performance of PRISM-III and PELOD-2. Pediatr Res 2023; 94:1951-1957. [PMID: 37185949 PMCID: PMC10860342 DOI: 10.1038/s41390-023-02619-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Illness severity scores predict mortality following pediatric critical illness. Given declining PICU mortality, we assessed the ability of the Pediatric Risk of Mortality-III (PRISM) and Pediatric Logistic Organ Dysfunction-2 (PELOD) scores to predict morbidity outcomes. METHODS Among 359 survivors <18 years in the Life After Pediatric Sepsis Evaluation multicenter prospective cohort study, we assessed functional morbidity at hospital discharge (Functional Status Scale increase ≥3 points from baseline) and health-related quality of life (HRQL; Pediatric Quality of Life Inventory or Functional Status II-R) deterioration >25% from baseline at 1, 3, 6, and 12 months post-admission. We determined discrimination of admission PRISM and admission, maximum, and cumulative 28-day PELOD with functional and HRQL morbidity at each timepoint. RESULTS Cumulative PELOD provided the best discrimination of discharge functional morbidity (area under the receive operating characteristics curve [AUROC] 0.81, 95% CI 0.76-0.87) and 3-month HRQL deterioration (AUROC 0.71, 95% CI 0.61-0.81). Prediction was inferior for admission PRISM and PELOD and for 6- and 12-month HRQL assessments. CONCLUSIONS Illness severity scores have a good prediction of early functional morbidity but a more limited ability to predict longer-term HRQL. Identification of factors beyond illness severity that contribute to HRQL outcomes may offer opportunities for intervention to improve outcomes. IMPACT Illness severity scores are commonly used for mortality prediction and risk stratification in pediatric critical care research, quality improvement, and resource allocation algorithms. Prediction of morbidity rather than mortality may be beneficial given declining pediatric intensive care unit mortality. The PRISM and PELOD scores have moderate to good ability to predict new functional morbidity at hospital discharge following pediatric septic shock but limited ability to predict health-related quality of life outcomes in the year following PICU admission. Further research is needed to identify additional factors beyond illness severity that may impact post-discharge health-related quality of life.
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Affiliation(s)
- Elizabeth Y Killien
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA.
- Harborview Injury Prevention & Research Center, Seattle, WA, USA.
| | - R Scott Watson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
- Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, WA, USA
| | | | | | - Kathleen L Meert
- Division of Pediatric Critical Care Medicine, Children's Hospital of Michigan, Detroit, MI, USA
- Central Michigan University, Mt. Pleasant, MI, USA
| | - Jerry J Zimmerman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
- Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
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Karns CM, Wade SL, Slocumb J, Keating T, Gau JM, Slomine BS, Suskauer SJ, Glang A. Traumatic Brain Injury Positive Strategies for Families: A Pilot Randomized Controlled Trial of an Online Parent-Training Program. Arch Phys Med Rehabil 2023; 104:1026-1034. [PMID: 37142177 PMCID: PMC10330502 DOI: 10.1016/j.apmr.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/16/2023] [Accepted: 03/03/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To determine program satisfaction and preliminary efficacy of Traumatic Brain Injury Positive Strategies (TIPS), a web-based training for parenting strategies after child brain injury. DESIGN A randomized controlled trial with parallel assignment to TIPS intervention or usual-care control (TAU). The three testing time-points were pretest, posttest within 30 days of assignment, and 3-month follow-up. Reported in accordance with CONSORT extensions to randomized feasibility and pilot trials SETTING: Online. PARTICIPANTS Eighty-three volunteers recruited nationally who were 18 years of age or older, U.S. residents, English speaking and reading, had access to high-speed internet, and were living with and caring for a child who was hospitalized overnight with a brain injury (ages 3-18 years, able to follow simple commands; N=83). INTERVENTIONS Eight interactive behavioral training modules on parent strategies. The usual-care control was an informational website. MAIN OUTCOME MEASURES The proximal outcomes were User Satisfaction, Usefulness, Usability, Feature Preference, Strategy Utilization and Effectiveness, and Learning and Self-Efficacy for TIPS program participants. The primary outcomes were: Strategy Knowledge, Application, and Strategy-Application Confidence; Family Impact Module of Pediatric Quality of Life Inventory (PedsQL); and Caregiver Self-Efficacy Scale. The secondary outcomes were TIPS vs TCore PedsQL and Health Behavior Inventory (HBI) RESULTS: Pre- and posttest assessments were completed by 76 of 83 caregivers; 74 completed their 3-month follow-up. Linear growth models indicated that relative to TAU, TIPS yielded greater increases in Strategy Knowledge over the 3-month study (d=.61). Other comparisons did not reach significance. Outcomes were not moderated by child age, SES, or disability severity measured by Cognitive Function Module of PedsQL. All TIPS participants were satisfied with the program. CONCLUSIONS Of the 10 outcomes tested, only TBI knowledge significantly improved relative to TAU.
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Affiliation(s)
| | - Shari L Wade
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Jody Slocumb
- Department of Psychology, University of Oregon, Eugene, OR
| | | | - Jeff M Gau
- College of Education, University of Oregon, Eugene, OR
| | - Beth S Slomine
- Kennedy Krieger Institute, Baltimore, MD; Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stacy J Suskauer
- Kennedy Krieger Institute, Baltimore, MD; Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ann Glang
- Department of Psychology, University of Oregon, Eugene, OR
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Esterov D, Witkowski J, McCall DM, Weaver AL, Brown AW. Long-Term Risk for Mood and Anxiety Disorders After Pediatric Traumatic Brain Injury: A Population-Based, Birth Cohort Analysis. J Head Trauma Rehabil 2023; 38:E212-E222. [PMID: 36731039 PMCID: PMC10413284 DOI: 10.1097/htr.0000000000000825] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine whether exposure to traumatic brain injury (TBI) before 10 years of age is associated with development of a mood or anxiety disorder by 25 years of age, and whether sex or injury severity influences this risk. SETTING Olmsted County, Minnesota. PARTICIPANTS A total of 5518 persons born from January 1, 1976, through December 31, 1982. DESIGN Population-based, birth cohort study. Children sustaining TBI before 10 years of age (index date) were confirmed by manual record review and classified by injury severity using the Mayo Classification System. Each TBI case was age- and sex-matched to 2 referents from the same birth cohort without a history of TBI at the index date. Cox proportional hazards models were fit to compare the risk of a subsequent clinically diagnosed mood or anxiety disorder by 25 years of age between TBI cases and referents. Separate analysis was performed stratified by sex and injury severity. MAIN MEASURES Incidence of mood and anxiety disorders determined through clinical diagnostic codes and manual record review. RESULTS The study included 562 children (238 females [42.3%] and 324 males [57.7%]) with TBI before 10 years of age (mean [SD] age at TBI: 4.7 [2.8] years). At least 1 mood or anxiety disorder was diagnosed for 115 persons with TBI and 215 referents. No statistically significant association existed between childhood TBI status and anxiety disorder (adjusted hazard ratio [aHR], 1.01 [95% confidence interval (CI), 0.71-1.43]; P = .97) or mood disorder (aHR, 1.16 [95% CI, 0.92-1.47]; P = .21). However, females who sustained TBI had a significantly increased risk of a subsequently diagnosed mood disorder compared with age-matched female referents (aHR, 1.40 [95% CI, 1.04-1.89]; P = .03). CONCLUSIONS This study suggests that isolated TBI before 10 years of age is not significantly associated with an increased risk of anxiety or mood disorder by 25 years of age, though females may be at an increased risk.
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Affiliation(s)
- Dmitry Esterov
- Department of Physical Medicine and Rehabilitation (Drs Esterov and Brown), Division of Clinical Trials and Biostatistics (Ms Weaver), Mayo Clinic, Rochester, Minnesota; and Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (Drs Witkowski and McCall). Dr Witkowski is now with the Department of Physical Medicine and Rehabilitation, Northwestern Medicine, Wheaton, Illinois. Dr McCall is now with the Gundersen Health System, La Crosse, Wisconsin
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McCart M, Todis B, Gomez D, Glang A. School experiences following traumatic brain injury: A longitudinal qualitative study. NeuroRehabilitation 2023:NRE220209. [PMID: 37125570 DOI: 10.3233/nre-220209] [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: 05/02/2023]
Abstract
BACKGROUND This longitudinal qualitative study tracked students with traumatic brain injury (TBI) from hospital discharge through their return to school and then for an average of four years of school. OBJECTIVE To better understand the experiences of students and parents in the education system following TBI. METHODS Participants were parents and educators of 21 students with TBI. Interviews were conducted using open-ended questions and students were observed in the classroom. RESULTS From these data, three themes were identified: lack of student tracking year to year, lack of educator training, and conflicting views between educators and parents about students' needs. These factors ultimately led to parent frustration and eventually conflict and deteriorating relationships between parents and educators. CONCLUSION The results suggest that improving educator training could positively affect the factors identified and possibly mitigate parent frustration.
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Affiliation(s)
- Melissa McCart
- Center on Brain Injury Research and Training, Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Bonnie Todis
- Center on Brain Injury Research and Training, Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Douglas Gomez
- Center on Brain Injury Research and Training, Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Ann Glang
- Center on Brain Injury Research and Training, Department of Psychology, University of Oregon, Eugene, OR, USA
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Timmermann D, Krenz U, Schmidt S, Lendt M, Salewski C, Brockmann K, von Steinbüchel N. Health-Related Quality of Life after Pediatric Traumatic Brain Injury: A Qualitative Comparison of Perspectives of Children and Adolescents after TBI and a Comparison Group without a History of TBI. J Clin Med 2022; 11:jcm11226783. [PMID: 36431260 PMCID: PMC9697382 DOI: 10.3390/jcm11226783] [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: 10/14/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The assessment of the impact of pediatric traumatic brain injury (TBI) on the health-related quality of life (HRQoL) of the children and adolescents affected can be ameliorated by a disease-specific instrument. Such an instrument does not yet exist. This qualitative study investigates how children and adolescents after TBI subjectively perceive their HRQoL and whether and how this differs from the perspective of individuals without a history of TBI. METHODS Eight problem-centered interviews were conducted with 11 children and adolescents around four years after mild TBI and with eight children and adolescents around three years after moderate to severe TBI. Nine problem-centered interviews were conducted with 25 participants without a history of TBI. The interviews were recorded and transcribed verbatim. The statements were assigned to inductively and deductively derived categories relevant to the HRQoL of children and adolescents after TBI and compared with those of individuals without a history of TBI. RESULTS The HRQoL of children and adolescents after TBI tended to display both structural and content-related differences, independently of TBI severity, on several HRQoL dimensions, in contrast to the comparison group. For example, participants after TBI reported a broader range of negative emotions (such as worry, sadness, shame, and guilt), permanent physical impairments, felt that they were treated differently from others, and perceived cognitive limitations. CONCLUSIONS The results of this qualitative study identified HRQoL dimensions that are relevant to children and adolescents after TBI and underlined the need for the development of a disease-specific instrument.
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Affiliation(s)
- Dagmar Timmermann
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
- Correspondence:
| | - Ugne Krenz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Silke Schmidt
- Department Health and Prevention, University of Greifswald, Robert-Blum-Str. 13, 17487 Greifswald, Germany
| | - Michael Lendt
- Neuropediatrics, St. Mauritius Therapeutic Clinic, Strümper Straße 111, 40670 Meerbusch, Germany
| | - Christel Salewski
- Department of Health Psychology, Germany’s State Distance-Learning University Hagen, Universitätsstr. 33, 58097 Hagen, Germany
| | - Knut Brockmann
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
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11
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Gao S, Treble-Barna A, Fabio A, Kelly MK, Beers SR, Rosario BL, Bell MJ, Wisniewski SR. Effects of inpatient rehabilitation after acute care on functional and quality-of-life outcomes in children with severe traumatic brain injury. Brain Inj 2022; 36:1280-1287. [PMID: 36101488 PMCID: PMC9890641 DOI: 10.1080/02699052.2022.2120211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 04/02/2022] [Accepted: 08/28/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Few studies have assessed the effectiveness of the rehabilitation process in children surviving severe traumatic brain injury (TBI). We evaluated whether receiving inpatient rehabilitation after acute hospitalization was associated with better functional outcomes compared to receiving only non-inpatient rehabilitation in children with severe TBI and explored an effect modification for Glasgow Coma Scale (GCS) score at hospital discharge. METHODS We included 254 children who received rehabilitation following severe TBI from a multinational observational study. The Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds), parent/guardian-reported and child-reported Pediatric Quality of Life Inventory (PedsQL) at 12 months post-injury were assessed and described using summary statistics. Unadjusted and propensity score-weighted linear/ordinal logistic regression modeling were also performed. RESULTS 180 children received inpatient rehabilitation and 74 children received only non-inpatient rehabilitation after acute hospitalization. Among children with a GCS<13 at discharge, those receiving inpatient rehabilitation had a more favorable GOS-E Peds score (OR = 0.12, p = 0.045). However, no such association was observed in children with a higher GCS. We found no differences in PedsQL scores between rehabilitation groups. CONCLUSIONS Future studies are warranted to confirm the benefits of inpatient rehabilitation for children with more severely impaired consciousness when medically stable.
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Affiliation(s)
- Shiyao Gao
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, USA
| | - Amery Treble-Barna
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, USA
| | - Anthony Fabio
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, USA
| | - M. Kathleen Kelly
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, USA
| | - Sue R. Beers
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Bedda L. Rosario
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, USA
| | - Michael J. Bell
- Department of Pediatrics, Division of Critical Care Medicine, Children’s National Hospital, Washington, D.C., USA
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12
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Crumlish L, Wallace SJ, Copley A, Rose TA. Exploring the measurement of pediatric cognitive-communication disorders in traumatic brain injury research: A scoping review. Brain Inj 2022; 36:1207-1227. [PMID: 36303459 DOI: 10.1080/02699052.2022.2111026] [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: 01/19/2023]
Abstract
OBJECTIVE To synthesize information about the constructs measured, measurement instruments used, and the timing of assessment of cognitive-communication disorders (CCDs) in pediatric traumatic brain injury (TBI) research. METHODS AND PROCEDURES Scoping review conducted in alignment with Arksey and O'Malley's five-stage methodological framework and reported per the PRISMA extension for Scoping Reviews. Inclusion criteria: (a) cohort description, case-control, and treatment studies; (b) participants with TBI aged 5-18 years; (c) communication or psychosocial outcomes; and (d) English full-text journal articles. The first author reviewed all titles, abstracts, and full-text articles; 10% were independently reviewed. OUTCOMES AND RESULTS Following screening, a total of 687 articles were included and 919 measurement instruments, measuring 2134 unique constructs, were extracted. The Child Behavior Checklist was the most used measurement instrument and 'Global Outcomes/Recovery' was the construct most frequently measured. The length of longitudinal monitoring ranged between ≤3 months and 16 years. CONCLUSIONS AND IMPLICATIONS We found considerable heterogeneity in the constructs measured, the measurement instruments used, and the timing of CCD assessment in pediatric TBI research. A consistent approach to measurement may support clinical decision-making and the efficient use of data beyond individual studies in systematic reviews and meta-analyses.
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Affiliation(s)
- Lauren Crumlish
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Queensland Aphasia Research Centre, Australia
| | - Anna Copley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Tanya A Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Queensland Aphasia Research Centre, Australia
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13
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Effect of Hypothermia Therapy on Children with Traumatic Brain Injury: A Meta-Analysis of Randomized Controlled Trials. Brain Sci 2022; 12:brainsci12081009. [PMID: 36009072 PMCID: PMC9406098 DOI: 10.3390/brainsci12081009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Hypothermia therapy is a promising therapeutic strategy for traumatic brain injury (TBI); however, some trials have shown that hypothermia therapy has a negative effect on patients with TBI. The treatment of hypothermia in children with TBI remains controversial. We conducted a search of six online databases to validate the literature on comparing hypothermia with normal therapy for children with TBI. Eight randomized controlled trials (514 patients) were included. The meta-analysis indicated that hypothermia therapy may increase the Glasgow Outcome Scale (GOS) scores. However, in terms of improving the rate of complications, intracranial pressure (ICP), mortality, cerebral perfusion pressure (CPP), and length of stay both in hospital as well as pediatric ICU, the difference was not statistically significant. Hypothermia therapy may have clinical advantages in improving the GOS scores in children with TBI compared with normothermic therapy, but hypothermia therapy may have no benefit in improving the incidence of complications, ICP, mortality, CPP, and length of stay both in pediatric ICU as well as hospital. The decision to implement hypothermia therapy for children with TBI depends on the advantages and disadvantages from many aspects and these must be considered comprehensively.
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14
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Abstract
It is unknown which families are at risk for poor outcomes following a child’s critical illness.
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15
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Olsen M, Vik A, Lien E, Schirmer-Mikalsen K, Fredriksli O, Follestad T, Sandrød O, Finnanger TG, Skandsen T. A population-based study of global outcome after moderate to severe traumatic brain injury in children and adolescents. J Neurosurg Pediatr 2022; 29:397-406. [PMID: 35061977 DOI: 10.3171/2021.11.peds21285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The primary aim of this study was to evaluate the global outcome longitudinally over 5 years in children and adolescents surviving moderate to severe traumatic brain injury (msTBI) to investigate changes in outcome over time. The secondary aim was to explore how age at the time of injury affected outcome. METHODS All children and adolescents (aged 0-17 years; subdivided into children aged 0-10 years and adolescents aged 11-17 years) with moderate (Glasgow Coma Scale [GCS] score 9-13) or severe (GCS score ≤ 8) TBI who were admitted to a level I trauma center in Norway over a 10-year period (2004-2014) were prospectively included. In addition, young adults (aged 18-24 years) with msTBI were included for comparison. Outcome was assessed with the Glasgow Outcome Scale-Extended (GOS-E) at 6 months, 12 months, and 5 years after injury. The effect of time since injury and age at injury on the probability of good outcome was estimated by the method of generalized estimating equations. RESULTS A total of 30 children, 39 adolescents, and 97 young adults were included, among which 24 children, 38 adolescents, and 76 young adults survived and were planned for follow-up. In-hospital mortality from TBI was 7% for children, 3% for adolescents, and 18% for young adults. In surviving patients at the 5-year follow-up, good recovery (GOS-E score 7 or 8) was observed in 87% of children and all adolescents with moderate TBI, as well as in 44% of children and 59% of adolescents with severe TBI. No patient remained in a persistent vegetative state. For all patients, the odds for good recovery increased from 6 to 12 months (OR 1.79, 95% CI 1.15-2.80; p = 0.010), although not from 12 months to 5 years (OR 0.98, 95% CI 0.62-1.55; p = 0.940). Children/adolescents (aged 0-17 years) had higher odds for good recovery than young adults (OR 2.86, 95% CI 1.26-6.48; p = 0.012). CONCLUSIONS In this population-based study of pediatric msTBI, surprisingly high rates of good recovery over 5 years were found, including good recovery for a large majority of children and all adolescents with moderate TBI. Less than half of the children and more than half of the adolescents with severe TBI had good outcomes. The odds for good recovery increased from 6 to 12 months and were higher in children/adolescents (aged 0-17 years) than in young adults.
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Affiliation(s)
- Mari Olsen
- 1Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital.,2Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU
| | - Anne Vik
- 2Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU.,3Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital
| | - Espen Lien
- 4Department of Pediatrics, St. Olavs Hospital, Trondheim University Hospital
| | - Kari Schirmer-Mikalsen
- 5Department of Anaesthesiology and Intensive Care, St. Olavs Hospital, Trondheim University Hospital; and
| | - Oddrun Fredriksli
- 2Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU.,3Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital
| | - Turid Follestad
- 6Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Oddrun Sandrød
- 5Department of Anaesthesiology and Intensive Care, St. Olavs Hospital, Trondheim University Hospital; and
| | - Torun G Finnanger
- 4Department of Pediatrics, St. Olavs Hospital, Trondheim University Hospital
| | - Toril Skandsen
- 1Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital.,2Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU
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16
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Components of Health-Related Quality of Life Most Affected Following Pediatric Critical Illness. Crit Care Med 2022; 50:e20-e30. [PMID: 34415865 PMCID: PMC9126196 DOI: 10.1097/ccm.0000000000005230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate which individual elements of health-related quality of life contribute most to decline in overall health-related quality of life status following pediatric critical care. DESIGN Retrospective cohort study. SETTING Seattle Children's Hospital. PATIENTS ICU patients age 1 month to 18 years admitted between December 2011 and February 2017. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We assessed health-relatedquality of life decline from baseline to postdischarge (median, 6 wk) and determined the individual items of the Pediatric Quality of Life Inventory Infant Scales (< 2 yr) and Generic Core Scales (2-18 yr) with the highest prevalence of decline. We used multivariable regression to estimate the risk of decline in each of seven thematic categories by patient age, baseline health status, diagnosis, Pediatric Risk of Mortality score, and ICU length of stay. Decline from baseline health-related quality of life occurred in 22.5% of 539 patients. Items most commonly affected for infants less than 2 years were primarily emotional (cranky/crying, sleep, and self-soothing). Children 2-18 years most commonly experienced declines in physical functioning (play/exercise, lifting, and pain). Across the entire cohort, declines in categories of energy (31.5%), activity (31.0%), sleep (28.0%), and fear (24.7%) were most commonly endorsed. Risk of decline in each category varied with patient age, medical complexity, and diagnosis. CONCLUSIONS Deconditioning, sleep, fear, and pain are important targets for intervention to improve health-related quality of life outcomes for critically ill children.
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17
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Campbell M, Zagel AL, Ortega H, Kreykes N, Tu A, Linabery AM, Plasencia L, Krause E, Bergmann KR. Quality Indicators for Children With Traumatic Brain Injury After Transition to an American College of Surgeons Level I Pediatric Trauma Center. Pediatr Emerg Care 2022; 38:e329-e336. [PMID: 33109937 DOI: 10.1097/pec.0000000000002276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to compare quality indicators, including frequency of acute surgical and emergent interventions, and resource utilization before and after American College of Surgeons (ACS) level I trauma verification among children with moderate or severe traumatic brain injury (TBI). METHODS This is a retrospective review of patients younger than 18 years treated for moderate or severe TBI, as determined by International Classification of Disease codes. Our institution obtained ACS level I trauma verification in 2013. Outcomes during the pre-ACS (June 2003-May 2008), interim (June 2008-May 2013), and post-ACS (June 2013-May 2018) periods were compared via nonparametric tests. Tests for linear trend were conducted using Cochran-Armitage tests for categorical data and by linear regression for continuous variables. RESULTS There were 677 children with moderate or severe TBIs (pre-ACS, 125; interim, 198; post-ACS, 354). Frequency of any surgical intervention increased significantly in the post-ACS period (12.2%) compared with interim (5.1%) and pre-ACS periods (5.6%, P = 0.007). More children in the post-ACS period required intracranial pressure monitoring (P = 0.017), external ventricular drain placement (P = 0.003), or endotracheal intubation (P = 0.001) compared with interim and pre-ACS periods. There was no significant change in time to operating room (P = 0.514), frequency of decompression (P = 0.096), or time to decompression (P = 0.788) between study periods. The median time to head CT decreased significantly in the post-ACS period (26 minutes; interquartile range [IQR], 9-60) compared with interim (36 minutes; IQR, 21-69) and pre-ACS periods (53 minutes; IQR, 36-89; P < 0.001). Frequency of repeat head computed tomography decreased significantly in the post-ACS period (30.2%) compared with interim (56.1%) and pre-ACS periods (64.0%, Ptrend = 0.044). CONCLUSIONS Transition to an ACS level I trauma verification was associated with improvements in quality indicators for children with moderate or severe TBI.
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Affiliation(s)
- Maryellen Campbell
- From the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | | | | | | | - Albert Tu
- Division of Pediatric Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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18
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Jimenez N, Fuentes M, Virtue A, Alonso-Gonzalez L, Lopez E, Zhou C, Crawley D, Apkon S, Johnston B, Rivara F. Feasibility and Acceptability of a Telephone-Based Intervention for Hispanic Children to Promote Treatment Adherence After Traumatic Brain Injury: A Pilot Study. J Head Trauma Rehabil 2021; 36:274-281. [PMID: 33656480 PMCID: PMC8249323 DOI: 10.1097/htr.0000000000000658] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the feasibility and acceptability of a telephone-based education and navigation program for Hispanic parents of children hospitalized with traumatic brain injury (TBI). SETTING Level I trauma hospital and pediatric inpatient rehabilitation unit in the Northwestern United States. PARTICIPANTS Fourteen Hispanic parent-child dyads. Parents were 85% female, with a mean age of 35 years. Children were 58% male, with a mean age of 9.7 years, and had been hospitalized for complicated mild/moderate (n = 5) or severe (n = 9) TBI. DESIGN Pilot prospective cohort design. MAIN MEASURES Feasibility measures include recruitment, retention, and intervention adherence rates. Acceptability of intervention was measured by parents' use of educational materials and satisfaction with navigation program. We also evaluated study processes, including completion of baseline, 3, 6, and 12 months functional assessments of the child; assessment of parental health literacy and self-efficacy; and adherence to follow-up rehabilitation appointments. RESULTS Eighty-two percent of approached potential participants were recruited into the study. One hundred percent of participants completed the intervention, and 85% had 1-year follow-up. Intervention acceptability was high: 90% reported satisfaction with navigator, and 92% used the educational manual. Assessments demonstrated significant improvement in parents' TBI caregiving and community self-efficacy; 92% attendance to follow-up rehabilitation appointments; and improvement in the child's functional measures, except communication skills. CONCLUSIONS Findings support feasibility and acceptability of a culturally relevant program to facilitate transitions of care for Hispanic children with TBI. A future randomized trial is warranted to determine the efficacy of the intervention on long-term treatment adherence and the child's post-TBI function.
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Affiliation(s)
- Nathalia Jimenez
- Departments of Anesthesiology and Pain Medicine (Dr Jimenez), Rehabilitation Medicine (Drs Fuentes and Apkon), Pediatrics (Drs Johnston and Rivara), Epidemiology (Dr Rivara), and Harborview Injury Prevention and Research Center (Drs Jimenez, Fuentes, and Rivara, Ms Virtue, and Mr Lopez), University of Washington, Seattle; Brain Injury Alliance of Washington, Seattle (Ms Crawley); and Center for Child Health, Behavior and Development, Seattle Children's Research Center, Seattle, Washington (Drs Jimenez, Fuentes, Zhou, and Rivara and Ms Alonso-Gonzalez)
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19
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Allonsius F, De Kloet AJ, Van Markus-Doornbosch F, Meesters JJL, Kromme CH, Vliet Vlieland TPM, Van Der Holst M. Parent-reported family impact in children and young adults with acquired brain injury in the outpatient rehabilitation setting. Brain Inj 2021; 35:563-573. [PMID: 33734919 DOI: 10.1080/02699052.2021.1891287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To increase knowledge/awareness on family impact (FI) after acquired brain injury (ABI) in rehabilitation settings, it is essential to investigate the associations between patient-functioning and impact on families. This has been explored in hospital-based cohorts, but not in rehabilitation settings.Methods: A cross-sectional, multi-center study among parents of children/young adults (aged 5-24 years) with ABI referred to rehabilitation was performed. Patient/injury/family-characteristics were noted, and parents completed the PedsQL™Family-Impact-Module and PedsQL™generic-core-4.0 to assess FI and health-related quality of life (HRQoL). Univariate- and multivariable-regression analyses were performed to investigate associations between HRQoL/patient/injury/family-related factors and FI.Results: 246 families participated; patients' median age was 14 year (IQR 11-16), 65 had non-traumatic-brain-injury (nTBI) (26%), 127 were female. FI was found to be considerable (median FIM-score 71.9, IQR:60-85). Especially referral to rehabilitation >6 months after onset, diminished patients' mental/emotional health and HRQoL (child/family factors), and premorbid problems were associated with higher FI.Conclusions: In this rehabilitation cohort, pediatric ABI caused considerably higher FI than in hospital-based studies with referral to rehabilitation >6 months, diminished child/family factors and presence of premorbid problems increasing FI. Assessing and monitoring FI and its associated factors enables professionals to individualize treatment, psychoeducation, support and follow-up.
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Affiliation(s)
- F Allonsius
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - A J De Kloet
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Centre of Expertsie in Health Innovations, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - F Van Markus-Doornbosch
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - J J L Meesters
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Centre of Expertsie in Health Innovations, The Hague University of Applied Sciences, The Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - C H Kromme
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands
| | - T P M Vliet Vlieland
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - M Van Der Holst
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
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20
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Anderson D, Gau JM, Beck L, Unruh D, Gioia G, McCart M, Davies SC, Slocumb J, Gomez D, Glang AE. Management of Return to School Following Brain Injury: An Evaluation Model. INTERNATIONAL JOURNAL OF EDUCATIONAL RESEARCH 2021; 108:10.1016/j.ijer.2021.101773. [PMID: 33927471 PMCID: PMC8076871 DOI: 10.1016/j.ijer.2021.101773] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Traumatic brain injury (TBI) affects children's ability to succeed at school. Few educators have the necessary training and knowledge needed to adequately monitor and treat students with a TBI, despite schools regularly serving as the long-term service provider. In this article, we describe a return to school model used in Oregon that implements best practices indicated by the extant literature, as well as our research protocol for evaluating this model. We discuss project aims and our planned procedures, including the measures used, our quasi-experimental design using matched controls, statistical power, and impact analyses. This project will provide the evidential base for implementation of a return to school model at scale.
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Affiliation(s)
| | - Jeff M. Gau
- University of Oregon, Eugene, 97403-5252, USA
| | - Laura Beck
- University of Oregon, Eugene, 97403-5252, USA
| | | | - Gerard Gioia
- Children’s National Health System, 111 Michigan
Avenue NW, Washington, DC, 20010
| | | | - Susan C Davies
- University of Dayton, University of Dayton, 300 College
Park Dayton, Ohio 45469, USA
| | | | - Doug Gomez
- University of Oregon, Eugene, 97403-5252, USA
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21
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Chevignard M, Câmara-Costa H, Dellatolas G. Pediatric traumatic brain injury and abusive head trauma. HANDBOOK OF CLINICAL NEUROLOGY 2020; 173:451-484. [PMID: 32958191 DOI: 10.1016/b978-0-444-64150-2.00032-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Childhood traumatic brain injury (TBI) commonly occurs during brain development and can have direct, immediately observable neurologic, cognitive, and behavioral consequences. However, it can also disrupt subsequent brain development, and long-term outcomes are a combination of preinjury development and abilities, consequences of brain injury, as well as delayed impaired development of skills that were immature at the time of injury. There is a growing number of studies on mild TBI/sport-related concussions, describing initial symptoms and their evolution over time and providing guidelines for effective management of symptoms and return to activity/school/sports. Mild TBI usually does not lead to long-term cognitive or academic consequences, despite reports of behavioral/psychologic issues postinjury. Regarding moderate to severe TBI, injury to the brain is more severe, with evidence of a number of detrimental consequences in various domains. Patients can display neurologic impairments (e.g., motor deficits, signs of cerebellar disorder, posttraumatic epilepsy), medical problems (e.g., endocrine pituitary deficits, sleep-wake abnormalities), or sensory deficits (e.g., visual, olfactory deficits). The most commonly reported deficits are in the cognitive-behavioral field, which tend to be significantly disabling in the long-term, impacting the development of autonomy, socialization and academic achievement, participation, quality of life, and later, independence and ability to enter the workforce (e.g., intellectual deficits, slow processing speed, attention, memory, executive functions deficits, impulsivity, intolerance to frustration). A number of factors influence outcomes following pediatric TBI, including preinjury stage of development and abilities, brain injury severity, age at injury (with younger age at injury most often associated with worse outcomes), and a number of family/environment factors (e.g., parental education and occupation, family functioning, parenting style, warmth and responsiveness, access to rehabilitation and care). Interventions should identify and target these specific factors, given their major role in postinjury outcomes. Abusive head trauma (AHT) occurs in very young children (most often <6 months) and is a form of severe TBI, usually associated with delay before appropriate care is sought. Outcomes are systematically worse following AHT than following accidental TBI, even when controlling for age at injury and injury severity. Children with moderate to severe TBI and AHT usually require specific, coordinated, multidisciplinary, and long-term rehabilitation interventions and school adaptations, until transition to adult services. Interventions should be patient- and family-centered, focusing on specific goals, comprising education about TBI, and promoting optimal parenting, communication, and collaborative problem-solving.
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Affiliation(s)
- Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Neurological Injury and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France; GRC 24, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France.
| | - Hugo Câmara-Costa
- GRC 24, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France; Centre d'Etudes en Santé des Populations, INSERM U1018, Paris, France
| | - Georges Dellatolas
- GRC 24, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France
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22
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van Markus-Doornbosch F, van der Holst M, de Kloet AJ, Vliet Vlieland TPM, Meesters JJL. Fatigue, Participation and Quality of Life in Adolescents and Young Adults with Acquired Brain Injury in an Outpatient Rehabilitation Cohort. Dev Neurorehabil 2020; 23:328-335. [PMID: 31746261 DOI: 10.1080/17518423.2019.1692948] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To study the association between fatigue and participation and QoL after acquired brain injury (ABI) in adolescents and young adults (AYAs). MATERIALS & METHODS Cross-sectional study with AYAs aged 14-25 years, diagnosed with ABI. The PedsQL™ Multidimensional Fatigue Scale, Child & Adolescent Scale of Participation, and PedsQL™4.0 Generic Core Scales were administered. RESULTS Sixty-four AYAs participated in the study, 47 with traumatic brain injury (TBI). Median age at admission was 17.6 yrs, 0.8 yrs since injury. High levels of fatigue (median 44.4 (IQR 34.7, 59.7)), limited participation (median 82.5 (IQR 68.8, 92.3)), and diminished QoL (median 63.0 (IQR 47.8, 78.3)) were reported. More fatigue was significantly associated with more participation restrictions (β 0.64, 95%CI 0.44, 0.85) and diminished QoL (β 0.87, 95%CI 0.72, 1.02). CONCLUSIONS AYAs with ABI reported high levels of fatigue, limited participation and diminished quality of life with a significant association between fatigue and both participation and QoL. Targeting fatigue in rehabilitation treatment could potentially improve participation and QoL.
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Affiliation(s)
| | - Menno van der Holst
- Basalt Rehabilitation , The Hague, The Netherlands.,Leiden University Medical Center , Leiden, The Netherlands
| | - Arend J de Kloet
- Basalt Rehabilitation , The Hague, The Netherlands.,The Hague University of Applied Sciences , The Hague, The Netherlands
| | - Thea P M Vliet Vlieland
- Basalt Rehabilitation , The Hague, The Netherlands.,Leiden University Medical Center , Leiden, The Netherlands
| | - Jorit J L Meesters
- Basalt Rehabilitation , The Hague, The Netherlands.,Leiden University Medical Center , Leiden, The Netherlands.,The Hague University of Applied Sciences , The Hague, The Netherlands
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23
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Flaherty BF, Jackson ML, Cox CS, Clark A, Ewing-Cobbs L, Holubkov R, Moore KR, Patel RP, Keenan HT. Ability of the PILOT score to predict 6-month functional outcome in pediatric patients with moderate-severe traumatic brain injury. J Pediatr Surg 2020; 55:1238-1244. [PMID: 31327541 PMCID: PMC6946892 DOI: 10.1016/j.jpedsurg.2019.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/18/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the Pediatric Intensity Level of Therapy (PILOT) score alone and in combination with Emergency Department (ED) GCS and Rotterdam score of initial head CT to predict functional outcomes in children with traumatic brain injury (TBI). METHODS Children (n=108) aged 31months-15years with moderate to severe TBI were prospectively enrolled at two sites. The ability of PILOT, ED GCS, and Rotterdam scores to predict the 6-month Pediatric Injury Functional Outcome Scale (PIFOS) was evaluated using multivariable regression models with enrollment site, age, and sex as covariates. RESULTS PILOT total (sum) score was more predictive of PIFOS (R2=0.23) compared to mean (R2 = 0.20) or peak daily PILOT scores (R2=0.11). PILOT total score predicted PIFOS better than ED GCS (R2=0.01) or Rotterdam score (R2=0.06) and was similar to PILOT, ED GCS, and Rotterdam score combined. PILOT total score performed better in patients with intracranial pressure monitors (n=30, R2=0.28, slope=0.30) than without (n=78, R2=0.09, slope=0.36). CONCLUSIONS The PILOT score correlated moderately with functional outcome following TBI and outperformed other common predictors. PILOT may be a useful predictor or moderator of functional outcomes. LEVEL OF EVIDENCE Prognosis study, Level II.
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Affiliation(s)
- Brian F. Flaherty
- Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine 295 Chipeta Way Salt Lake City, UT 84108
| | - Margaret L. Jackson
- Department of Surgery, University of Texas McGovern Medical School 6431 Fannin Street, Suite 4.331 Houston, TX 77030
| | - Charles S. Cox
- Department of Pediatric Surgery, University of Texas McGovern Medical School 6431 Fannin Street, Suite 5.258 Houston, TX 77030
| | - Amy Clark
- Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine 295 Chipeta Way Salt Lake City, UT 84108
| | - Linda Ewing-Cobbs
- Department of Pediatrics and Children’s Learning Institute, University of Texas McGovern Medical School, 7000 Fannin Street, Suite 2300, Houston, TX 77030
| | - Richard Holubkov
- Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine 295 Chipeta Way Salt Lake City, UT 84108
| | - Kevin R. Moore
- Department of Medical Imaging, Primary Children’s Hospital 100 Mario Capecchi Drive Salt Lake City, UT 84113
| | - Rajan P. Patel
- Division of Neuroradiology, Department of Diagnostic and Interventional Radiology, University of Texas McGovern Medical School, 6431 Fannin Street, Suite 2.130B Houston, TX 77030
| | - Heather T. Keenan
- Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine 295 Chipeta Way Salt Lake City, UT 84108
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Harvey J, Farquharson K, Schneider-Cline W, Bush E, Pelatti CY. Describing the Composition of Individualized Education Plans for Students With Traumatic Brain Injury. Lang Speech Hear Serv Sch 2020; 51:839-851. [PMID: 32492357 DOI: 10.1044/2020_lshss-19-00074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The purpose of this study was to explore and describe the features of Individualized Education Plans (IEPs) for a cohort of students with traumatic brain injury (TBI) to help elucidate current special education practices for students with TBI. Method We obtained permission from administrators of a local school district of 41,000 students in a Midwestern state to review de-identified IEP records of students verified with TBI. We examined demographic information (i.e., cause and age at time of injury), IEP services and intensity, IEP goal categories, and previous verification status. Results Descriptive results support that intervention services were more intense for students with TBI with greater lengths of time postinjury. Target behaviors within goals were more often related to math and reading than to the cognitive processes that govern these skills, such as attention, memory, and executive functioning. Finally, more than a third of our sample had been verified with a disability and were receiving special education services via an IEP prior to their TBI. Conclusions This work represents an important first step in understanding the special education services for students with TBI. Future research should explore interventions that are ecologically valid for school-based settings and are developed to address the idiosyncratic deficits of students with TBI, particularly interventions that focus on the underlying cognitive processes experienced by these students.
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Affiliation(s)
- Judy Harvey
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
| | - Kelly Farquharson
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | | | - Erin Bush
- Department of Communication Disorders, University of Wyoming, Laramie
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Jimenez N, Fuentes M, Frias-Garcia M, Crawley D, Moore M, Rivara F. Transitions to Outpatient Care After Traumatic Brain Injury for Hispanic Children. Hosp Pediatr 2020; 10:509-515. [PMID: 32393515 PMCID: PMC7250677 DOI: 10.1542/hpeds.2019-0304] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Rehabilitation after a child's traumatic brain injury (TBI) occurs in hospital, community, and school settings, requiring coordination of care and advocacy by parents. Our objective was to explore Hispanic parents' experiences during child's transitions of care after TBI. METHODS We conducted this qualitative study using semistructured interviews. We used a convenient sample of Hispanic parents of children hospitalized for a TBI in a single level I trauma center. Thematic content analysis using iterative deductive coding and triangulation with clinical data was conducted to identify barriers and facilitators for transitions of care. RESULTS Fifteen mothers, mostly from rural areas and with limited English proficiency, participated in the study. Obtaining outpatient rehabilitation was difficult. Barriers included lack of therapists and clinical providers close to home, worsened by insufficient transportation and other support resources; poor understanding of child's illness and treatments; and suboptimal communication with clinicians and school administrators. Facilitators included interpreter use, availability of Spanish written information, and receipt of inpatient rehabilitation. Parents of patients discharged to inpatient rehabilitation reported that observing therapies, receiving school discharge plans by hospital-teachers, and coordination of care were facilitators to access outpatient treatments and to support school return. Parents of children discharged from the hospital from acute care reported need of legal services to obtain school services. CONCLUSIONS Hispanic parents, especially those with limited English proficiency, can face significant challenges accessing TBI outpatient rehabilitation and school resources for their children. Although barriers are multifactorial, efforts to improve communication, parent's TBI education, and care coordination during transitions of care may facilitate a child's reintegration to the community and school.
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Affiliation(s)
- Nathalia Jimenez
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and
| | - Molly Fuentes
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and
| | - Mariana Frias-Garcia
- Department of Family Medicine, West Virginia University, Bridgeport, West Virginia; and
| | | | - Megan Moore
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and
| | - Frederick Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and
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Preliminary Efficacy of Online Traumatic Brain Injury Professional Development for Educators: An Exploratory Randomized Clinical Trial. J Head Trauma Rehabil 2020; 34:77-86. [PMID: 30499929 DOI: 10.1097/htr.0000000000000447] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the efficacy of an online traumatic brain injury (TBI) professional development intervention, In the Classroom After Concussion: Best Practices for Student Success. DESIGN A randomized controlled trial with a sample of 100 general educators, who were randomly assigned to the In the Classroom Web site (treatment group) or the LEARNet Web site (control group). Participants completed the pretest, accessed the In the Classroom or LEARNet site and the posttest and completed follow-up assessments 60 days after posttest. MEASURES (1) Knowledge of effective strategies for working with students with TBI; (2) knowledge application; (3) self-efficacy in handling situations presented in text and video scenarios, and (4) a standardized self-efficacy measure. RESULTS On the posttest assessment, In the Classroom educators showed significantly greater gains in knowledge (P < .0001, d = 1.36 [large effect]), TBI knowledge application (P = .0261, d = 0.46), and general self-efficacy (P = .0106, d = 0.39) than the LEARNet controls. In the Classroom educators maintained significant gains in knowledge (P = .001, d = 0.82) and general self-efficacy (P = .018, d = 0.38) but not in TBI knowledge application (P = .921, d = 0.02). CONCLUSION Given the prevalence of TBI, it is important to develop evidence-based, cost-effective approaches to knowledge transfer and exchange in TBI professional development. In the Classroom is one such approach.
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Neumane S, Câmara-Costa H, Francillette L, Araujo M, Toure H, Brugel D, Laurent-Vannier A, Ewing-Cobbs L, Meyer P, Dellatolas G, Watier L, Chevignard M. Functional outcome after severe childhood traumatic brain injury: Results of the TGE prospective longitudinal study. Ann Phys Rehabil Med 2020; 64:101375. [PMID: 32275965 DOI: 10.1016/j.rehab.2020.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Childhood severe traumatic brain injury (TBI) is a leading cause of long-lasting acquired disability, but little is known about functional outcome. OBJECTIVE We aimed to 1) study clinical recovery and functional outcome over 24 months after severe childhood TBI, 2) identify early sociodemographic and severity factors influencing outcome, and 3) examine the clinical utility of the Pediatric Injury Functional Outcome Scale (PIFOS) to assess functional outcome. METHODS Children (0-15 years) consecutively admitted in a trauma centre after accidental severe TBI over 3 years were included in a prospective longitudinal study (Traumatisme Grave de l'Enfant cohort). We measured clinical/neurological recovery, functional status (Pediatric Injury Functional Outcome Scale, [PIFOS]), overall disability (pediatric Glasgow Outcome Scale [GOS-Peds]) as well as intellectual ability (Wechsler scales) and educational outcome (mainstream school vs special education) of survivors at 1, 3, 12 and 24 months post-injury. RESULTS For 45 children (aged 3 to 15 years at injury), functional impairments were severe within the first 3 months. Despite the initial rapid clinical recovery and significant improvement over the first year, substantial alterations persisted for most children at 12 months post-TBI, with no significant improvement up to 2 years. Up to 80% of children still had moderate or severe overall disability (GOS-Peds) at 24 months. The severity of functional impairments (PIFOS) at 12 and 24 months was mostly related to socio-emotional, cognitive and physical impairments, and was significantly correlated with clinical/neurological deficits and cognitive (intellectual, executive) and behavioural disorders. Initial TBI severity was the main prognostic factor associated with functional status over the first 2 years post-injury. CONCLUSIONS Our results confirm the significant impact of severe childhood TBI on short- and medium-term functional outcomes and overall disability. All patients should benefit from systematic follow-up. The PIFOS appeared to be an accurate and reliable tool to assess functional impairment evolution and clinically meaningful outcomes over the first 2 years post-injury.
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Affiliation(s)
- Sara Neumane
- Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France; Sorbonne University, Faculty of Medicine, Paris, France
| | - Hugo Câmara-Costa
- Université Paris-Saclay, Université Paris-SUD, UVSQ, CESP, INSERM, Paris, France; Sorbonne Université, Laboratoire d'Imagerie Biomédicale, Paris, France.
| | | | - Mélanie Araujo
- INSERM UMR 1027, Laboratoire de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Hanna Toure
- Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Dominique Brugel
- Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Anne Laurent-Vannier
- Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Linda Ewing-Cobbs
- Children's Learning Institute and Department of Pediatrics, McGovern Medical School, University of Texas. Health Science Center at Houston, Texas, USA
| | - Philippe Meyer
- Pediatric Anesthesiology Department, Hôpital Necker Enfants Malades, Paris, France; Paris Descartes University, Faculty of Medicine, Paris, France
| | - Georges Dellatolas
- Université Paris-Saclay, Université Paris-SUD, UVSQ, CESP, INSERM, Paris, France; GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Sorbonne Université, Paris, France
| | - Laurence Watier
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France; Sorbonne Université, Laboratoire d'Imagerie Biomédicale, Paris, France; GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Sorbonne Université, Paris, France
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Gladstone E, Narad ME, Hussain F, Quatman-Yates CC, Hugentobler J, Wade SL, Gubanich PJ, Kurowski BG. Neurocognitive and Quality of Life Improvements Associated With Aerobic Training for Individuals With Persistent Symptoms After Mild Traumatic Brain Injury: Secondary Outcome Analysis of a Pilot Randomized Clinical Trial. Front Neurol 2019; 10:1002. [PMID: 31620073 PMCID: PMC6759771 DOI: 10.3389/fneur.2019.01002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 09/02/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To report secondary neurocognitive and quality of life outcomes for a pilot randomized clinical trial (RCT) of aerobic training for management of prolonged symptoms after a mild traumatic brain injury (mTBI) in adolescents. Setting: Outpatient research setting. Participants: Thirty adolescents between the ages of 12 and 17 years who sustained a mTBI and had between 4 and 16 weeks of persistent post-concussive symptoms. Design: Secondary outcome analysis of a partially masked RCT of sub-symptom exacerbation aerobic training compared with a full-body stretching program highlighting cognitive and quality of life outcomes. Main Measures: The secondary outcomes assessed included neurocognitive changes in fluid and crystallized age-adjusted cognition using the National Institutes of Health (NIH) toolbox and self and parent-reported total quality of life using the Pediatric Quality of Life Inventory. Results: Twenty-two percent of eligible participants enrolled in the trial. General linear models did not reveal statistically significant differences between groups. Within group analyses using paired t-tests demonstrated improvement in age-adjusted fluid cognition [t (13) = 3.39, p = 0.005, Cohen's d = 0.61] and crystallized cognition [t (13) = 2.63, p = 0.02, Cohen's d = 0.70] within the aerobic training group but no significant improvement within the stretching group. Paired t-tests demonstrated significant improvement in both self-reported and parent-reported total quality of life measures in the aerobic training group [self-report t (13) = 3.51, p = 0.004, Cohen's d = 0.94; parent-report t (13) = 6.5, p < 0.0001, Cohen's d = 1.80] and the stretching group [self-report t (14) = 4.20, p = 0.0009, Cohen's d = 1.08; parent-report t (14) = 4.06, p = 0.0012, Cohen's d = 1.045]. Conclusion: Quality of life improved significantly in both the aerobic exercise and stretching groups; however, this study suggests that only sub-symptom exacerbation aerobic training was potentially beneficial for neurocognitive recovery, particularly the fluid cognition subset in the NIH Toolbox. Limited sample size and variation in outcomes measures limited ability to detect between group differences. Future research should focus on developing larger studies to determine optimal timing post-injury and intensity of active rehabilitation to facilitate neurocognitive recovery and improve quality of life after mTBI. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02035579.
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Affiliation(s)
- Emily Gladstone
- Department of Physical Medicine and Rehabilitation, MetroHealth and Case Western Reserve College of Medicine, Cleveland, OH, United States
| | - Megan E Narad
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Fadhil Hussain
- College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Catherine C Quatman-Yates
- Division of Occupational Therapy and Physical Therapy, Department of Physical Therapy, Cincinnati Children's Hospital Medical Center, The Ohio State University, Columbus, OH, United States.,Division of Physical Therapy, Sports Medicine Research Institute, and Chronic Brain Injury Program, Columbus, OH, United States
| | - Jason Hugentobler
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Shari L Wade
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Paul J Gubanich
- Division of Sports Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University College of Medicine, Cincinnati, OH, United States.,Department of Internal Medicine, University College of Medicine, Cincinnati, OH, United States
| | - Brad G Kurowski
- Division of Pediatric Rehabilitation Medicine, Departments of Pediatrics and Neurology and Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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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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Racial Disparities in Outpatient Mental Health Service Use Among Children Hospitalized for Traumatic Brain Injury. J Head Trauma Rehabil 2019; 33:177-184. [PMID: 29194176 DOI: 10.1097/htr.0000000000000348] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine racial differences in mental health service utilization after hospitalization for traumatic brain injury (TBI) among children with Medicaid insurance. DESIGN AND MAIN MEASURES Retrospective analysis of the MarketScan Multi-State Medicaid database from 2007 to 2012 was performed. Outpatient mental health service utilization (psychiatric and psychological individual and group services) was compared at TBI hospitalization, from discharge to 3 months and from 4 to 12 months after discharge, between children of non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and "Other" racial groups. Multivariable mixed-effects Poisson regression models with robust standard errors were utilized. RESULTS A total of 5674 children (aged <21 years) were included in the study. There were no differences by race/ethnicity in mental health service utilization during hospitalization. At 3 months postdischarge, NHB children and children in the "Other" racial category were significantly less likely to receive outpatient mental health services than NHW children (NHB relative risk [RR] = 0.84; 95% confidence interval [CI], 0.72-0.98; Other RR = 0.72; 95% CI, 0.57-0.90). At 12 months, all racial minority children were significantly less likely to receive outpatient mental health services than NHW children (NHB RR = 0.84; 95% CI, 0.75-0.94; Hispanic RR = 0.72; 95% CI, 0.55-0.94; Other RR = 0.71; 95% CI, 0.60-0.84). CONCLUSIONS Racial disparities in utilization of outpatient mental health services exist for minority children hospitalized for TBI and insured by Medicaid. Future research should focus on improving transitions of care from inpatient to outpatient services for these children.
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Abstract
OBJECTIVES Mortality from pediatric sepsis has steadily declined over the past several decades; however, little is known about morbidity among survivors. We aimed to determine the prevalence of and risk factors for failure to recover to baseline health-related quality of life following community-acquired pediatric sepsis. DESIGN Retrospective cohort study. SETTING Seattle Children's Hospital. PATIENTS Children aged 1 month to 21 years admitted to the inpatient wards or ICUs from 2012 to 2015 who met 2005 consensus sepsis criteria within 4 hours of hospitalization and were enrolled in the hospital's Outcomes Assessment Program with baseline, admission, and post-discharge health-related quality of life data available. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We assessed health-related quality of life with the Pediatric Quality of Life Inventory for pre-admission baseline, admission, and post-discharge (median, 31 d) status. We determined associations between patient and illness characteristics with failure to recover within 4.5 points of baseline at follow-up (the minimum clinically significant difference between two scores). Of 790 patients, 23.8% failed to recover to baseline health-related quality of life at follow-up. Factors associated with failure to recover were septic shock, older age, private insurance, complex chronic disease, immune compromise, CNS infection or bacteremia, ICU admission, and longer length of stay. On multivariable analysis controlling for time to follow-up, failure to recover was independently associated with septic shock (relative risk, 1.79; 95% CI, 1.24-2.58), older age (relative risk, 1.02/yr; 95% CI, 1.01-1.05), immune compromise (relative risk, 1.83; 95% CI, 1.40-2.40), and length of stay (relative risk, 1.03/d; 95% CI, 1.01-1.04). CONCLUSIONS Nearly one-quarter of children surviving hospitalization for community-acquired sepsis experienced a clinically significant deterioration in health-related quality of life. We identify risk factors for poor outcomes following sepsis and highlight the need for ongoing evaluation and treatment by primary and specialty care providers for pediatric sepsis survivors after hospital discharge.
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McCart M, Glang AE, Slocumb J, Gau J, Beck L, Gomez D. A quasi-experimental study examining the effects of online traumatic brain injury professional development on educator knowledge, application, and efficacy in a practitioner setting. Disabil Rehabil 2019; 42:2430-2436. [PMID: 30978108 DOI: 10.1080/09638288.2019.1578423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Each year ∼700 000 U.S. children ages 0-19 years sustain a traumatic brain injury. Children who experience brain injury are at risk for impairments in executive function, processing speed, cognition, memory, attention, and behavior which can lead to school failure. However, few teachers or other educational professionals receive training on effectively working with students who have traumatic brain injury (TBI). The purpose of this study was to examine the efficacy of an online traumatic brain injury professional development intervention, In the Classroom after Concussion: Best Practices for Student Success.Methods: This quasi-experimental study examined the effects of online traumatic brain injury professional development (In the Classroom after Concussion: Best Practices for Student Success) on educator knowledge, knowledge application, and self-efficacy in a practitioner setting with a sample of 81 educators from all professional backgrounds. Participants completed the pretest, accessed the In the Classroom training and posttest, and completed follow-up assessments 30 days after the posttest. Measures: (1) knowledge of effective strategies for working with students with TBI; (2) knowledge application; (3) self-efficacy in handling situations presented in text and video scenarios, and (4) a standardized measure of educator self-efficacy.Results: On the posttest assessment, educators showed significant gains in knowledge (p = 0.001, r = 0.62), knowledge application (p = 0.001, r = 0.63), and self-efficacy (p = 0.008, r = 0.29). At 30-day follow up, educators maintained significant gains in knowledge (p = 0.001, r = 0.62) and self-efficacy (p value = 0.008, r = 0.28), but not in knowledge application.Conclusion: Given the prevalence of traumatic brain injury, it is important to develop evidence-based, cost-effective approaches to knowledge transfer and exchange in traumatic brain injury professional development. In the Classroom is one such approach.Implications for rehabilitationWithout training in TBI, educators will be poorly prepared to monitor students' post-injury challenges and to address learning and behavioral challenges as they occur.Given the prevalence of TBI, it is important to develop evidence-based, cost-effective approaches to knowledge transfer and exchange in TBI professional development. In the Classroom is one such approach.
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Affiliation(s)
- Melissa McCart
- Center on Brain Injury Research and Training, University of Oregon, Eugene, OR, USA
| | - Ann E Glang
- Center on Brain Injury Research and Training, University of Oregon, Eugene, OR, USA
| | - Jody Slocumb
- Center on Brain Injury Research and Training, University of Oregon, Eugene, OR, USA
| | - Jeff Gau
- Center on Brain Injury Research and Training, University of Oregon, Eugene, OR, USA
| | - Laura Beck
- Center on Brain Injury Research and Training, University of Oregon, Eugene, OR, USA
| | - Doug Gomez
- Center on Brain Injury Research and Training, University of Oregon, Eugene, OR, USA
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Câmara-Costa H, Francillette L, Opatowski M, Toure H, Brugel D, Laurent-Vannier A, Meyer P, Dellatolas G, Watier L, Chevignard M. Participation seven years after severe childhood traumatic brain injury . Disabil Rehabil 2019; 42:2402-2411. [PMID: 30950661 DOI: 10.1080/09638288.2019.1594398] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Participation in home, school and community activities is considered as the ultimate aim of rehabilitation. The aims of this study were to examine participation seven years post-severe childhood traumatic brain injury and factors associated with participation.Materials and methods: Participants were enrolled in the Traumatisme Grave de l'Enfant (Severe Childhood Injury) cohort study following severe accidental childhood traumatic brain injury. Participation seven years post-injury, was examined using parent- and self-report forms of the Child and Adolescent Scale of Participation among 37 patients [62% males, mean age 15.4 years (SD = 4.4), mean length of coma 6.68 days (SD = 4.96)] and 33 matched controls.Results: Parent reports indicated significantly lower participation among patients compared to controls, but the self-reports did not. In the traumatic brain injury group, parent-reported participation was variable, with 22% of the patients clearly showing greater restrictions than controls. Participation restrictions were significantly associated with injury severity, poor functional outcome one-year post-injury, executive and behavioral difficulties and higher fatigue levels seven years post-injury, but not with pre-injury nor family factors.Conclusions: Several years after severe childhood traumatic brain injury, participation appears to depend more on injury-related factors than on environmental factors. In self-reports assessments of participation, it could be difficult for children and adolescents to distinguish capacity from performance.Implications for rehabilitationParticipation outcomes were highly variable in a sample of patients who sustained severe childhood traumatic brain injury.Participation should be assessed systematically following severe traumatic brain injury, both initially but also in the long-term, ideally using a combination of self- and proxy-report measures.Among patients with severe injuries, the influence of initial brain injury severity markers on participation seems much stronger than that of social/family environment factors.Children's and adolescents' self-reported participation assessed with the Child and Adolescent Scale of Participation may be difficult to interpret.
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Affiliation(s)
- Hugo Câmara-Costa
- Paris-Saclay University, Paris-Sud University, UVSQ, CESP, INSERM, Paris, France.,Sorbonne University, Laboratory of Biomedical Imaging (LIB), Paris, France
| | - Leila Francillette
- Sorbonne University, Laboratory of Biomedical Imaging (LIB), Paris, France
| | - Marion Opatowski
- Department of Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Hanna Toure
- Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Dominique Brugel
- Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France.,Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Anne Laurent-Vannier
- Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France.,Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Philippe Meyer
- Department of Paediatric Anesthesiology, Hôpital Necker Enfants Malades, Paris, France.,Faculty of Medicine René Descartes, Paris 5 University, Paris, France
| | - Georges Dellatolas
- Paris-Saclay University, Paris-Sud University, UVSQ, CESP, INSERM, Paris, France
| | - Laurence Watier
- Department of Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Mathilde Chevignard
- Sorbonne University, Laboratory of Biomedical Imaging (LIB), Paris, France.,Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France.,Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France.,Clinical Research Group of Cognitive Handicap and Rehabilitation (HanCRe), Sorbonne University, Paris, France
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Cohen ML, Tulsky DS, Boulton AJ, Kisala PA, Bertisch H, Yeates KO, Zonfrillo MR, Durbin DR, Jaffe KM, Temkin N, Wang J, Rivara FP. Reliability and Construct Validity of the TBI-QOL Communication Short Form as a Parent-Proxy Report Instrument for Children With Traumatic Brain Injury. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:84-92. [PMID: 30950756 DOI: 10.1044/2018_jslhr-l-18-0074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The purpose of this study was to evaluate the internal consistency and construct validity of the Traumatic Brain Injury Quality of Life Communication Item Bank (TBI-QOL COM) short form as a parent-proxy report measure. The TBI-QOL COM is a patient-reported outcome measure of functional communication originally developed as a self-report measure for adults with traumatic brain injury (TBI), but it may also be valid as a parent-proxy report measure for children who have sustained TBI. Method One hundred twenty-nine parent-proxy raters completed the TBI-QOL COM short form 6 months postinjury as a secondary aim of a multisite study of pediatric TBI outcomes. The respondents' children with TBI were between 8 and 18 years old ( M age = 13.2 years old) at the time of injury, and the proportion of TBI severity mirrored national trends (73% complicated-mild; 27% moderate or severe). Results The parent-proxy report version of the TBI-QOL COM displayed strong internal consistency (ordinal α = .93). It also displayed evidence of known-groups validity by virtue of more severe injuries associated with more abnormal scores. The instrument also showed evidence of convergent and discriminant validity by displaying a pattern of correlations with other constructs according to their conceptual relatedness to functional communication. Conclusions This preliminary psychometric investigation of the TBI-QOL COM supports the further development of a parent report version of the instrument. Future development of the TBI-QOL COM with this population may include expanding the content of the item bank and developing calibrations specifically for parent-proxy raters. Supplemental Material https://doi.org/10.23641/asha.7616534.
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Affiliation(s)
- Matthew L Cohen
- Department of Communication Sciences and Disorders, University of Delaware, Newark
- Center for Health Assessment Research and Translation, University of Delaware, Newark
- Department of Psychological and Brain Sciences, University of Delaware, Newark
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark
- Department of Physical Therapy, University of Delaware, Newark
- Department of Psychological and Brain Sciences, University of Delaware, Newark
| | - Aaron J Boulton
- Center for Health Assessment Research and Translation, University of Delaware, Newark
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark
| | - Hilary Bertisch
- Rusk Rehabilitation, New York University Langone Medical Center, New York
| | - Keith Owen Yeates
- Department of Psychology, Hotchkiss Brain Institute, and Alberta Children's Hospital Research Institute, University of Calgary, Canada
| | | | - Dennis R Durbin
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus
| | - Kenneth M Jaffe
- Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle
| | - Nancy Temkin
- Departments of Biostatistics and Neurological Surgery, University of Washington, Seattle
| | - Jin Wang
- Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle
- Department of Pediatrics and Department of Epidemiology, University of Washington, Seattle
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35
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Lee JB, Affeldt BM, Gamboa Y, Hamer M, Dunn JF, Pardo AC, Obenaus A. Repeated Pediatric Concussions Evoke Long-Term Oligodendrocyte and White Matter Microstructural Dysregulation Distant from the Injury. Dev Neurosci 2018; 40:358-375. [PMID: 30466074 DOI: 10.1159/000494134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/30/2018] [Indexed: 11/19/2022] Open
Abstract
Concussion or mild traumatic brain injury (mTBI) is often accompanied by long-term behavioral and neuropsychological deficits. Emerging data suggest that these deficits can be exacerbated following repeated injuries. However, despite the overwhelming prevalence of mTBI in children due to falls and sports-related activities, the effects of mTBI on white matter (WM) structure and its development in children have not been extensively examined. Moreover, the effect of repeated mTBI (rmTBI) on developing WM has not yet been studied, despite the possibility of exacerbated outcomes with repeat injuries. To address this knowledge gap, we investigated the long-term effects of single (s)mTBI and rmTBI on the WM in the pediatric brain, focusing on the anterior commissure (AC), a WM structure distant to the injury site, using diffusion tensor imaging (DTI) and immunohistochemistry (IHC). We hypothesized that smTBI and rmTBI to the developing mouse brain would lead to abnormalities in microstructural integrity and impaired oligodendrocyte (OL) development. We used a postnatal day 14 Ascl1-CreER: ccGFP mouse closed head injury (CHI) model with a bilateral repeated injury. We demonstrate that smTBI and rmTBI differentially lead to myelin-related diffusion changes in the WM and to abnormal OL development in the AC, which are accompanied by behavioral deficits 2 months after the initial injury. Our results suggest that mTBIs elicit long-term behavioral alterations and OL-associated WM dysregulation in the developing brain. These findings warrant additional research into the development of WM and OL as key components of pediatric TBI pathology and potential therapeutic targets.
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Affiliation(s)
- Jeong Bin Lee
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Bethann M Affeldt
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Yaritxa Gamboa
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Mary Hamer
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Jeff F Dunn
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea C Pardo
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andre Obenaus
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA, .,Department of Pediatrics, University of California Irvine School of Medicine, Irvine, California, USA,
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36
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Lumba-Brown A, Wright DW, Sarmiento K, Houry D. Emergency Department Implementation of the Centers for Disease Control and Prevention Pediatric Mild Traumatic Brain Injury Guideline Recommendations. Ann Emerg Med 2018; 72:581-585. [PMID: 29753521 PMCID: PMC6224131 DOI: 10.1016/j.annemergmed.2018.03.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Kelly Sarmiento
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Debra Houry
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
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Lambregts SAM, Van Markus-Doornbosch F, Catsman-Berrevoets CE, Berger MAM, De Kloet AJ, Hilberink SR, Roebroeck ME. Neurological outcome in children and youth with acquired brain injury 2-year post-injury. Dev Neurorehabil 2018; 21:465-474. [PMID: 29652209 DOI: 10.1080/17518423.2018.1460770] [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: 10/17/2022]
Abstract
OBJECTIVE To determine neurological outcome in children and youth with acquired brain injury (ABI) and explore associated factors. DESIGN Cross-sectional study, two-years post-injury. PATIENTS Hospital-based sample (n=112) aged 6-22 years. METHODS Neurological outcome and participation were assessed with a multidimensional neurological examination and the Child and Adolescent Scale of Participation. Logistic regression analyses were used to explore the relationships. RESULTS Both sensorimotor and cognitive deficits were found in 30-31%, language deficits and behavioural deficits in 10-17%. Non-traumatic injury had a negative impact on neurological outcome, specifically regarding sensorimotor and language deficits. Lower education level showed a significantly poorer neurological outcome. High levels of age-expected participation were reported, with a significant relation between deficits and participation restrictions, especially at school. CONCLUSION One out of three have a poor neurological outcome, related to type of injury and lower level of education. The amount of deficits is associated with participation restrictions.
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Affiliation(s)
- Suzanne A M Lambregts
- a Department of Rehabilitation Medicine , Erasmus MC University Medical Centre, Rotterdam , The Netherlands.,b Department of Pediatric Rehabilitation , Revant Rehabilitation Centres , Breda , The Netherlands
| | | | | | - Monique A M Berger
- e Department of Acquired Brain Injury Rehabilitation , The Hague University of applied sciences, Expert Group Rehabilitation , The Hague , The Netherlands
| | - Arend J De Kloet
- c Department of Pediatric and Youth Rehabilitation , Sophia Rehabilitation Centre , The Hague , The Netherlands.,e Department of Acquired Brain Injury Rehabilitation , The Hague University of applied sciences, Expert Group Rehabilitation , The Hague , The Netherlands
| | - Sander R Hilberink
- a Department of Rehabilitation Medicine , Erasmus MC University Medical Centre, Rotterdam , The Netherlands
| | - Marij E Roebroeck
- a Department of Rehabilitation Medicine , Erasmus MC University Medical Centre, Rotterdam , The Netherlands.,f Department of Rehabilitation Medicine , Rijndam Rehabilitation Institute , Rotterdam , The Netherlands
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Golos A, Bedell G. Responsiveness and discriminant validity of the Child and Adolescent Scale of Participation across three years for children and youth with traumatic brain injury. Dev Neurorehabil 2018; 21:431-438. [PMID: 28692352 DOI: 10.1080/17518423.2017.1342711] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To examine responsiveness and discriminant validity of the Child and Adolescent Scale of Participation (CASP) across three years. METHODS Examined longitudinal data on 515 children and youth with TBI and arm injuries. Repeated measures analyses of variance were used to examine CASP scores (pre-injury; 3, 12, 24, 36 months post-injury). RESULTS Scores decreased from pre-injury to 3 months, but significantly only for moderate and severe TBI groups. Scores gradually increased post-injury for all groups except severe TBI. Scores were consistently lowest for severe TBI, followed by moderate TBI, mild TBI, and arm injury across time. Severe TBI scores were significantly lower than scores for mild TBI and arm injury, but not moderate TBI. CONCLUSIONS CASP scores were responsive to change over time at most measurements and differentiated between groups, particularly severe TBI. Further research is needed with a larger sample of children with moderate/severe TBI as they were underrepresented in this study.
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Affiliation(s)
- Anat Golos
- a School of Occupational Therapy of Hadassah and the Hebrew University , Jerusalem , Israel
| | - Gary Bedell
- b Department of Occupational Therapy , Tufts University , Medford , MA , USA
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39
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Kurowski BG, Stancin T, Taylor HG, McNally KA, Kirkwood MW, Cassedy A, King E, Sklut M, Narad ME, Wade SL. Comparative effectiveness of family problem-solving therapy (F-PST) for adolescents after traumatic brain injury: Protocol for a randomized, multicenter, clinical trial. Contemp Clin Trials Commun 2018; 10:111-120. [PMID: 30023445 PMCID: PMC6046511 DOI: 10.1016/j.conctc.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction The objective of this manuscript is to describe the methodology that will be used to test the comparative effectiveness, feasibility, and acceptability of three formats of family problem solving therapy (F-PST) for improving functional outcomes of complicated mild to severe adolescent TBI. Methods Three-arm comparative effectiveness, randomized clinical trial (RCT) design. We describe the protocol of a three-arm RCT comparing the effectiveness of three modalities of F-PST to reduce executive dysfunction and behavior problems following TBI in adolescence. The RCT will compare the relative effectiveness among face-to-face; online and self-directed; and therapist-supported online modes of treatment. Ethics and dissemination It is anticipated that findings from this work will inform future clinical care practices, with implications for treatment of other patient populations of youth with psychological symptoms arising from neurological conditions. Institutional review board approval will be obtained from all sites prior to commencement of the study.
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Affiliation(s)
- Brad G. Kurowski
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Corresponding author. Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 4009, Cincinnati, OH, 45229-3039, USA.
| | - Terry Stancin
- Case Western Reserve University and MetroHealth Medical Center, Cleveland Medical Center, Cleveland, OH, USA
| | - H. Gerry Taylor
- Biobehavioral Health Center, Nationwide Children's Hospital Research Institute, The Ohio State University, Columbus, OH, USA
- Case Western Reserve University, Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kelly A. McNally
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Michael W. Kirkwood
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy Cassedy
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eileen King
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - McKenna Sklut
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Megan E. Narad
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shari L. Wade
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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40
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Huh JW, Raghupathi R. Therapeutic strategies to target acute and long-term sequelae of pediatric traumatic brain injury. Neuropharmacology 2018; 145:153-159. [PMID: 29933010 DOI: 10.1016/j.neuropharm.2018.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 12/15/2022]
Abstract
Pediatric traumatic brain injury (TBI) remains one of the leading causes of morbidity and mortality in children. Experimental and clinical studies demonstrate that the developmental age, the type of injury (diffuse vs. focal) and sex may play important roles in the response of the developing brain to a traumatic injury. Advancements in acute neurosurgical interventions and neurocritical care have improved and led to a decrease in mortality rates over the past decades. However, survivors are left with life-long behavioral deficits underscoring the need to better define the cellular mechanisms underlying these functional changes. A better understanding of these mechanisms some of which begin in the acute post-traumatic period may likely lead to targeted treatment strategies. Key considerations in designing pre-clinical experiments to test therapeutic strategies in pediatric TBI include the use of age-appropriate and pathologically-relevant models, functional outcomes that are tested as animals age into adolescence and beyond, sex as a biological variable and the recognition that doses and dosing strategies that have been demonstrated to be effective in animal models of adult TBI may not be effective in the developing brain. This article is part of the Special Issue entitled "Novel Treatments for Traumatic Brain Injury".
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Affiliation(s)
- Jimmy W Huh
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ramesh Raghupathi
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, USA.
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41
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DePompei R, Glang A. Have we made progress with educational services for students with TBI? NeuroRehabilitation 2018; 42:255-257. [PMID: 29710739 DOI: 10.3233/nre-180001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Ann Glang
- Center on Brain Injury Research and Training, University of Oregon, Eugene, OR, USA
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42
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Keret A, Shweiki M, Bennett-Back O, Abed-Fteiha F, Matoth I, Shoshan Y, Benifla M. The clinical characteristics of posttraumatic epilepsy following moderate-to-severe traumatic brain injury in children. Seizure 2018; 58:29-34. [DOI: 10.1016/j.seizure.2018.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/01/2018] [Accepted: 03/18/2018] [Indexed: 10/17/2022] Open
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Skaper SD, Facci L, Zusso M, Giusti P. An Inflammation-Centric View of Neurological Disease: Beyond the Neuron. Front Cell Neurosci 2018; 12:72. [PMID: 29618972 PMCID: PMC5871676 DOI: 10.3389/fncel.2018.00072] [Citation(s) in RCA: 301] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/27/2018] [Indexed: 12/13/2022] Open
Abstract
Inflammation is a complex biological response fundamental to how the body deals with injury and infection to eliminate the initial cause of cell injury and effect repair. Unlike a normally beneficial acute inflammatory response, chronic inflammation can lead to tissue damage and ultimately its destruction, and often results from an inappropriate immune response. Inflammation in the nervous system (“neuroinflammation”), especially when prolonged, can be particularly injurious. While inflammation per se may not cause disease, it contributes importantly to disease pathogenesis across both the peripheral (neuropathic pain, fibromyalgia) and central [e.g., Alzheimer disease, Parkinson disease, multiple sclerosis, motor neuron disease, ischemia and traumatic brain injury, depression, and autism spectrum disorder] nervous systems. The existence of extensive lines of communication between the nervous system and immune system represents a fundamental principle underlying neuroinflammation. Immune cell-derived inflammatory molecules are critical for regulation of host responses to inflammation. Although these mediators can originate from various non-neuronal cells, important sources in the above neuropathologies appear to be microglia and mast cells, together with astrocytes and possibly also oligodendrocytes. Understanding neuroinflammation also requires an appreciation that non-neuronal cell—cell interactions, between both glia and mast cells and glia themselves, are an integral part of the inflammation process. Within this context the mast cell occupies a key niche in orchestrating the inflammatory process, from initiation to prolongation. This review will describe the current state of knowledge concerning the biology of neuroinflammation, emphasizing mast cell-glia and glia-glia interactions, then conclude with a consideration of how a cell's endogenous mechanisms might be leveraged to provide a therapeutic strategy to target neuroinflammation.
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Affiliation(s)
- Stephen D Skaper
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Laura Facci
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Morena Zusso
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Pietro Giusti
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
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44
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Lambregts S, Smetsers J, Verhoeven I, de Kloet A, van de Port I, Ribbers G, Catsman-Berrevoets C. Cognitive function and participation in children and youth with mild traumatic brain injury two years after injury. Brain Inj 2017; 32:230-241. [DOI: 10.1080/02699052.2017.1406990] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S.A.M Lambregts
- Department of Rehabilitation Medicine Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Revant Rehabilitation Centres, Breda, The Netherlands
| | - J.E.M Smetsers
- Department of Neuropsychology, Utrecht University, Utrecht, The Netherlands
| | - I.M.A.J Verhoeven
- Expertise Group, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - A.J de Kloet
- Expertise Group, The Hague University of Applied Sciences, The Hague, The Netherlands
- Department of Rehabilitation Medicine, Sophia Rehabilitation Centre, The Hague, The Netherlands
| | - I.G.L van de Port
- Department of Rehabilitation Medicine, Revant Rehabilitation Centres, Breda, The Netherlands
| | - G.M Ribbers
- Department of Rehabilitation Medicine Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Rijndam Rehabilitation Institute, Rotterdam, The Netherlands
| | - C.E Catsman-Berrevoets
- Department of Pediatric Neurology Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Chhor V, Moretti R, Le Charpentier T, Sigaut S, Lebon S, Schwendimann L, Oré MV, Zuiani C, Milan V, Josserand J, Vontell R, Pansiot J, Degos V, Ikonomidou C, Titomanlio L, Hagberg H, Gressens P, Fleiss B. Role of microglia in a mouse model of paediatric traumatic brain injury. Brain Behav Immun 2017; 63:197-209. [PMID: 27818218 PMCID: PMC5441571 DOI: 10.1016/j.bbi.2016.11.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/22/2016] [Accepted: 11/02/2016] [Indexed: 12/20/2022] Open
Abstract
The cognitive and behavioural deficits caused by traumatic brain injury (TBI) to the immature brain are more severe and persistent than TBI in the mature brain. Understanding this developmental sensitivity is critical as children under four years of age sustain TBI more frequently than any other age group. Microglia (MG), resident immune cells of the brain that mediate neuroinflammation, are activated following TBI in the immature brain. However, the type and temporal profile of this activation and the consequences of altering it are still largely unknown. In a mouse model of closed head weight drop paediatric brain trauma, we characterized i) the temporal course of total cortical neuroinflammation and the phenotype of ex vivo isolated CD11B-positive microglia/macrophage (MG/MΦ) using a battery of 32 markers, and ii) neuropathological outcome 1 and 5days post-injury. We also assessed the effects of targeting MG/MΦ activation directly, using minocycline a prototypical microglial activation antagonist, on these processes and outcome. TBI induced a moderate increase in both pro- and anti-inflammatory cytokines/chemokines in the ipsilateral hemisphere. Isolated cortical MG/MΦ expressed increased levels of markers of endogenous reparatory/regenerative and immunomodulatory phenotypes compared with shams. Blocking MG/MΦ activation with minocycline at the time of injury and 1 and 2days post-injury had only transient protective effects, reducing ventricular dilatation and cell death 1day post-injury but having no effect on injury severity at 5days. This study demonstrates that, unlike in adults, the role of MG/MΦ in injury mechanisms following TBI in the immature brain may not be negative. An improved understanding of MG/MΦ function in paediatric TBI could support translational efforts to design therapeutic interventions.
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Affiliation(s)
- Vibol Chhor
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France; Department of Anesthesia and Intensive Care, Georges Pompidou European Hospital, Paris, France
| | - Raffaella Moretti
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France; Università degli Studi di Udine, Udine, Italy
| | - Tifenn Le Charpentier
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France
| | - Stephanie Sigaut
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France
| | - Sophie Lebon
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France
| | - Leslie Schwendimann
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France
| | - Marie-Virginie Oré
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France
| | - Chiara Zuiani
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France
| | - Valentina Milan
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France
| | - Julien Josserand
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France
| | - Regina Vontell
- Department of Perinatal Imaging and Health, Department of Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Julien Pansiot
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France
| | - Vincent Degos
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France; Department of Anesthesia and Intensive Care, Pitié Salpétrière Hospital, F-75013 Paris, France
| | | | - Luigi Titomanlio
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France
| | - Henrik Hagberg
- Department of Perinatal Imaging and Health, Department of Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, United Kingdom; Department of Clinical Sciences, Sahlgrenska Academy/East Hospital, Gothenburg University, 416 85 Gothenburg, Sweden
| | - Pierre Gressens
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France; Department of Perinatal Imaging and Health, Department of Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Bobbi Fleiss
- PROTECT, INSERM, Unversité Paris Diderot, Sorbonne Paris Cité, Paris, France; PremUP, Paris, France; Department of Perinatal Imaging and Health, Department of Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, United Kingdom.
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Exercise training improves physical function and fitness in long-term paediatric brain tumour survivors treated with cranial irradiation. Eur J Cancer 2017; 80:63-72. [DOI: 10.1016/j.ejca.2017.04.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/24/2017] [Accepted: 04/20/2017] [Indexed: 11/30/2022]
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Golos A, Bedell G. Psychometric properties of the Child and Adolescent Scale of Participation (CASP) across a 3-year period for children and youth with traumatic brain injury. NeuroRehabilitation 2017; 38:311-9. [PMID: 27061159 DOI: 10.3233/nre-161322] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Children with traumatic brain injury are often restricted in their participation due to impairments and environmental barriers. Reliable and valid instruments are essential for monitoring their participation over time. OBJECTIVE To examine the construct validity and internal consistency of the Child and Adolescent Scale of Participation (CASP) across a 3-year period. METHODS A longitudinal prospective cohort study (USA) that included 926 children (0-18 years) with TBI and arm injury. Three measures were administered at 3, 12, 24, and 36 months post-injury: The CASP, Pediatric Quality of Life Inventory (PedsQL), and Adaptive Behavior Assessment Scale II (ABAS). RESULTS Associations between the CASP and PedsQL and ABAS were moderate-to-high at all time periods. Internal consistency of the CASP and its sub-sections was high, with a pattern of gradual increase over time. Factor analyses indicated a clearer four factor solution at 3, 12 and 24 months resembling the four CASP sub-sections. CONCUSIONS Results provide evidence of convergent validity and internal consistency of the CASP and support its use for assessing participation of children with TBI over time. Prudence should be taken when considering use of factor scores due to differences in factor solutions found in this study and prior studies.
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Affiliation(s)
- Anat Golos
- School of Occupational Therapy of Hadassah and the Hebrew University, Jerusalem, Israel
| | - Gary Bedell
- Tufts University, Department of Occupational Therapy, Medford, MA, USA
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Bertisch H, Rivara FP, Kisala PA, Wang J, Yeates KO, Durbin D, Zonfrillo MR, Bell MJ, Temkin N, Tulsky DS. Psychometric evaluation of the pediatric and parent-proxy Patient-Reported Outcomes Measurement Information System and the Neurology and Traumatic Brain Injury Quality of Life measurement item banks in pediatric traumatic brain injury. Qual Life Res 2017; 26:1887-1899. [PMID: 28271316 DOI: 10.1007/s11136-017-1524-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE The primary objective is to provide evidence of convergent and discriminant validity for the pediatric and parent-proxy versions of the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, Depression, Anger, Peer Relations, Mobility, Pain Interference, and Fatigue item banks, the Neurology Quality of Life measurement system (Neuro-QOL) Cognition-General Concerns and Stigma item banks, and the Traumatic Brain Injury Quality of Life (TBI-QOL) Executive Function and Headache item banks in a pediatric traumatic brain injury (TBI) sample. METHODS Participants were 134 parent-child (ages 8-18 years) days. Children all sustained TBI and the dyads completed outcome ratings 6 months after injury at one of six medical centers across the United States. Ratings included PROMIS, Neuro-QOL, and TBI-QOL item banks, as well as the Pediatric Quality of Life inventory (PedsQL), the Health Behavior Inventory (HBI), and the Strengths and Difficulties Questionnaire (SDQ) as legacy criterion measures against which these item banks were validated. RESULTS The PROMIS, Neuro-QOL, and TBI-QOL item banks demonstrated good convergent validity, as evidenced by moderate to strong correlations with comparable scales on the legacy measures. PROMIS, Neuro-QOL, and TBI-QOL item banks showed weaker correlations with ratings of unrelated constructs on legacy measures, providing evidence of discriminant validity. CONCLUSION Our results indicate that the constructs measured by the PROMIS, Neuro-QOL, and TBI-QOL item banks are valid in our pediatric TBI sample and that it is appropriate to use these standardized scores for our primary study analyses.
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Affiliation(s)
- Hilary Bertisch
- NYU Rusk Rehabilitation, New York University School of Medicine, 240 East 38th Street, Suite 17-72, New York, NY, 10016, USA.
| | - Frederick P Rivara
- Departments of Pediatrics and Epidemiology, Harborview Injury Prevention and Research Center, University of Washington, Seattle Children's Research Institute, Seattle, WA, USA
| | - Pamela A Kisala
- Center on Assessment Research and Translation, Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
| | - Keith Owen Yeates
- Department of Psychology, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, USA
| | - Dennis Durbin
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark R Zonfrillo
- Department of Emergency Medicine, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael J Bell
- Critical Care Medicine, Neurological Surgery and Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nancy Temkin
- Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle, WA, USA
| | - David S Tulsky
- Center on Assessment Research and Translation, Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE, USA.,Kessler Foundation, West Orange, NJ, USA
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Catroppa C, Hearps S, Crossley L, Yeates K, Beauchamp M, Fusella J, Anderson V. Social and Behavioral Outcomes following Childhood Traumatic Brain Injury: What Predicts Outcome at 12 Months Post-Insult? J Neurotrauma 2016; 34:1439-1447. [PMID: 27809667 DOI: 10.1089/neu.2016.4594] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study sought to investigate social and behavioral outcomes 12 months following childhood traumatic brain injury (TBI) and to identify predictors of these outcomes. The study also compared rates of impairment in social and behavioral outcomes at 12 months post-injury between children with TBI and a typically developing (TD) control group. The study comprised 114 children ages 5.5 to 16.0 years, 79 with mild, moderate, or severe TBI and 35 TD children, group-matched for age, sex and socio-economic status. Children with TBI were recruited via consecutive hospital admissions and TD children from the community. Social and behavioral outcomes were measured via parent-rated questionnaires. Analysis of covariance models identified a significant mean difference between the mild and moderate groups for social problems only, but the moderate and severe TBI groups showed a higher rate of impairment, particularly in externalizing problems. Pre-injury function, injury severity, parent mental health, and child self-esteem all contributed significantly to predicting social and behavioral outcomes. Both injury and non-injury factors should be considered when identifying children at risk for long-term difficulties in social and behavioral domains.
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Affiliation(s)
- Cathy Catroppa
- 1 Murdoch Children's Research Institute , Victoria, Australia
| | - Stephen Hearps
- 1 Murdoch Children's Research Institute , Victoria, Australia
| | - Louise Crossley
- 1 Murdoch Children's Research Institute , Victoria, Australia
| | - Keith Yeates
- 2 Yeates, Keith; Alberta Children's Hospital Research Institute , Calgary, Alberta, Canada
| | - Miriam Beauchamp
- 3 Department of Psychology, University of Montreal , Montreal, Quebec, Canada
| | | | - Vicki Anderson
- 1 Murdoch Children's Research Institute , Victoria, Australia .,5 Department of Psychology, Royal Children's Hospital , Melbourne, Australia .,6 Department of Psychological Sciences and Pediatrics, University of Melbourne , Melbourne, Australia
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