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Dowell K, Dluzniewski A, Casanova MP, Allred CM, Cady AC, Baker RT. International Knee Documentation Committee Subjective Knee Form Latent Growth Model Analysis: Assessing Recovery Trajectories. Healthcare (Basel) 2024; 12:1021. [PMID: 38786431 PMCID: PMC11121256 DOI: 10.3390/healthcare12101021] [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: 03/26/2024] [Revised: 05/01/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
Patient-Reported Outcome Measures (PROMs), such as the six-item International Knee Documentation Committee Subjective Knee Form (IKDC-6), play a crucial role in assessing health conditions and guiding clinical decisions. Latent Growth Modeling (LGM) can be employed to understand recovery trajectories in patients post-operatively. Therefore, the purpose of this study was to assess LGM properties of the IKDC-6 in patients with knee pathologies that require surgical intervention and to assess differences between subgroups (i.e., sex and age). A cross-sectional study was conducted using the Surgical Outcome System (SOS) database with patients who had undergone knee arthroscopy. Our results found that preoperative scores did not influence the rate of change overtime. Perceived knee health improved over time, with varying rates among individuals. The adolescent age subgroup and male subgroup exhibited faster recovery rates compared to the older age subgroup and female subgroup. While initial hypotheses suggested IKDC-6 could serve as a prognostic tool, results did not support this. However, results indicated favorable outcomes irrespective of preoperative perceived knee impairment levels. This study provides valuable insights into recovery dynamics following knee surgery, emphasizing the need for personalized rehabilitation strategies tailored to individual patient characteristics.
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Affiliation(s)
- Katrina Dowell
- WWAMI Medical Education Program, University of Washington School of Medicine, Seattle, WA 98195, USA;
| | - Alexandra Dluzniewski
- WWAMI Medical Education Program, University of Idaho, Moscow, ID 83844, USA; (A.D.); (M.P.C.); (C.M.A.)
- Idaho Office of Underserved and Rural Medical Research, University of Idaho, Moscow, ID 83844, USA
| | - Madeline P. Casanova
- WWAMI Medical Education Program, University of Idaho, Moscow, ID 83844, USA; (A.D.); (M.P.C.); (C.M.A.)
- Idaho Office of Underserved and Rural Medical Research, University of Idaho, Moscow, ID 83844, USA
| | - Caleb M. Allred
- WWAMI Medical Education Program, University of Idaho, Moscow, ID 83844, USA; (A.D.); (M.P.C.); (C.M.A.)
| | - Adam C. Cady
- Kaiser Permanente, Woodland Hills, CA 91367, USA;
| | - Russell T. Baker
- WWAMI Medical Education Program, University of Idaho, Moscow, ID 83844, USA; (A.D.); (M.P.C.); (C.M.A.)
- Idaho Office of Underserved and Rural Medical Research, University of Idaho, Moscow, ID 83844, 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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Blackwell LS, Grell R. Pediatric Traumatic Brain Injury: Impact on the Developing Brain. Pediatr Neurol 2023; 148:215-222. [PMID: 37652817 DOI: 10.1016/j.pediatrneurol.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/16/2023] [Accepted: 06/23/2023] [Indexed: 09/02/2023]
Abstract
Traumatic brain injury (TBI) is a serious public health concern impacting millions of children and adolescents each year. Experiencing a brain injury during key critical periods of brain development can affect the normal formation of brain networks that are responsible for a range of complex neurocognitive outcomes. In addition, there are multiple pre- and postinjury factors that influence the trajectory of recovery and outcomes. In this review, we will focus on the current state of the literature within pediatric TBI; systematically review the available research on developmental aspects of TBI in children, focusing on the pathophysiology of the injury and its impact on the developing brain; and highlight knowledge gaps for further exploration.
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Affiliation(s)
| | - Robert Grell
- Department of Pediatrics, Emory University, Atlanta, Georgia
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Crook L, Riccardi JS, Eagan-Johnson B, Vaccaro M, Ciccia AH. Factors impacting educational outcomes for students with traumatic brain injury in BrainSTEPS. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:677-687. [PMID: 36255122 DOI: 10.1080/17549507.2022.2127899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Purpose: To describe child pre-injury and injury factors impacting post-injury educational outcomes for students with traumatic brain injury (TBI) participating in a state-wide, school-based, school re-entry consultation program, BrainSTEPS in Pennsylvania.Method: Retrospective analysis of a BrainSTEPS annual follow-up survey.Result: A total of 296 parent surveys were completed. Analysis revealed a significant difference between levels of severity of TBI and current educational placement (p < 0.001), receipt of current therapy (p < 0.05) and need for additional consult (p < 0.05). Severity of TBI was not related to other examined educational outcome variables (i.e. school performance, current symptoms). History of TBI, symptoms and treatment were not found to be associated with educational outcomes.Conclusion: These results both support findings from previous studies, and extend previous work by highlighting ongoing needs, including continued, individualised support, of children who sustain a moderate-severe TBI during childhood, and are currently in the chronic stages of injury, with consideration of pre- and post- injury factors. Programs such as BrainSTEPS provide identification of educational needs and provide needed services and supports for children with TBI. Sensitive, validated measures are needed to further understand the role of pre-injury and injury factors on educational outcomes, particularly in programs like BrainSTEPS.
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Affiliation(s)
- Libby Crook
- Communication Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jessica S Riccardi
- Communication Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | - Monica Vaccaro
- Brain Injury Association of Pennsylvania, Pittsburgh, PA, USA, and
| | - Angela H Ciccia
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
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Rempe G, Petranovich C, Narad ME, Yeates KO, Taylor HG, Stancin T, Wade S. Trajectories of Executive Functions After Early Childhood Traumatic Brain Injury: Teacher Ratings in the Initial 81 Months Postinjury. J Head Trauma Rehabil 2023; 38:E203-E211. [PMID: 36730995 PMCID: PMC10102250 DOI: 10.1097/htr.0000000000000833] [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 explore teacher-rated trajectories of executive functioning (EF) after early childhood traumatic brain injury (TBI) and to identify injury-related, academic, and family factors associated with growth trajectories using latent class growth analysis. PARTICIPANTS A total of 121 children who sustained a TBI or orthopedic injury (OI) between the ages of 3 and 7 years were recruited from 3 tertiary care children's hospitals and a general hospital in Ohio, including 57 with moderate or severe TBI and 64 with OI. DESIGN Assessments were completed at baseline (0-3 months postinjury) and an average of 6, 12, 18, and 81 months postinjury. Changes in teacher-rated EF were modeled across time and heterogeneity in recovery and moderating factors was examined. MEASURES Study variables included participant demographics, teacher-rated EF (Behavior Rating Inventory of Executive Function), family functioning (McMaster Family Assessment Device), and parenting style (Parenting Practices Questionnaire). RESULTS Analysis of teacher-rated EF yielded 2 trajectories: Normative (64.71%) and At-Risk (35.29%). Traumatic brain injury was a weak predictor of membership in the At-Risk trajectory ( P = .05). Membership in the At-Risk trajectory (compared with Normative category) was associated with a higher incidence of Individualized Education Programs, higher baseline EF concerns, increased endorsement of authoritarian parenting, lower socioeconomic status, and non-White race. CONCLUSION Teacher-rated EF after pediatric TBI differs from OI. Increased EF concerns over time were associated with increased baseline EF and characteristics of the home and school environment. These findings extend previous research on recovery of EF to educational settings and outline potentially modifiable risk factors that can maximize success in the school settings for children who experience early-childhood traumatic injury.
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Affiliation(s)
- Gary Rempe
- Neuropsychological Services of New Mexico, Albuquerque, New Mexico (Dr Rempe); Children's Hospital Colorado and the University of Colorado School of Medicine, Department of Rehabilitation Medicine, Aurora, Colorado (Dr Petranovich); Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Narad); Department of Psychology, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Alberta, Calgary (Dr Yeates); Abigail Wexner Research Institute, Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio (Dr Taylor); MetroHealth Medical Center, Cleveland, Ohio (Dr Stancin); Department of Rehabilitation, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Wade)
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Brain-derived neurotrophic factor Val66Met and neuropsychological functioning after early childhood traumatic brain injury. J Int Neuropsychol Soc 2023; 29:246-256. [PMID: 35465864 PMCID: PMC9592678 DOI: 10.1017/s1355617722000194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The present study examined the differential effect of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism on neuropsychological functioning in children with traumatic brain injury (TBI) relative to orthopedic injury (OI). METHODS Participants were drawn from a prospective, longitudinal study of children who sustained a TBI (n = 69) or OI (n = 72) between 3 and 7 years of age. Children completed a battery of neuropsychological measures targeting attention, memory, and executive functions at four timepoints spanning the immediate post-acute period to 18 months post-injury. Children also completed a comparable age-appropriate battery of measures approximately 7 years post-injury. Parents rated children's dysexecutive behaviors at all timepoints. RESULTS Longitudinal mixed models revealed a significant allele status × injury group interaction with a medium effect size for verbal fluency. Cross-sectional models at 7 years post-injury revealed non-significant but medium effect sizes for the allele status x injury group interaction for fluid reasoning and immediate and delayed verbal memory. Post hoc stratified analyses revealed a consistent pattern of poorer neuropsychological functioning in Met carriers relative to Val/Val homozygotes in the TBI group, with small effect sizes; the opposite trend or no appreciable effect was observed in the OI group. CONCLUSIONS The results suggest a differential effect of the BDNF Val66Met polymorphism on verbal fluency, and possibly fluid reasoning and immediate and delayed verbal memory, in children with early TBI relative to OI. The Met allele-associated with reduced activity-dependent secretion of BDNF-may confer risk for poorer neuropsychological functioning in children with TBI.
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Larson KR, Demers LA, Holding EZ, Williams CN, Hall TA. Variability Across Caregiver and Performance-Based Measures of Executive Functioning in an Acute Pediatric Neurocritical Care Population. Neurotrauma Rep 2023; 4:97-106. [PMID: 36895819 PMCID: PMC9989517 DOI: 10.1089/neur.2022.0083] [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: 03/05/2023] Open
Abstract
Youth admitted to the pediatric intensive care unit (PICU) for traumatic brain injury (TBI) commonly struggle with long-term residual effects in the domains of physical, cognitive, emotional, and psychosocial/family functioning. In the cognitive domain, executive functioning (EF) deficits are often observed. The Behavior Rating Inventory of Executive Functioning, Second Edition (BRIEF-2) is a parent/caregiver-completed measure that is regularly utilized to assess caregivers' perspectives of daily EF abilities. Using parent/caregiver-completed measures like the BRIEF-2 in isolation as outcome measures for capturing symptom presence and severity might be problematic given that caregiver ratings are vulnerable to influence from external factors. As such, this study aimed to investigate the association between the BRIEF-2 and performance-based measures of EF in youth during the acute recovery period post-PICU admission for TBI. A secondary aim was to explore associations among potential confounding factors, including family-level distress, injury severity, and the impact of pre-existing neurodevelopmental conditions. Participants included 65 youths, 8-19 years of age, admitted to the PICU for TBI, who survived hospital discharge and were referred for follow-up care. Non-significant correlations were found between BRIEF-2 outcomes and performance-based measures of EF. Measures of injury severity were strongly correlated with scores from performance-based EF measures, but not BRIEF-2. Parent/caregiver-reported measures of their own health-related quality of life were related to caregiver responses on the BRIEF-2. Results demonstrate the differences captured by performance-based versus caregiver-report measures of EF, and also highlight the importance of considering other morbidities related to PICU admission.
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Affiliation(s)
- Kera R Larson
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Lauren A Demers
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Emily Z Holding
- Developmental Medical Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Cydni N Williams
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Trevor A Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
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Sleep and Executive Functioning in Pediatric Traumatic Brain Injury Survivors after Critical Care. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050748. [PMID: 35626925 PMCID: PMC9139390 DOI: 10.3390/children9050748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022]
Abstract
Over 50,000 children are hospitalized annually for traumatic brain injury (TBI) and face long-term cognitive morbidity. Over 50% develop sleep/wake disturbances (SWDs) that can affect brain development and healing. We hypothesized SWDs would portend worse executive function outcomes in children aged 3−18 years with TBI 1−3 months after hospital discharge. SWDs were defined using the Sleep Disturbances Scale for Children (t-scores ≥ 60). Outcomes included the Global Executive Composite (GEC, t-score) from the Behavior Rating Inventory of Executive Function, Second and Preschool Editions, and multiple objective executive function assessments combined through Principal Components Analysis into a Neurocognitive Index (NCI, z-score). Multiple linear regression evaluated associations between SWDs and executive function outcomes, controlling for covariates. Among 131 children, 68% had clinically significant SWDs, which were associated with significantly worse median scores on the GEC (56 vs. 45) and NCI (−0.02 vs. 0.42; both p < 0.05). When controlling for baseline characteristics and injury severity in multivariable analyses, SWDs were associated with worse GEC (β-coefficient = 7.8; 95% Confidence Interval = 2.5, 13.1), and worse NCI (β-coefficient = −0.4; 95% Confidence Interval = −0.8, −0.04). SWDs in children with TBI are associated with worse executive function outcomes after hospital discharge, and may serve as modifiable targets to improve outcomes.
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A Review of Family Environment and Neurobehavioral Outcomes Following Pediatric Traumatic Brain Injury: Implications of Early Adverse Experiences, Family Stress, and Limbic Development. Biol Psychiatry 2022; 91:488-497. [PMID: 34772505 DOI: 10.1016/j.biopsych.2021.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/21/2021] [Accepted: 08/11/2021] [Indexed: 12/30/2022]
Abstract
Pediatric traumatic brain injury (TBI) is a public health crisis, with neurobehavioral morbidity observed years after an injury associated with changes in related brain structures. A substantial literature base has established family environment as a significant predictor of neurobehavioral outcomes following pediatric TBI. The neural mechanisms linking family environment to neurobehavioral outcomes have, however, received less empiric study in this population. In contrast, limbic structural differences as well as challenges with emotional adjustment and behavioral regulation in non-TBI populations have been linked to a multitude of family environmental factors, including family stress, parenting style, and adverse childhood experiences. In this article, we systematically review the more comprehensive literature on family environment and neurobehavioral outcomes in pediatric TBI and leverage the work in both TBI and non-TBI populations to expand our understanding of the underlying neural mechanisms. Thus, we summarize the extant literature on the family environment's role in neurobehavioral sequelae in children with TBI and explore potential neural correlates by synthesizing the wealth of literature on family environment and limbic development, specifically related to the amygdala. This review underscores the critical role of environmental factors, especially those predating the injury, in modeling recovery outcomes post-TBI in childhood, and discusses clinical and research implications across pediatric populations. Given the public health crisis of pediatric TBI, along with the context of sparse available medical interventions, a broader understanding of factors contributing to outcomes is warranted to expand the range of intervention targets.
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Parent- and Adolescent-reported Executive Functioning in the Context of Randomized Controlled Trials of Online Family Problem-Solving Therapy. J Int Neuropsychol Soc 2022; 28:123-129. [PMID: 33896436 DOI: 10.1017/s1355617721000308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We examined parent- and adolescent-reported executive functioning (EF) behaviors following pediatric traumatic brain injury (TBI) in the context of Online Family Problem-Solving Therapy (OFPST) and moderators of change in EF behaviors. METHOD In total, 274 families were randomized to OFPST or an internet resource comparison group. Parents and adolescents completed the Behavior Rating Inventory of Executive Function at four time points. Mixed models were used to examine EF behaviors, assessing the effects of visit, treatment group, rater, TBI severity, age, socioeconomic status, and family functioning. RESULTS Parents rated their adolescents' EF as poorer (F(3,1156) = 220.15, p < .001; M = 58.11, SE = 0.73) than adolescents rated themselves (M = 51.81, SE = 0.73). Across raters, EF behaviors were poorer for adolescents whose parents had less education (F(3,1156) = 8.60, p = .003; M = 56.76, SE = 0.98) than for those with more education (M = 53.16, SE = 0.88). Age at baseline interacted with visit (F(3,1156) = 5.05, p = .002), such that families of older adolescents reported improvement in EF behaviors over time. Family functioning also interacted with visit (F(3, 1156) = 2.61, p = .049), indicating more improvement in EF behaviors over time in higher functioning families. There were no effects of treatment or TBI severity. CONCLUSION We identified a discrepancy between parent- and adolescent-reported EF, suggesting reduced awareness of deficits in adolescents with TBI. We also found that poorer family functioning and younger age were associated with poorer recovery after TBI, whereas adolescents of parents with less education were reported as having greater EF deficits across time points.
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Liao H, Yan C, Ma Y, Wang J. Association Between Dynamic Trends of Functional Disability and Poverty Among People Aged 45 and Over. Front Public Health 2022; 9:742385. [PMID: 35111709 PMCID: PMC8801517 DOI: 10.3389/fpubh.2021.742385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background The disability problem has become prominent with the acceleration of the global aging process. Individual disability is associated with economic conditions and contributes to family poverty. As disability will change over a long period of time and may even show distinct dynamic trends, we aimed to focus on activities of daily living (ADL) and classify functional disability trends. Moreover, we aimed to highlight and analyze the association between functional disability trends and economic conditions and explore the influencing factors. Materials and Methods A total of 11,222 individuals who were 45 years old or older were included in four surveys conducted by the China Health and Retirement Longitudinal Study in 2011, 2013, 2015, and 2018. Samples were analyzed after excluding those with missing key variables. The latent class growth model was used to classify the ADL trends. Two binary logistic regressions were established to observe the association between the ADL trends and follow-up economic conditions or catastrophic health expenditure trends. Results ADL trends of older adults were classified into improving (25.4%), stabilizing (57.0%), and weakening ADL (17.6%). ADL trend was associated with follow-up poverty (p = 0.002) and catastrophic health expenditure trends (p < 0.001). Compared with the improving ADL trend, the stabilizing ADL may have a negative influence on individuals' economic conditions (OR = 1.175, 95%CI = 1.060–1.303). However, a stabilizing ADL trend was less likely to bring about catastrophic health expenditures (OR = 0.746, 95%CI = 0.678–0.820) compared with an improving ADL trend. Conclusion The improvement of functional disability would make the medical expense burden heavier but would still be beneficial for the prevention of poverty. A significant association was found between socioeconomic factors and poverty. Preventing the older adults from developing disability and illness, improving the compensation level of medical insurance, and optimizing the long-term care insurance and the primary healthcare system can potentially contribute to the prevention of poverty. Meanwhile, focusing on people who are poor at early stages, women, middle-aged, low-educated, and in rural areas is important.
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Affiliation(s)
- Hui Liao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaoyang Yan
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Ma
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- The Key Research Institute of Humanities and Social Science of Hubei Province, Huazhong University of Science and Technology, Wuhan, China
- Institute for Poverty Reduction and Development, Huazhong University of Science and Technology, Wuhan, China
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Treble-Barna A, Wade SL, Pilipenko V, Martin LJ, Yeates KO, Taylor HG, Kurowski BG. Brain-Derived Neurotrophic Factor Val66Met and Behavioral Adjustment after Early Childhood Traumatic Brain Injury. J Neurotrauma 2022; 39:114-121. [PMID: 33605167 PMCID: PMC8785712 DOI: 10.1089/neu.2020.7466] [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] [Indexed: 01/03/2023] Open
Abstract
The present study examined the differential effect of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism on behavioral adjustment in children with traumatic brain injury (TBI) relative to children with orthopedic injury (OI). Participants were drawn from a prospective, longitudinal study of children who sustained a TBI (n = 69) or OI (n = 72) between 3 and 7 years of age. Parents completed the Child Behavior Checklist (CBCL) at the immediate post-acute period, 6, 12, and 18 months after injury, and an average of 3.5 and 7 years after injury. Longitudinal mixed models examined the BDNF Val66Met allele status (Met carriers vs. Val/Val homozygotes) × injury group (TBI vs. OI) interaction in association with behavioral adjustment. After adjusting for continental ancestry, socioeconomic status, time post-injury, and pre-injury functioning, the allele status × injury group interaction was statistically significant for Internalizing, Externalizing, and Total Behavior problems. Post hoc within-group analysis suggested a consistent trend of poorer behavioral adjustment in Met carriers relative to Val/Val homozygotes in the TBI group; in contrast, the opposite trend was observed in the OI group. These within-group differences, however, did not reach statistical significance. The results support a differential effect of the BDNF Val66Met polymorphism on behavioral adjustment in children with early TBI relative to OI, and suggest that the Met allele associated with reduced activity-dependent secretion of BDNF may impart risk for poorer long-term behavioral adjustment in children with TBI.
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Affiliation(s)
- Amery Treble-Barna
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shari L. Wade
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Valentina Pilipenko
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Lisa J. Martin
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - H. Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Brad G. Kurowski
- Division of Pediatric Rehabilitation Medicine and Departments of Pediatrics and Neurology and Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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13
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From Early Childhood to Adolescence: Lessons About Traumatic Brain Injury From the Ohio Head Injury Outcomes Study. J Head Trauma Rehabil 2021; 35:226-239. [PMID: 31996606 DOI: 10.1097/htr.0000000000000555] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The Ohio Head Injury Outcomes study was a 12-year longitudinal study of early childhood traumatic brain injury (TBI). This article reviewed the findings pertaining to caregiver and family functioning and child cognition, behavior, social competence, emotional functioning, and academics. We further considered individual and social-environmental influences on recovery and interventions. SETTING Recruitment was completed at 3 children's hospitals and 1 general hospital. PARTICIPANTS Children aged 3 to 7 years at the time of injury with complicated mild to moderate and severe TBI or orthopedic injury requiring hospitalization were included. DESIGN A concurrent cohort/prospective research design was used. A baseline assessment was completed shortly after the injury. Follow-up assessments were completed at 6, 12, and 18 months and at an average of 38 and 82 months postinjury. MAIN MEASURES At baseline, parents/guardians completed retrospective ratings of their child's behavioral, emotional, and social functioning preinjury. At the subsequent assessments, ratings reflected current functioning. Information about current family and caregiver functioning was collected at each time point and cognitive testing was completed at selected time points. RESULTS AND CONCLUSIONS Recovery after TBI is complex, varies over time, and involves injury-related and premorbid influences, cognition, genetics, and caregiver and family functioning. A sizable number of children with TBI have persisting unmet clinical needs.
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14
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Impact of Secondary ADHD on Long-Term Outcomes After Early Childhood Traumatic Brain Injury. J Head Trauma Rehabil 2021; 35:E271-E279. [PMID: 31834065 PMCID: PMC7205557 DOI: 10.1097/htr.0000000000000550] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the impact of secondary attention-deficit/hyperactivity disorder (SADHD) on long-term global and executive functioning in adolescents after traumatic brain injury (TBI). SETTING Three tertiary cared children's hospitals and 1 general hospital. PARTICIPANTS One hundred twenty children (TBI: n = 54; orthopedic injury: n = 66) without preinjury ADHD evaluated approximately 6.8 years postinjury. DESIGN Cross-sectional data analysis from a prospective, longitudinal study. MAIN MEASURES Outcomes included functional impairment (Child and Adolescent Functional Assessment Scale) and executive functioning (Behavior Rating Inventory of Executive Function [BRIEF]). RESULTS SADHD moderated the association of injury type with the BRIEF-Behavioral Regulation Index (F1,113 = 4.42, P = .04) and the Child and Adolescent Functional Assessment Scale (F1,112 = 8.95, P = .003). TBI was only associated with poorer outcomes in the context of SADHD. SADHD was also associated with poorer outcomes on the BRIEF-Global Executive Composite (F1,113 = 52.92, P < .0001) and BRIEF-Metacognitive Index scores (F1,113 = 48.64, P < .0001) across groups. Adolescents with TBI had greater BRIEF-Global Executive Composite scores than those with orthopedic injury (F1,113 = 5.00, P = .03). CONCLUSIONS Although SADHD was associated with poorer functioning across groups, its adverse effects on behavioral regulation and overall functioning were amplified following TBI. TBI + SADHD may confer an elevated risk for significant impairments in early adolescence.
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Ryan NP, Catroppa C, Hughes N, Painter FL, Hearps S, Beauchamp MH, Anderson VA. Executive function mediates the prospective association between neurostructural differences within the central executive network and anti-social behavior after childhood traumatic brain injury. J Child Psychol Psychiatry 2021; 62:1150-1161. [PMID: 33624844 DOI: 10.1111/jcpp.13385] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite increasing evidence of a link between early life brain injury and anti-social behavior, very few studies have assessed factors that explain this association in children with traumatic brain injury (TBI). One hypothesis suggests that childhood TBI elevates risk for anti-social behavior via disruption to anatomically distributed neural networks implicated in executive functioning (EF). In this longitudinal prospective study, we employed high-resolution structural neuroimaging to (a) evaluate the impact of childhood TBI on regional morphometry of the central executive network (CEN) and (b) evaluate the prediction that lower EF mediates the prospective relationship between structural differences within the CEN and postinjury anti-social behaviors. METHODS This study involved 155 children, including 112 consecutively recruited, hospital-confirmed cases of mild-severe TBI and 43 typically developing control (TDC) children. T1-weighted brain magnetic resonance imaging (MRI) sequences were acquired sub-acutely in a subset of 137 children [TBI: n = 103; TDC: n = 34]. All participants were evaluated using direct assessment of EF 6 months postinjury, and parents provided ratings of anti-social behavior 12 months postinjury. RESULTS Severe TBI was associated with postinjury volumetric differences within the CEN and its putative hub regions. When compared with TD controls, the TBI group had significantly worse EF, which was associated with more frequent anti-social behaviors and abnormal CEN morphometry. Mediation analysis indicated that reduced EF mediated the prospective association between postinjury volumetric differences within the CEN and more frequent anti-social behavior. CONCLUSIONS Our longitudinal prospective findings suggest that detection of neurostructural abnormalities within the CEN may aid in the early identification of children at elevated risk for postinjury executive dysfunction, which may in turn contribute to chronic anti-social behaviors after early life brain injury. Findings underscore the potential value of early surveillance and preventive measures for children presenting with neurostructural and/or neurocognitive risk factors.
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Affiliation(s)
- Nicholas P Ryan
- School of Psychology, Deakin University, Geelong, Vic., Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Cathy Catroppa
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Nathan Hughes
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | | | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, QC, Canada.,Research Centre, Ste-Justine Hospital, Montreal, QC, Canada
| | - Vicki A Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
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16
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Ewing-Cobbs L, Montroy JJ, Clark AE, Holubkov R, Cox CS, Keenan HT. As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury. Front Neurol 2021; 12:687740. [PMID: 34290664 PMCID: PMC8287068 DOI: 10.3389/fneur.2021.687740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To model pre-injury child and family factors associated with the trajectory of internalizing and externalizing behavior problems across the first 3 years in children with pediatric traumatic brain injury (TBI) relative to children with orthopedic injuries (OI). Parent-reported emotional symptoms and conduct problems were expected to have unique and shared predictors. We hypothesized that TBI, female sex, greater pre-injury executive dysfunction, adjustment problems, lower income, and family dysfunction would be associated with less favorable outcomes. Methods: In a prospective longitudinal cohort study, we examined the level of behavior problems at 12 months after injury and rate of change from pre-injury to 12 months and from 12 to 36 months in children ages 4-15 years with mild to severe TBI relative to children with OI. A structural equation model framework incorporated injury characteristics, child demographic variables, as well as pre-injury child reserve and family attributes. Internalizing and externalizing behavior problems were indexed using the parent-rated Emotional Symptoms and Conduct Problems scales from the Strengths and Difficulties questionnaire. Results: The analysis cohort of 534 children [64% boys, M (SD) 8.8 (4.3) years of age] included 395 with mild to severe TBI and 139 with OI. Behavior ratings were higher after TBI than OI but did not differ by TBI severity. TBI, higher pre-injury executive dysfunction, and lower income predicted the level and trajectory of both Emotional Symptoms and Conduct Problems at 12 months. Female sex and poorer family functioning were vulnerability factors associated with greater increase and change in Emotional Symptoms by 12 months after injury; unique predictors of Conduct Problems included younger age and prior emotional/behavioral problems. Across the long-term follow-up from 12 to 36 months, Emotional Symptoms increased significantly and Conduct Problems stabilized. TBI was not a significant predictor of change during the chronic stage of recovery. Conclusions: After TBI, Emotional Symptoms and Conduct Problem scores were elevated, had different trajectories of change, increased or stayed elevated from 12 to 36 months after TBI, and did not return to pre-injury levels across the 3 year follow-up. These findings highlight the importance of addressing behavioral problems after TBI across an extended time frame.
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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, Houston, TX, United States
| | - Janelle J. Montroy
- Department of Pediatrics and Children's Learning Institute, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Amy E. Clark
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Richard Holubkov
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Charles S. Cox
- Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Heather T. Keenan
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
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17
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Luther M, Poppert Cordts KM, Williams CN. Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery. Sleep 2021; 43:5824413. [PMID: 32328648 DOI: 10.1093/sleep/zsaa083] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Sleep is vital for brain development and healing after injury, placing children with sleep-wake disturbances (SWD) after traumatic brain injury (TBI) at risk for worse outcomes. We conducted a systematic review to quantify SWD after pediatric TBI including prevalence, phenotypes, and risk factors. We also evaluated interventions for SWD and the association between SWD and other posttraumatic outcomes. METHODS Systematic searches were conducted in MEDLINE, PsychINFO, and reference lists for English language articles published from 1999 to 2019 evaluating sleep or fatigue in children hospitalized for mild complicated, moderate, or severe TBI. Two independent reviewers assessed eligibility, extracted data, and assessed risk of bias using the Newcastle-Ottowa Score for observational studies. RESULTS Among 966 articles identified in the search, 126 full-text articles were reviewed, and 24 studies were included (11 prospective, 9 cross-sectional, and 4 case studies). Marked heterogeneity was found in study populations, measures defining SWD, and time from injury to evaluation. Studies showed at least 20% of children with TBI had trouble falling or staying asleep, fatigue, daytime sleepiness, and nightmares. SWD are negatively correlated with posttraumatic cognitive, behavioral, and quality of life outcomes. No comparative intervention studies were identified. The risk of bias was moderate-high for all studies often related to lack of validated or objective SWD measures and small sample size. Heterogeneity precluded meta-analyses. CONCLUSIONS SWD are important morbidities after pediatric TBI, though current data are limited. SWD have implications for TBI recovery and may represent a modifiable target for improving outcomes after pediatric TBI.
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Affiliation(s)
- Madison Luther
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR
| | - Katrina M Poppert Cordts
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE
| | - Cydni N Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR.,Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR
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18
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Schorr E, Wade SL, Taylor HG, Stancin T, Yeates KO. Parenting styles as a predictor of long-term psychosocial outcomes after traumatic brain injury (TBI) in early childhood. Disabil Rehabil 2020; 42:2437-2443. [PMID: 31006276 PMCID: PMC7141764 DOI: 10.1080/09638288.2019.1602676] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/21/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
Abstract
Objective: This study sought to determine whether parenting styles predict long-term psychosocial outcomes after traumatic brain injury in young children.Methods: The study involved a concurrent cohort, prospective design, with longitudinal assessments up to early adolescence. Participants included 126 children with moderate to severe traumatic brain injury or orthopedic injury, ages 3 to 6 years 11 months, recruited between 2003 and 2006. Parents rated children's pre-injury behavioral adjustment, social competence, and executive functioning shortly after injury, and again 6.8 years post injury. Parents also rated their parenting styles (permissive, authoritarian, authoritative) at both occasions.Results: After controlling for pre-injury functioning, the groups differed significantly on all three outcomes (ΔR2 0.07 to 0.13). Late but not early parenting styles predicted outcomes in all groups (ΔR2 0.06 to 0.17): more permissive parenting predicted worse outcomes in all domains (β= -0.18, 0.20, 0.27); and more authoritative parenting predicted better social competence and executive functioning (β= -0.17, 0.46). Severe traumatic brain injury interacted with parenting style for several outcomes, with ineffective parenting exacerbating the negative sequelae.Conclusions: Parenting style predicts children's long-term psychosocial functioning after early childhood injury, and may moderate the effects of early traumatic brain injury.Implications for rehabilitationChildren with traumatic brain injury (especially those with severe injuries) are likely to require long-term monitoring and rehabilitation to address their psychosocial functioning.Interventions that focus on parenting may be an important avenue for promoting better psychosocial outcomes among children with severe traumatic brain injury.
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Affiliation(s)
- Emily Schorr
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Shari L Wade
- Division of Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - H Gerry Taylor
- Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Terry Stancin
- Division of Child & Adolescent Psychiatry & Psychology, Department of Psychiatry, Case Western Reserve University and MetroHealth Medical Center, Cleveland, OH, USA
| | - Keith Owen Yeates
- Department of Psychology, Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
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19
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Huth SF, Slater A, Waak M, Barlow K, Raman S. Predicting Neurological Recovery after Traumatic Brain Injury in Children: A Systematic Review of Prognostic Models. J Neurotrauma 2020; 37:2141-2149. [PMID: 32460675 DOI: 10.1089/neu.2020.7158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Predictive modeling is foundational to treatment and long-term management of children with traumatic brain injury (TBI). Assessment of injury severity in the acute-care setting enables early stratification of patients based on their risk of death, lifelong disability, or unfavorable outcome. This review evaluates predictive models that have been developed or validated for pediatric TBI patients. The predictive accuracy of these models, the outcomes and time points predicted, and the variables and statistical methods utilized in model development were compared. Embase, Scopus, MEDLINE®, and Web of Science were searched for studies that developed statistical models for predicting patient outcomes following pediatric TBI. Studies were excluded if they focused on adults or non-traumatic brain injury, or if they did not assess classification accuracy. A total of 4538 entries were identified and screened, with 7 studies included for analysis. This included five studies in which adult predictive models were validated for use in the pediatric setting, and two in which new models were derived from a pediatric cohort. Trials of adult prediction tools in pediatric cohorts, including the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) and Corticoid Randomisation After Significant Head Injury (CRASH)-TBI models, showed comparable accuracy between classification of adults and children. Models derived from pediatric cohorts showed improved accuracy. Most studies solely focused on clinical variables, with two studies incorporating biochemical and imaging variables. Predictive models for pediatric TBI are primarily based on methods and variables identified in adult studies. Although adult models have proven effective in select pediatric cohorts, they may be suboptimal when compared with models derived or adjusted for children.
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Affiliation(s)
- Samuel F Huth
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Anthony Slater
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Michaela Waak
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Department of Paediatric Intensive Care Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Karen Barlow
- Acquired Brain Injury in Children Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sainath Raman
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Department of Paediatric Intensive Care Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
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20
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Treble-Barna A, Pilipenko V, Wade SL, Jegga AG, Yeates KO, Taylor HG, Martin LJ, Kurowski BG. Cumulative Influence of Inflammatory Response Genetic Variation on Long-Term Neurobehavioral Outcomes after Pediatric Traumatic Brain Injury Relative to Orthopedic Injury: An Exploratory Polygenic Risk Score. J Neurotrauma 2020; 37:1491-1503. [PMID: 32024452 PMCID: PMC7307697 DOI: 10.1089/neu.2019.6866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The addition of genetic factors to prognostic models of neurobehavioral recovery following pediatric traumatic brain injury (TBI) may account for unexplained heterogeneity in outcomes. The present study examined the cumulative influence of candidate genes involved in the inflammatory response on long-term neurobehavioral recovery in children with early childhood TBI relative to children with orthopedic injuries (OI). Participants were drawn from a prospective, longitudinal study evaluating outcomes of children who sustained TBI (n = 67) or OI (n = 68) between the ages of 3 and 7 years. Parents completed ratings of child executive function and behavior at an average of 6.8 years after injury. Exploratory unweighted and weighted polygenic risk scores (PRS) were constructed from single nucleotide polymorphisms (SNPs) across candidate inflammatory response genes (i.e., angiotensin converting enzyme [ACE], brain-derived neurotrophic factor [BDNF], interleukin-1 receptor antagonist [IL1RN], and 5'-ectonucleotidase [NT5E]) that showed nominal (p ≤ 0.20) associations with outcomes in the TBI group. Linear regression models tested the PRS × injury group (TBI vs. OI) interaction term and post-hoc analyses examined the effect of PRS within each injury group. Higher inflammatory response PRS were associated with more executive dysfunction and behavior problems in children with TBI but not in children with OI. The cumulative influence of inflammatory response genes as measured by PRS explained additional variance in long-term neurobehavioral outcomes, over and above well-established predictors and single candidate SNPs tested individually. The results suggest that some of the unexplained heterogeneity in long-term neurobehavioral outcomes following pediatric TBI may be attributable to a child's genetic predisposition to a greater or lesser inflammatory response to TBI.
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Affiliation(s)
- Amery Treble-Barna
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennslvania, USA
| | - Valentina Pilipenko
- Division of Human Genetics, Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shari L. Wade
- Division of Pediatric Rehabilitation Medicine, Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Anil G. Jegga
- Division of Biomedical Informatics, Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - H. Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Lisa J. Martin
- Division of Human Genetics, Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brad G. Kurowski
- Division of Pediatric Rehabilitation Medicine, Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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21
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Narad ME, Nalepka P, Miley AE, Beebe DW, Kurowski BG, Wade SL. Driving after pediatric traumatic brain injury: Impact of distraction and executive functioning. Rehabil Psychol 2020; 65:268-278. [PMID: 32525341 DOI: 10.1037/rep0000329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of the current study was to examine the driving performance of young drivers with a history of moderate to severe traumatic brain injury (TBI) compared with an uninjured control group. The impact of cell phone related distraction (conversation and texting) and executive functioning (EF) were also explored. METHOD Individuals aged 16-25 years with (n = 19) and without (n = 19) a history of TBI engaged in a simulated drive under 3 distraction conditions (no distraction, cell phone conversation, and texting). Mean speed, maximum speed, standard deviation of speed, standard deviation of lane position, and crash rates were used as outcomes. The Global Executive Composite (GEC) from the Behavior Rating Inventory of Executive Functioning (BRIEF) was used to measure EF. RESULTS Significant Injury × Distraction × GEC interaction effects were noted on max speed and speed variability, with a trending Distraction × GEC interaction noted for lane position variability. The effect of distraction was most notable among individuals with greater GEC scores, across both injury groups. CONCLUSIONS A history of pediatric TBI did not specifically impact driving performance independent of EF, with EF playing a central role in functioning across domains of driving performance. Consistent effect of EF suggests that deficits in driving performance may be associated with EF specifically, with individuals with EF difficulties following TBI at greater risk for poor driving performance. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Megan E Narad
- Division of Behavioral Medicine and Clinical Psychology
| | | | | | - Dean W Beebe
- Division of Behavioral Medicine and Clinical Psychology
| | | | - Shari L Wade
- Division of Physical Medicine and Rehabilitation
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22
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Fraser EE, Downing MG, Biernacki K, McKenzie DP, Ponsford JL. Cognitive Reserve and Age Predict Cognitive Recovery after Mild to Severe Traumatic Brain Injury. J Neurotrauma 2019; 36:2753-2761. [DOI: 10.1089/neu.2019.6430] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Elinor E. Fraser
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia
| | - Marina G. Downing
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia
| | - Kathryn Biernacki
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, New Jersey
| | - Dean P. McKenzie
- Epworth HealthCare, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennie L. Ponsford
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia
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23
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Narad ME, Treble-Barna A, Zang H, Zhang N, Smith-Paine J, Yeates KO, Taylor HG, Stancin T, Wade SL. Parenting Behaviors after Moderate - Severe Traumatic Injury in Early Childhood. Dev Neurorehabil 2019; 22:437-444. [PMID: 30235048 PMCID: PMC6426679 DOI: 10.1080/17518423.2018.1518350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose: Examine the impact of traumatic brain injury (TBI) on parenting behavior over time. Method: Included 206 children (3-7 years old) with moderate to severe TBI or orthopedic injury, using a prospective longitudinal cohort study design. Assessments completed at baseline, 6-months, 12-months, 18-months, 3.5 years, and 6.8 years after injury. Dependent variables included authoritative, permissive, and authoritarian parenting. Results: Injury characteristics had limited impact on parenting behaviors over time. Levels of authoritative parenting remained stable over time; however, levels of warmth and involvement declined over time for those with TBI. Levels of permissive and authoritarian parenting declined for all participants by 3.5 years post injury. SES and stressors impacted parenting behaviors. Conclusions: While there was limited effect of TBI on parenting behavior over time, it remains unclear how individuals respond to these parenting behaviors years after injury. Clinicians should monitor family and parenting behaviors to foster an environment to promote positive recovery.
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Affiliation(s)
- Megan E. Narad
- Division of Physical Medicine & Rehabilitation, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Amery Treble-Barna
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Huaiyu Zang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Julia Smith-Paine
- Division of Physical Medicine & Rehabilitation, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, Department of Psychology, University of Cincinnati, Cincinnati, OH
| | - Keith O. Yeates
- Department of Psychology, Alberta Children’s Hospital Research Institute Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - H. Gerry Taylor
- Division of Developmental & Behavioral Pediatrics and Psychology, Department of Pediatrics, Case Western Reserve University, Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Cleveland, OH
| | - Terry Stancin
- Division of Pediatric Psychology, Department of Pediatrics, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Shari L. Wade
- Division of Physical Medicine & Rehabilitation, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and The University of Cincinnati College of Medicine, Cincinnati, OH
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24
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Maloney KA, Schmidt AT, Hanten GR, Levin HS. [Formula: see text] Executive dysfunction in children and adolescents with behavior disorders and traumatic brain injury. Child Neuropsychol 2019; 26:69-82. [PMID: 31311419 DOI: 10.1080/09297049.2019.1640868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Traumatic brain injury (TBI) is known to contribute to deficits in executive functioning (EF). Executive functioning abilities are disrupted in adolescents with either conduct disorder or oppositional defiant disorder, collectively known as disruptive behavior disorders (DBDs). There is little research on the relationship between executive dysfunction and DBDs in a group with a confirmed history of TBI. The current study endeavored to examine EF abilities, as measured by parent report on the Behavior Rating Inventory of Executive Function (BRIEF), in four groups: (1) adolescents with a TBI history and co-occurring DBDs history, (2) adolescents with a TBI history and no DBDs history, (3) adolescents with an orthopedic injury (OI) history and co-occurring DBDs history, and (4) adolescents with an OI history and no DBDs history. Groups were matched on the basis of age at injury and estimated socioeconomic status. Participants were evaluated at five time-points throughout the study, within 1 month of injury (initial assessment), 3, 12, 18, and 24 months post-injury. Results indicated the TBI and DBDs group was not significantly different from the OI and DBDs group, and both DBDs groups suffered higher levels of executive dysfunction than the TBI only and OI only groups, which were not significantly different from each other. Results also showed across the four groups, EF deficits were significantly lower at 1 month and 24 months post-injury, suggesting a positive trajectory in EF skill development. Results are discussed in terms of the prognostic importance of EF deficits in children with DBDs.
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Affiliation(s)
- Kelsey A Maloney
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Adam T Schmidt
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Gerri R Hanten
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Harvey S Levin
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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Gardner RC, Cheng J, Ferguson AR, Boylan R, Boscardin J, Zafonte RD, Manley GT. Divergent Six Month Functional Recovery Trajectories and Predictors after Traumatic Brain Injury: Novel Insights from the Citicoline Brain Injury Treatment Trial Study. J Neurotrauma 2019; 36:2521-2532. [PMID: 30909795 DOI: 10.1089/neu.2018.6167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cross-sectional approaches to outcome assessment may not adequately capture heterogeneity in recovery after traumatic brain injury (TBI). Using latent class mixed models (LCMM), a data-driven analytic that identifies groups of patients with similar trajectories, we identified distinct 6 month functional recovery trajectories in a large cohort (n = 1046) of adults 18-70 years of age with complicated mild to severe TBI who participated in the Citicoline Brain Injury Treatment Trial (COBRIT). We used multinomial logistic fixed effect models and backward elimination, forward selection, and forward stepwise selection with several stopping rules to explore baseline predictors of functional recovery trajectory. Based on statistical and clinical considerations, the seven-class model was deemed superior. Visualization of these seven functional recovery trajectories revealed that each trajectory class started at one of three recovery levels at 1 month, which, for ease of reference we labeled groups A-C: Group A, good recovery (two classes; A1 and A2); Group B, moderate disability (two classes; B1 and B2); and Group C, severe disability (three classes; C1, C2, and C3). By 6 months, these three groups experienced dramatically divergent trajectories. Group A experienced stable good recovery (A1, n = 115) or dramatic decline (A2, n = 4); Group B experienced rapid complete recovery (B1, n = 71) or gradual recovery (B2, n = 742); Group C experienced dramatic rapid recovery (C1, n = 12), no recovery (C2, n = 91), or death (C3, n = 11). Trajectory class membership was not predicted by citicoline treatment (p = 0.57). The models identified demographic, pre-injury, and injury-related predictors of functional recovery trajectory, including: age, race, education, pre-injury employment, pre-injury diabetes, pre-injury psychiatric disorder, site, Glasgow Coma Scale (GCS) score, post-traumatic amnesia, TBI mechanism, major extracranial injury, hemoglobin, and acute computed tomographic (CT) findings. GCS was the most consistently selected predictor across all models. All models also selected at least one demographic or pre-injury medical predictor. LCMM successfully identified dramatically divergent, clinically meaningful 6 month recovery trajectories with utility to inform clinical trial design.
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Affiliation(s)
- Raquel C Gardner
- Department of Neurology, Memory and Aging Center, and Weill Institute for Neurosciences, University of California, San Franscisco, San Francisco, California.,Department of Neurology and Center for Population Brain Health, San Francisco Veterans Affairs Mecical Center, San Francisco, California
| | - Jing Cheng
- Deparment of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Adam R Ferguson
- Department of Neurological Surgery and Weil Institute for Neurosciences, University of California San Francisco, San Francisco, California.,Brain and Spinal Injury Center, Zuckerberg san Francisco General Hospital, San Francisco, California.,Department of Research and Development, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Ross Boylan
- Deparment of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - John Boscardin
- Deparment of Epidemiology and Biostatistics, University of California, San Francisco, California.,Department of Research and Development, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Department of Medicine, University of California, san Francisco, California
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Geoffrey T Manley
- Department of Neurological Surgery and Weil Institute for Neurosciences, University of California San Francisco, San Francisco, California.,Brain and Spinal Injury Center, Zuckerberg san Francisco General Hospital, San Francisco, California
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26
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Kurowski BG, Treble-Barna A, Pilipenko V, Wade SL, Yeates KO, Taylor HG, Martin LJ, Jegga AG. Genetic Influences on Behavioral Outcomes After Childhood TBI: A Novel Systems Biology-Informed Approach. Front Genet 2019; 10:481. [PMID: 31191606 PMCID: PMC6540783 DOI: 10.3389/fgene.2019.00481] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 05/06/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives: To test whether genetic associations with behavioral outcomes after early childhood traumatic brain injury (TBI) are enriched for biologic pathways underpinning neurocognitive and behavioral networks. Design: Cross-sectional evaluation of the association of genetic factors with early (~ 6 months) and long-term (~ 7 years) post-TBI behavioral outcomes. We combined systems biology and genetic association testing methodologies to identify biologic pathways associated with neurocognitive and behavior outcomes after TBI. We then evaluated whether genes/single nucleotide polymorphism (SNPs) associated with these biologic pathways were more likely to demonstrate a relationship (i.e., enrichment) with short and long-term behavioral outcomes after early childhood TBI compared to genes/SNPs not associated with these biologic pathways. Setting: Outpatient research setting. Participants:140 children, ages 3–6:11 years at time of injury, admitted for a TBI or orthopedic injury (OI). Interventions: Not Applicable. Main Outcome Measures: Child behavior checklist total problems T score. Results: Systems biology methodology identified neuronal systems and neurotransmitter signaling (Glutamate receptor, dopamine, serotonin, and calcium signaling), inflammatory response, cell death, immune systems, and brain development as important biologic pathways to neurocognitive and behavioral outcomes after TBI. At 6 months post injury, the group (TBI versus OI) by polymorphism interaction was significant when the aggregate signal from the highest ranked 40% of case gene associations was compared to the control set of genes. At ~ 7 years post injury, the selected polymorphisms had a significant main effect after controlling for injury type when the aggregate signal from the highest ranked 10% of the case genes were compared to the control set of genes Conclusions: Findings demonstrate the promise of applying a genomics approach, informed by systems biology, to understanding behavioral recovery after pediatric TBI. A mixture of biologic pathways and processes are associated with behavioral recovery, specifically genes associated with cell death, inflammatory response, neurotransmitter signaling, and brain development. These results provide insights into the complex biology of TBI recovery.
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Affiliation(s)
- Brad G Kurowski
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center and Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Amery Treble-Barna
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Valentina Pilipenko
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Shari L Wade
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Keith Owen Yeates
- Departments of Psychology, Pediatrics, and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University, Columbus, OH, United States
| | - Lisa J Martin
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Anil G Jegga
- Division of Bioinformatics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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A Comparison of 2 Online Parent Skills Training Interventions for Early Childhood Brain Injury: Improvements in Internalizing and Executive Function Behaviors. J Head Trauma Rehabil 2019; 34:65-76. [DOI: 10.1097/htr.0000000000000443] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Smith-Paine J, Wade SL, Treble-Barna A, Zhang N, Zang H, Martin LJ, Yeates KO, Taylor HG, Kurowski BG. The Moderating Effect of the Ankyrin Repeat and Kinase Domain Containing One Gene on the Association of Family Environment with Longitudinal Executive Function following Traumatic Brain Injury in Early Childhood: A Preliminary Study. J Neurotrauma 2018; 35:2796-2802. [PMID: 29717626 DOI: 10.1089/neu.2017.5388] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study examined whether the ankyrin repeat and kinase domain containing 1 gene (ANKK1) C/T single-nucleotide polymorphism (SNP) rs1800497 moderated the association of family environment with long-term executive function (EF) following traumatic injury in early childhood. Caregivers of children with traumatic brain injury (TBI) and children with orthopedic injury completed the Behavior Rating Inventory of Executive Function (BRIEF) at post-injury visits. DNA was collected to identify the rs1800497 genotype in the ANKK1 gene. General linear models examined gene-environment interactions as moderators of the effects of TBI on EF at two times post-injury (12 months and 7 years). At 12 months post-injury, analyses revealed a significant three-way interaction of genotype with level of permissive parenting and injury type. Post hoc analyses showed genetic effects were more pronounced for children with TBI from more positive family environments, such that children with TBI who were carriers of the risk allele (T-allele) had significantly poorer EF compared with non-carriers only when they were from more advantaged environments. At 7 years post-injury, analyses revealed a significant two-way interaction of genotype with level of authoritarian parenting. Post hoc analyses found that carriers of the risk allele had significantly poorer EF compared with non-carriers only when they were from more advantaged environments. These results suggest a gene-environment interaction involving the ANKK1 gene as a predictor of EF in a pediatric injury population. The findings highlight the importance of considering environmental influences in future genetic studies on recovery following TBI and other traumatic injuries in childhood.
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Affiliation(s)
- Julia Smith-Paine
- 1 Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shari L Wade
- 1 Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amery Treble-Barna
- 2 Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Nanhua Zhang
- 3 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Huaiyu Zang
- 3 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lisa J Martin
- 4 Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Keith Owen Yeates
- 5 Department of Psychology, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - H Gerry Taylor
- 6 Center for Biobehavioral Health, Nationwide Children's Hospital, Research Institute, and Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Brad G Kurowski
- 1 Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio.,7 Departments of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Ciccia AH, Beekman L, Ditmars E. A clinically focused systematic review of social communication in pediatric TBI. NeuroRehabilitation 2018; 42:331-344. [DOI: 10.3233/nre-172384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Angela Hein Ciccia
- Department of Psychological Sciences, Communication Sciences Program, Case Western Reserve University, Cleveland, OH, USA
| | - Leah Beekman
- Department of Psychological Sciences, Communication Sciences Program, Case Western Reserve University, Cleveland, OH, USA
| | - Emily Ditmars
- Department of Psychological Sciences, Communication Sciences Program, Case Western Reserve University, Cleveland, OH, USA
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Gaudet CE, Cook NE, Kavanaugh BC, Studeny J, Holler K. Prevalence of low test scores in a pediatric psychiatric inpatient population: Applying multivariate base rate analyses. APPLIED NEUROPSYCHOLOGY-CHILD 2018; 8:163-173. [PMID: 29308918 DOI: 10.1080/21622965.2017.1417126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The understanding of neuropsychological functioning in pediatric psychiatric inpatient populations is growing, but limited, resulting in interpretive challenges. This study examined the application of multivariate base rate (MVBR) analysis in a clinical sample to appraise its utility in characterizing the frequency of low scores, as well as predictors of low scores, when using a flexible test battery. Participants included 99 children from a psychiatric inpatient unit referred for neuropsychological testing. Children hospitalized with psychiatric disorders exhibited high rates of low scores at varying criteria across the battery of tests. Hierarchical multiple regression analyses revealed that after accounting for demographic and psychiatric factors, intellectual functioning accounted for approximately 26% of the variance in observed low scores. The results suggest that a substantial percentage of this population produces low scores on neuropsychological testing and, consistent with prior research, intellectual functioning is strongly associated with low score frequency. To our knowledge, this is the first study to examine the clinical application of MVBR analysis in a pediatric psychiatric inpatient population using a flexible test battery. Taken together, this investigation highlights the potential clinical utility of MVBR analysis when interpreting neuropsychological performance in clinical pediatric populations.
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Affiliation(s)
- Charles E Gaudet
- a Psychology Department , University of Rhode Island , Kingston , Rhode Island , USA
| | - Nathan E Cook
- a Psychology Department , University of Rhode Island , Kingston , Rhode Island , USA.,b Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts , USA.,c MassGeneral Hospital for Children Sport Concussion Program , Boston , Massachusetts , USA
| | - Brian C Kavanaugh
- d Department of Psychiatry & Human Behavior , Alpert Medical School, Brown University , Providence , Rhode Island , USA
| | - Jane Studeny
- e Psychology Department , Antioch University - New England , Keene , New Hampshire , USA
| | - Karen Holler
- d Department of Psychiatry & Human Behavior , Alpert Medical School, Brown University , Providence , Rhode Island , USA
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31
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Narad ME, Yeates KO, Taylor HG, Stancin T, Wade SL. Maternal and Paternal Distress and Coping Over Time Following Pediatric Traumatic Brain Injury. J Pediatr Psychol 2017; 42:304-314. [PMID: 27633324 PMCID: PMC5896624 DOI: 10.1093/jpepsy/jsw079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 08/15/2016] [Accepted: 08/23/2016] [Indexed: 11/12/2022] Open
Abstract
Objective Examine differences in maternal and paternal coping and distress following traumatic brain injury (TBI) and orthopedic injuries (OI). Method Concurrent cohort/prospective design with five assessments between 1 and an average of 7 years after injury of children aged 3-6 years hospitalized for TBI ( n = 87) or OI ( n = 119). Mixed models analyses were used to examine hypotheses. Results Overall, fathers reported greater depression and general distress than mothers 18 months after injury, but not at long-term follow-up. Active and acceptance coping were unrelated to parental sex, injury factors, or time since injury. A group × rater × time interaction was noted for Denial coping. Following severe TBI, fathers reported greater denial at 18 months, whereas mothers reported greater denial at the long-term follow-up. Denial coping did not differ between mothers and fathers following OI and moderate TBI. Conclusions Parental response to early TBI is complex and may warrant clinical intervention even years after injury.
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Affiliation(s)
- Megan E. Narad
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Keith O. Yeates
- Department of Psychology, Alberta Children’s Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary
| | - H. Gerry Taylor
- Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Case Western Reserve University
| | - Terry Stancin
- MetroHealth Medical Center, Case Western Reserve University
| | - Shari L. Wade
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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32
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Treble-Barna A, Wade SL, Martin LJ, Pilipenko V, Yeates KO, Taylor HG, Kurowski BG. Influence of Dopamine-Related Genes on Neurobehavioral Recovery after Traumatic Brain Injury during Early Childhood. J Neurotrauma 2017; 34:1919-1931. [PMID: 28323555 DOI: 10.1089/neu.2016.4840] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The present study examined the association of dopamine-related genes with short- and long-term neurobehavioral recovery, as well as neurobehavioral recovery trajectories over time, in children who had sustained early childhood traumatic brain injuries (TBI) relative to children who had sustained orthopedic injuries (OI). Participants were recruited from a prospective, longitudinal study evaluating outcomes of children who sustained a TBI (n = 68) or OI (n = 72) between the ages of 3 and 7 years. Parents completed ratings of child executive function and behavior at the immediate post-acute period (0-3 months after injury); 6, 12, and 18 months after injury; and an average of 3.5 and 7 years after injury. Thirty-two single nucleotide polymorphisms (SNPs) in dopamine-related genes (dopamine receptor D2 [DRD2], solute carrier family 6 member 3 [SLC6A3], solute carrier family 18 member A2 [SLC18A2], catechol-o-methyltransferase [COMT], and ankyrin repeat and kinase domain containing 1 [ANKK1]) were examined in association with short- and long-term executive function and behavioral adjustment, as well as their trajectories over time. After controlling for premorbid child functioning, genetic variation within the SLC6A3 (rs464049 and rs460000) gene was differentially associated with neurobehavioral recovery trajectories over time following TBI relative to OI, with rs464049 surviving multiple testing corrections. In addition, genetic variation within the ANKK1 (rs1800497 and rs2734849) and SLC6A3 (rs464049, rs460000, and rs1042098) genes was differentially associated with short- and long-term neurobehavioral recovery following TBI, with rs460000 and rs464049 surviving multiple testing corrections. The findings provide preliminary evidence that genetic variation in genes involved in DRD2 expression and density (ANKK1) and dopamine transport (SLC6A3) plays a role in neurobehavioral recovery following pediatric TBI.
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Affiliation(s)
- Amery Treble-Barna
- 1 Division of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Shari L Wade
- 2 Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Lisa J Martin
- 3 Division of Human Genetics, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Valentina Pilipenko
- 3 Division of Human Genetics, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Keith Owen Yeates
- 4 Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - H Gerry Taylor
- 5 Division of Developmental and Behavioral Pediatrics and Psychology, Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital , Cleveland, Ohio
| | - Brad G Kurowski
- 2 Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
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Goldstein G, Mayfield J, Thaler NS, Walker J, Allen DN. Cognitive and academic achievement changes associated with day hospital rehabilitation in children with acquired brain injury. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 7:110-116. [PMID: 27854141 DOI: 10.1080/21622965.2016.1253478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
An evaluation was made of the outcome of a day hospital rehabilitation program for children who experienced an acquired neurological illness, mainly traumatic brain injury. Participants were administered neuropsychological and academic evaluations upon entry to the program, immediately upon discharge and several months after discharge Repeated measures ANOVA results for variables selected from the Reynolds Intellectual Assessment and the Delis-Kaplan Executive Function System found that comparisons showed significant (≥p < .01) improvement occurred between the first and second assessment, generally with large effect sizes. There were some nonsignificant decrements in performance between the discharge and follow-up assessments. A correlational analysis showed that while the association between cognitive function and academic achievement was robust, correlation coefficients did not differ in strength before and following rehabilitation. The study demonstrates significant improvement in children with acquired neurological disorders following rehabilitation.
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Affiliation(s)
- Gerald Goldstein
- a Mental Illness Research, Educational and Clinical Center (VISN-4) VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA
| | | | | | - Jon Walker
- a Mental Illness Research, Educational and Clinical Center (VISN-4) VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA
| | - Daniel N Allen
- d Department of Psychology , University of Nevada Las Vegas , Las Vegas , Nevada , USA
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