Arithmetic difficulties in children with mild traumatic brain injury at the subacute stage of recovery

AIM

Arithmetic difficulties have been reported in children with mild traumatic brain injury (mTBI), but the electrophysiological abnormalities underlying these impairments remain unknown. We therefore used event-related potentials (ERPs) to investigate brain functioning during arithmetic in children in the subacute phase after mTBI.

METHOD

The participants comprised 16 children with mTBI at the subacute phase of recovery (10 males, mean age 10y 8mo; six females, mean age 10y 8mo) and 16 well-matched comparison children (11 males, mean age 10y 11mo; five females, mean age 10y 6mo). All children were asked to solve single-digit addition problems of small (sum ≤10) and large problem size (sum >10) and ERPs were simultaneously recorded.

RESULTS

Children with mTBI performed significantly less accurately (mean 81%) than comparison children (mean 91%) on the large (p=0.026) but not on the small problems (p=0.171). We observed no group differences in the early ERP components P1, N1, P2, and N2 (all p values ≥0.241), yet significant group differences (p=0.019) emerged for the late positivity component (LPC), which showed smaller mean amplitudes (mean 8.35μV) in mTBI patients than comparison children (mean 12.95μV).

INTERPRETATION

Immediately after the injury, arithmetic difficulties in children with mTBI are particularly pronounced on more complex arithmetical problems that are less automated. This is reflected in the ERP pattern, with decreased LPC but normal N2 and early ERP components.

Functional recovery ten years after pediatric traumatic brain injury: outcomes and predictors

Functional impairments (adaptive, behavioral, educational) are common after preschool traumatic brain injury (TBI). In comparison with cognitive outcome, functional outcomes have received limited attention, with little evidence to determine whether these difficulties persist in the long term. The aim of this study was to examine functional outcomes at 10 years post-injury and identify predictors of outcome. The study compared children with a diagnosis of TBI (n=40) to a healthy age-, gender-, and socioeconomic status (SES)-matched control group (n=19) at 10 years post-injury. Outcomes and predictors of functional skills were investigated. Poorer adaptive skills were evident for those with more severe injury. Behavioral difficulties were present regardless of injury severity. Post-injury, arithmetic skills were the most compromised in the longer term. Pre-injury status, interventions accessed, and acute intellectual function were significant predictors of outcome. These results highlight the importance of monitoring functional skills in the long term, especially for those children presenting with risk factors.

The effects of traumatic brain injury during adolescence on career plans and outcomes

Traumatic brain injury (TBI) often occurs during the years when individuals are aiming for vocational goals and acquiring skills needed to achieve vocational success. This exploratory study aimed to describe the perceived long-term impact on career outcomes for individuals who were hospitalized with a TBI during adolescence. This study used a retrospective cohort design. A telephone questionnaire was administered 5 years postinjury to a consecutive series of 51 participants aged 15-19 years at time of injury, as well as 46 informants who knew the participants well. Participants and informants described the impact the injury had on career plans and outcomes. The nature of occupation postinjury was compared with preinjury plans, with results indicating many participants altering preinjury career plans following TBI.

Outcome and predictors of functional recovery 5 years following pediatric traumatic brain injury (TBI)

OBJECTIVES

The aim was to examine functional outcomes following traumatic brain injury (TBI) during early childhood, to investigate impairments up to 5 years postinjury and identify predictors of outcome.

METHODS

The study compared three groups of children (mild = 11, moderate = 22, severe = 15), aged 2.0-6.11 years at injury, to a healthy control group (n = 17). Using a prospective, longitudinal design, adaptive abilities, behavior, and family functioning were investigated acutely, 6, 30 months and 5 years postinjury, with educational progress investigated at 30 months and 5 years postinjury.

RESULTS

A strong association was suggested between injury severity and outcomes across all domains. Further, 5-year outcomes in adaptive and behavioral domains were best predicted by preinjury levels of child function, and educational performance by injury severity.

CONCLUSION

Children who sustain a severe TBI in early childhood are at greatest risk of long-term impairment in day-to-day skills in the long-term postinjury.

Recovery of educational skills following paediatric traumatic brain injury

Academic success in the classroom is often dependent upon a child's ability in the areas of literacy, such as reading and spelling, and arithmetic. Following traumatic brain injury these skills are often compromised. The present study examined the recovery of educational skills (reading accuracy, reading comprehension, spelling and arithmetic) over 24 months post-injury, in a group of children who had sustained a mild, moderate or severe TBI. Results showed that the severe TBI group exhibited greater deficits on reading comprehension and arithmetic, while the moderate and severe TBI groups performed similarly in the areas of reading accuracy and spelling. Future research is required to further investigate predictors of educational outcome post-TBI.

Assessment of syntax after adolescent brain injury: effects of memory on test performance

In this study, we investigated the influence of working memory load on performance of a task designed to measure receptive syntax ability. Subjects were 6 brain-injured adolescents and 6 hospitalized control subjects matched for age, sex, and general ability. Each subject was administered the Listening/Grammar subtest of the Test of Adolescent Language (TOAL-3) and a modified version of this subtest with identical syntax and fewer response choices (i.e., a reduced working memory processing and storage load). The syntactic structures tested on these tasks also were measured in spontaneous narratives. The brain-injured subjects' performance was significantly worse than that of controls on both versions of the syntax comprehension subtest. There was a significant group-by-task interaction, as brain-injured subjects' performance was significantly worse on the Listening/Grammar subtest than the modified subtest, whereas Control subjects'performance did not differ across the two tasks. In their spontaneous narratives, subjects in both groups produced the syntactic structures tested on the receptive syntax tasks, with no between-groups difference in syntax production. The results are discussed in terms of test validity and the impact of measurement methods on test performance in disordered groups.

Assessment of pragmatic communication skills in adolescents after traumatic brain injury

Deficits in pragmatic communication ability have a significant impact on functional outcome from traumatic brain injury (TBI), particularly during adolescence, when sophisticated social communication skills are developing. There are few published tests designed to assess pragmatic skills in this age group. In the present study, four tasks designed to tap various aspects of pragmatic communication ability were administered to three brain-injured adolescents and 36 of their uninjured peers aged 15-18 years. The tasks evaluated the ability to negotiate, hint, describe a simple procedure, and understand sarcasm. The four tasks were found to tap distinct aspects of pragmatic ability in control subjects. Further, within the control group, task performance was related more to non-verbal reasoning ability than vocabulary skills. Scores for two of the three TBI subjects were poorer than those of their peers, while a third mildly injured subject performed within normal limits. Pragmatic task scores were consistent with the results of neuropsychological testing in the three TBI subjects. Implications for clinical management and recommendations for future research are discussed.

Cognitive effects of mild head injury in children and adolescents

A comprehensive review of recent neuropsychological studies of mild head injury (MHI) involving children and adolescents is presented. The seminal work of Rutter and his colleagues is reviewed. An alternative conceptualization of MHI as proposed by various researchers is elaborated and further research investigating the cognitive sequelae of MHI is reviewed. MHI is discussed within the context of development and information processing models. Finally, the sequelae of MHI are reviewed with respect to academic functioning. Methodological problems inherent in studies of MHI are identified and discussed. The studies reviewed here support the conclusion that both the cognitive and emotional consequences of MHI should receive serious evaluation.