1
|
Shen J, Wang Y, Quinn S, Suskauer SJ, Birch J, Busch T, Svingos A, Crawfis R, Yeates KO, Taylor HG. Efficacy of a virtual reality-based cognitive interactive training program for children with traumatic brain injuries: study protocol for a parallel-group randomized controlled trial. Trials 2024; 25:185. [PMID: 38481293 PMCID: PMC10935958 DOI: 10.1186/s13063-024-08049-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/08/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a leading cause of disability in children. Cognitive rehabilitation for this population is critical for their long-term health outcomes. This trial aims to evaluate the efficacy of a virtual reality-based program (VICT) for training executive functions in children with TBI. METHODS A parallel group randomized controlled trial will be conducted among up to 32 children with TBI. Children in the intervention group will receive the VICT training while children in the control group will play a comparable VR game without executive function training. Each participant will be assessed at baseline, post-intervention, and 1-month follow-up. Outcomes will include core executive functions, attention, and health-related quality of life measured by computerized tasks or standardized questionnaires. DISCUSSION Cognitive rehabilitation is among the top healthcare needs for pediatric TBI patients. Virtual reality-based training is promising due to its versatile content, flexibility, and potential cost savings for both patients and providers. Findings of this trial will provide data on the efficacy of the VICT program on core executive functions, attention problems, and health-related quality of life and serve as the empirical foundation for future larger multi-site effectiveness trials. TRIAL REGISTRATION ClinicalTrials.gov NCT04526639 . Registered on August 18, 2020.
Collapse
Affiliation(s)
- Jiabin Shen
- Department of Psychology, University of Massachusetts Lowell, Lowell, USA.
| | - Yan Wang
- Department of Psychology, University of Massachusetts Lowell, Lowell, USA
| | - Susan Quinn
- Inpatient Rehabilitation Unit, Spaulding Rehabilitation Hospital, Boston, USA
| | - Stacy J Suskauer
- Kennedy Krieger Institute and Departments of Physical Medicine & Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Julia Birch
- Spaulding Rehabilitation Hospital, Boston, USA
| | - Tyler Busch
- Brain Injury Clinical Research Center, Kennedy Krieger Institute, Departments of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Adrian Svingos
- Brain Injury Clinical Research Center, Kennedy Krieger Institute, Departments of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Roger Crawfis
- Department of Computer Science & Engineering, The Ohio State University, Columbus, USA
| | | | - H Gerry Taylor
- Abigail Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, USA
| |
Collapse
|
2
|
Schachar RJ. Fifty years of executive control research in attention-deficit/hyperactivity disorder:What we have learned and still need to know. Neurosci Biobehav Rev 2023; 155:105461. [PMID: 37949153 DOI: 10.1016/j.neubiorev.2023.105461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
For 50 years, attention-deficit/hyperactivity disorder (ADHD) has been considered a disorder of executive control (EC), the higher-order, cognitive skills that support self-regulation, goal attainment and what we generally call "attention." This review surveys our current understanding of the nature of EC as it pertains to ADHD and considers the evidence in support of eight hypotheses that can be derived from the EC theory of ADHD. This paper provides a resource for practitioners to aid in clinical decision-making. To support theory building, I draw a parallel between the EC theory of ADHD and the common gene-common variant model of complex traits such as ADHD. The conclusion offers strategies for advancing collaborative research.
Collapse
Affiliation(s)
- Russell J Schachar
- Department of Psychiatry, The Hospital for Sick Children and University of Toronto, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G1X8, Canada.
| |
Collapse
|
3
|
Shen IH, Lin YJ, Chen CL, Liao CC. Neural Correlates of Response Inhibition and Error Processing in Individuals with Mild Traumatic Brain Injury: An Event-Related Potential Study. J Neurotrauma 2019; 37:115-124. [PMID: 31317830 DOI: 10.1089/neu.2018.6122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Individuals with a mild traumatic brain injury (mTBI) often have executive control deficits; however, the underlying neural mechanisms of such deficits are yet to be clarified. Inhibitory control and cognitive monitoring are two fundamental aspects of executive control processes. This study investigated the executive control of mTBI by using the Stop-signal task. Eighteen adults with mTBI and 18 age-, sex-, and education level-matched controls were recruited. Behavioral performance and event-related potential correlates of response inhibition and error processing were compared between groups. The mTBI group tended to have a lower probability of inhibition and a longer stop signal reaction time. N1 amplitude was greater on successful trials. Also on successful trials, N2 and P3 peaked earlier than on failed trials. The N2 amplitude of the mTBI group tended to be smaller than that of the controls. The control group had larger P3 amplitude on successful trials than on failed trials, whereas the mTBI group exhibited no P3 amplitudes difference between the two trial types. In addition, the mTBI group showed significantly longer error positivity latency than did the controls. These results suggest that inhibitory control and error processing were inefficient in the mTB group even more than three months after injury. Electrophysiological markers of cognitive dysfunction can be used as a sensitive tool for determining executive control after mTBI.
Collapse
Affiliation(s)
- I-Hsuan Shen
- Department of Occupational Therapy, Graduate Institute of Behavioral Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Linkou branch, Taoyuan, Taiwan
| | - Ying-Ju Lin
- Department of Occupational Therapy, Graduate Institute of Behavioral Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Northern Service Center, Sunshine Social Welfare Foundation, Taipei, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Linkou branch, Taoyuan, Taiwan.,Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Chih Liao
- Department of Neurosurgery, Division of Neurospine, Chang Gung Memorial Hospital Linkou branch, Taoyuan, Taiwan.,Department of Neurospinal Surgery, Mennonite Christian Hospital, Hualien, Taiwan
| |
Collapse
|
4
|
Rogers A, McKinlay A. The long-term effects of childhood traumatic brain injury on adulthood relationship quality. Brain Inj 2019; 33:649-656. [PMID: 30664366 DOI: 10.1080/02699052.2019.1567936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PRIMARY OBJECTIVE To investigated the long-term effect of childhood Traumatic Brain Injury (TBI) on adulthood Relationship Quality (RQ), examining injury severity, age of injury, and markers of prefrontal cortex (PFC) functioning, apathy, disinhibition, and executive dysfunction. RESEARCH DESIGN Longitudinal, between-subjects, cross-sectional design using retrospective and current data. METHODS AND PROCEDURES Participants (N = 169; 61 mild TBI (mTBI); 65 moderate to severe TBI (MSTBI); 43 orthopaedic injury (OI); Injury age: 1-17 years; Testing age: 18-31 years) completed a structured interview regarding their injury, demographic characteristics and RQ, the National Adults Reading Test, and Frontal Systems Behaviour Scale. Data were analyzed using IBM SPSS 25. MAIN OUTCOMES AND RESULTS Adults who had experienced childhood TBI had significantly poorer RQ than adults who had experienced childhood OI. Severity of TBI did not impact adulthood RQ. Earlier age of injury predicted reduced adulthood RQ in the MSTBI group. Greater PFC dysfunction predicted poorer RQ in adults with a history of childhood TBI. While elevated levels of apathy, disinhibition, and executive dysfunction were associated with poorer RQ, no individual marker had predictive value. CONCLUSION Experiencing a childhood TBI can have a long-term negative influence on adulthood RQ. Such RQ deficits can underpin reduced life satisfaction and increased health issues.
Collapse
Affiliation(s)
- Alana Rogers
- a Melbourne School of Psychological Sciences , The University of Melbourne , Melbourne , Australia.,b School of Psychological Sciences , University of Melbourne , Melbourne , Australia
| | - Audrey McKinlay
- b School of Psychological Sciences , University of Melbourne , Melbourne , Australia.,c Department of Psychology , University of Canterbury , Melbourne , Australia
| |
Collapse
|
5
|
Stephens JA, Salorio CF, Barber AD, Risen SR, Mostofsky SH, Suskauer SJ. Preliminary findings of altered functional connectivity of the default mode network linked to functional outcomes one year after pediatric traumatic brain injury. Dev Neurorehabil 2018; 21:423-430. [PMID: 28692408 PMCID: PMC5843556 DOI: 10.1080/17518423.2017.1338777] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE AND METHOD This study examined functional connectivity of the default mode network (DMN) and examined brain-behavior relationships in a pilot cohort of children with chronic mild to moderate traumatic brain injury (TBI). RESULTS Compared to uninjured peers, children with TBI demonstrated less anti-correlated functional connectivity between DMN and right Brodmann Area 40 (BA 40). In children with TBI, more anomalous less anti-correlated) connectivity between DMN and right BA 40 was linked to poorer performance on response inhibition tasks. CONCLUSION Collectively, these preliminary findings suggest that functional connectivity between DMN and BA 40 may relate to longterm functional outcomes in chronic pediatric TBI.
Collapse
Affiliation(s)
- Jaclyn A. Stephens
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Cynthia F. Salorio
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anita D. Barber
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Sarah R. Risen
- Department of Pediatric Neurology, Baylor College of Medicine, Texas Children’s Hospital, Houston TX, USA
| | - Stewart H. Mostofsky
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Stacy J. Suskauer
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
6
|
Wilkinson AA, Dennis M, Taylor MJ, Guerguerian AM, Boutis K, Choong K, Campbell C, Fraser D, Hutchison J, Schachar R. Performance Monitoring in Children Following Traumatic Brain Injury Compared to Typically Developing Children. Child Neurol Open 2017; 4:2329048X17732713. [PMID: 29051909 PMCID: PMC5639967 DOI: 10.1177/2329048x17732713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/12/2017] [Accepted: 08/25/2017] [Indexed: 11/17/2022] Open
Abstract
Children with traumatic brain injury are reported to have deficits in performance monitoring, but the mechanisms underlying these deficits are not well understood. Four performance monitoring hypotheses were explored by comparing how 28 children with traumatic brain injury and 28 typically developing controls (matched by age and sex) performed on the stop-signal task. Control children slowed significantly more following incorrect than correct stop-signal trials, fitting the error monitoring hypothesis. In contrast, the traumatic brain injury group showed no performance monitoring difference with trial types, but significant group differences did not emerge, suggesting that children with traumatic brain injury may not perform the same way as controls.
Collapse
Affiliation(s)
- Amy A Wilkinson
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maureen Dennis
- Dr Maureen Dennis passed away during the completion of this study
| | - Margot J Taylor
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne-Marie Guerguerian
- Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathy Boutis
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen Choong
- Division of Pediatric Intensive Care, Department of Pediatrics, Children's Hospital of Hamilton, Hamilton, Ontario, Canada
| | - Craig Campbell
- Department of Pediatrics, Clinical Neurological Sciences and Epidemiology, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Douglas Fraser
- Department of Pediatrics, Clinical Neurological Sciences and Epidemiology, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Jamie Hutchison
- Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Russell Schachar
- Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | |
Collapse
|
7
|
Stephens JA, Salorio CF, Gomes JP, Nebel MB, Mostofsky SH, Suskauer SJ. Response Inhibition Deficits and Altered Motor Network Connectivity in the Chronic Phase of Pediatric Traumatic Brain Injury. J Neurotrauma 2017. [PMID: 28648110 DOI: 10.1089/neu.2017.5081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Poor response inhibition is a hallmark of pediatric traumatic brain injury (TBI). We assessed motor response inhibition by measuring commission error rates on Simple (minimized cognitive demands) and Motivation (monetary reward) Go/No-Go tasks, comparing 17 children with chronic TBI (>1 year post-injury) and 14 matched, uninjured peers. Using resting state functional magnetic resonance imaging (fMRI), we examined between-group differences in whole-brain intrinsic connectivity of the motor network as derived from the averaged time course of bilateral primary motor cortex seeds, to identify regions of interest (ROIs) for brain-behavior correlations. Independent sample t tests compared Go/No-Go performance and connectivity at the ROI level. Pearson correlations examined relationships between intrinsic connectivity at the ROI level and Go/No-Go performance. Adolescents with TBI showed poorer performance on Simple and Motivation Go/No-Go tasks compared with controls. In whole-brain contrasts, adolescents with TBI showed significantly reduced functional connectivity between the motor network and voxels within the left caudate. Furthermore, in ROI analyses, the group with TBI had significantly lower connectivity between the motor network and left caudate and numerically lower connectivity between the motor network and right caudate. In adolescents with TBI, lower motor network to left caudate connectivity correlated with poorer Simple task performance; lower motor network to right caudate connectivity correlated with poorer Simple and Motivation task performance. No significant brain-behavior relationships existed among controls. These results are consistent with previous pediatric TBI literature and suggest that disrupted intrinsic connectivity of a corticostriatal motor network may contribute to response inhibition deficits.
Collapse
Affiliation(s)
- Jaclyn A Stephens
- 1 Kennedy Krieger Institute , Baltimore, Maryland.,2 Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Cynthia F Salorio
- 1 Kennedy Krieger Institute , Baltimore, Maryland.,2 Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Jerald P Gomes
- 1 Kennedy Krieger Institute , Baltimore, Maryland.,3 Howard University College of Medicine , Washington, DC
| | - Mary Beth Nebel
- 1 Kennedy Krieger Institute , Baltimore, Maryland.,4 Department of Neurology, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Stewart H Mostofsky
- 1 Kennedy Krieger Institute , Baltimore, Maryland.,4 Department of Neurology, Johns Hopkins School of Medicine , Baltimore, Maryland.,5 Department of Pediatrics, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Stacy J Suskauer
- 1 Kennedy Krieger Institute , Baltimore, Maryland.,2 Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine , Baltimore, Maryland.,5 Department of Pediatrics, Johns Hopkins School of Medicine , Baltimore, Maryland
| |
Collapse
|
8
|
Profiles of Executive Function Across Children with Distinct Brain Disorders: Traumatic Brain Injury, Stroke, and Brain Tumor. J Int Neuropsychol Soc 2017; 23:529-538. [PMID: 28502261 DOI: 10.1017/s1355617717000364] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study examined whether children with distinct brain disorders show different profiles of strengths and weaknesses in executive functions, and differ from children without brain disorder. METHODS Participants were children with traumatic brain injury (N=82; 8-13 years of age), arterial ischemic stroke (N=36; 6-16 years of age), and brain tumor (N=74; 9-18 years of age), each with a corresponding matched comparison group consisting of children with orthopedic injury (N=61), asthma (N=15), and classmates without medical illness (N=68), respectively. Shifting, inhibition, and working memory were assessed, respectively, using three Test of Everyday Attention: Children's Version (TEA-Ch) subtests: Creature Counting, Walk-Don't-Walk, and Code Transmission. Comparison groups did not differ in TEA-Ch performance and were merged into a single control group. Profile analysis was used to examine group differences in TEA-Ch subtest scaled scores after controlling for maternal education and age. RESULTS As a whole, children with brain disorder performed more poorly than controls on measures of executive function. Relative to controls, the three brain injury groups showed significantly different profiles of executive functions. Importantly, post hoc tests revealed that performance on TEA-Ch subtests differed among the brain disorder groups. CONCLUSIONS Results suggest that different childhood brain disorders result in distinct patterns of executive function deficits that differ from children without brain disorder. Implications for clinical practice and future research are discussed. (JINS, 2017, 23, 529-538).
Collapse
|
9
|
Hermans L, Beeckmans K, Michiels K, Lafosse C, Sunaert S, Coxon JP, Swinnen SP, Leunissen I. Proactive Response Inhibition and Subcortical Gray Matter Integrity in Traumatic Brain Injury. Neurorehabil Neural Repair 2016; 31:228-239. [DOI: 10.1177/1545968316675429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Lize Hermans
- Movement Control and Neuroplasticity Research Group, Biomedical Sciences Group, KU Leuven, Belgium
| | - Kurt Beeckmans
- Center for Epilepsy and Acquired Brain Injury (CEPOS), Duffel, Belgium
| | - Karla Michiels
- Department of Physical Medicine and Rehabilitation, University Hospital Leuven - Campus Pellenberg, Belgium
| | | | - Stefan Sunaert
- Medical Imaging Center, Group Biomedical Sciences, KU Leuven, Belgium
| | - James P. Coxon
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
| | - Stephan P. Swinnen
- Movement Control and Neuroplasticity Research Group, Biomedical Sciences Group, KU Leuven, Belgium
- Leuven Research Institute for Neuroscience & Disease (LIND), Leuven, Belgium
| | - Inge Leunissen
- Movement Control and Neuroplasticity Research Group, Biomedical Sciences Group, KU Leuven, Belgium
| |
Collapse
|
10
|
Serum Biomarkers Help Predict Attention Problems in Critically Ill Children With Traumatic Brain Injury. Pediatr Crit Care Med 2016; 17:638-48. [PMID: 27167007 DOI: 10.1097/pcc.0000000000000752] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the association between acute serum biomarkers, and the changes in attention at 1 year following traumatic brain injury. DESIGN AND SETTING A prospective observational and laboratory study conducted in PICUs at five Canadian children's hospitals. STUDY POPULATION AND MEASUREMENTS Fifty-eight patients aged 5 to 17 years with traumatic brain injury were enrolled in the study. Nine brain-specific and inflammatory serum protein biomarkers were measured multiple times over the first week following injury. Attention was measured at "baseline" to represent pre-injury function and at 1 year following injury using the Conners Third Parent Rating Scale. RESULTS Compared with baseline, there were significantly more clinical symptoms of inattention at 1 year post injury. The Glasgow Coma Scale score, age at injury, baseline levels of inattention, and highest levels of serum biomarkers were used to estimate the probability of developing inattention. These independent variables were first evaluated individually followed by combinations of the best predictors using area under the receiver operating characteristic curve analyses. A combination of high baseline levels of inattention and high serum levels of the biomarker neuron-specific enolase was the best predictor for inattention. Glasgow Coma Scale and age at injury were not associated with inattention at 1 year post injury. CONCLUSIONS Combining baseline assessment of attention with measurement of serum biomarkers shows promise as reliable, early predictors of long-term attention after childhood traumatic brain injury.
Collapse
|
11
|
|
12
|
Dennis M, Spiegler BJ, Simic N, Sinopoli KJ, Wilkinson A, Yeates KO, Taylor HG, Bigler ED, Fletcher JM. Functional plasticity in childhood brain disorders: when, what, how, and whom to assess. Neuropsychol Rev 2014; 24:389-408. [PMID: 24821533 PMCID: PMC4231018 DOI: 10.1007/s11065-014-9261-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 04/17/2014] [Indexed: 12/29/2022]
Abstract
At every point in the lifespan, the brain balances malleable processes representing neural plasticity that promote change with homeostatic processes that promote stability. Whether a child develops typically or with brain injury, his or her neural and behavioral outcome is constructed through transactions between plastic and homeostatic processes and the environment. In clinical research with children in whom the developing brain has been malformed or injured, behavioral outcomes provide an index of the result of plasticity, homeostasis, and environmental transactions. When should we assess outcome in relation to age at brain insult, time since brain insult, and age of the child at testing? What should we measure? Functions involving reacting to the past and predicting the future, as well as social-affective skills, are important. How should we assess outcome? Information from performance variability, direct measures and informants, overt and covert measures, and laboratory and ecological measures should be considered. In whom are we assessing outcome? Assessment should be cognizant of individual differences in gene, socio-economic status (SES), parenting, nutrition, and interpersonal supports, which are moderators that interact with other factors influencing functional outcome.
Collapse
Affiliation(s)
- Maureen Dennis
- Department of Psychology, Program in Neurosciences and Mental Health, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada,
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Neuropsychological performance of youth with secondary attention-deficit/hyperactivity disorder 6- and 12-months after traumatic brain injury. J Int Neuropsychol Soc 2014; 20:971-81. [PMID: 25489810 PMCID: PMC5010863 DOI: 10.1017/s1355617714000903] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The present study compared executive dysfunction among children with attention-deficit/hyperactivity disorder (ADHD) after traumatic brain injury (TBI), also called secondary ADHD (S-ADHD), pre-injury ADHD and children with TBI only (i.e., no ADHD). Youth aged 6-16 years admitted for TBI to five trauma centers were enrolled (n=177) and evaluated with a semi-structured psychiatric interview scheduled on three occasions (within 2 weeks of TBI, i.e., baseline assessment for pre-injury status; 6-months and 12-months post-TBI). This permitted the determination of 6- and 12-month post-injury classifications of membership in three mutually exclusive groups (S-ADHD; pre-injury ADHD; TBI-only). Several executive control measures were administered. Unremitted S-ADHD was present in 17/141 (12%) children at the 6-month assessment, and in 14/125 (11%) children at 12-months post-injury. The study found that children with S-ADHD exhibited deficient working memory, attention, and psychomotor speed as compared to children with pre-injury ADHD. Furthermore, the children with S-ADHD and the children with TBI-only were impaired compared to the children with pre-injury ADHD with regard to planning. No group differences related to response inhibition emerged. Age, but not injury severity, gender, or adaptive functioning was related to executive function outcome. Neuropsychological sequelae distinguish among children who develop S-ADHD following TBI and those with TBI only. Moreover, there appears to be a different pattern of executive control performance in those who develop S-ADHD than in children with pre-injury ADHD suggesting that differences exist in the underlying neural mechanisms that define each disorder, underscoring the need to identify targeted treatment interventions.
Collapse
|
14
|
Vonder Haar C, Smith TR, French EJ, Martens KM, Jacobs EA, Hoane MR. Simple tone discriminations are disrupted following experimental frontal traumatic brain injury in rats. Brain Inj 2014; 28:235-43. [PMID: 24456061 DOI: 10.3109/02699052.2013.860473] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To assess cognitive deficits in a rat model of brain injury. RESEARCH DESIGN Cognitive deficits are some of the most pervasive and enduring symptoms of frontal traumatic brain injury (TBI) in human patients. In animal models, the assessment of cognitive deficits from TBI has primarily been limited to tests of spatial learning. Recently, simple discrimination performance has been shown to be sensitive to frontal brain damage. The current study provides a detailed characterization of deficits in a two-choice tone discrimination following a bilateral frontal controlled cortical impact injury. METHODS AND PROCEDURES Rats were trained on a two-tone discrimination task in a standard operant chamber, then either a frontal brain injury was delivered or sham procedures performed. Following recovery, they were re-tested on the discrimination task and then tested on a reversal of the discrimination. MAIN OUTCOMES AND RESULTS Frontal injury caused substantial deficits in responding and discrimination accuracy as well as an increase in side bias. CONCLUSIONS Based on the outcomes seen in this study, discrimination and other operant tasks may provide a sensitive tool to assess the effect of therapeutic agents on cognitive deficits in animal models, which could lead to improved characterization of deficits and yield an improved assessment tool to aid in drug discovery.
Collapse
|
15
|
Tavano A, Galbiati S, Recla M, Bardoni A, Dominici C, Pastore V, Strazzer S. Cognitive recovery after severe traumatic brain injury in children/adolescents and adults: Similar positive outcome but different underlying pathways? Brain Inj 2014; 28:900-5. [DOI: 10.3109/02699052.2014.890742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
16
|
Lipszyc J, Levin H, Hanten G, Hunter J, Dennis M, Schachar R. Frontal white matter damage impairs response inhibition in children following traumatic brain injury. Arch Clin Neuropsychol 2014; 29:289-99. [PMID: 24618405 DOI: 10.1093/arclin/acu004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Inhibition, the ability to suppress inappropriate cognitions or behaviors, can be measured using computer tasks and questionnaires. Inhibition depends on the frontal cortex, but the role of the underlying white matter (WM) is unclear. We assessed the specific impact of frontal WM damage on inhibition in 29 children with moderate-to-severe traumatic brain injury (15 with and 14 without frontal WM damage), 21 children with orthopedic injury, and 29 population controls. We used the Stop Signal Task to measure response inhibition, the Behavior Rating Inventory of Executive Function to assess everyday inhibition, and T2 fluid-attenuated inversion recovery magnetic resonance imaging to identify lesions. Children with frontal WM damage had impaired response inhibition compared with all other groups and poorer everyday inhibition than the orthopedic injury group. Frontal WM lesions most often affected the superior frontal gyrus. These results provide evidence for the critical role of frontal WM in inhibition.
Collapse
Affiliation(s)
- Jonathan Lipszyc
- Department of Psychiatry, Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
17
|
Fecteau S, Levasseur-Moreau J, García-Molina A, Kumru H, Vergara RP, Bernabeu M, Roig T, Pascual-Leone A, Tormos JM. Risk taking in hospitalized patients with acute and severe traumatic brain injury. PLoS One 2013; 8:e83598. [PMID: 24386232 PMCID: PMC3873371 DOI: 10.1371/journal.pone.0083598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 11/05/2013] [Indexed: 11/26/2022] Open
Abstract
Rehabilitation can improve cognitive deficits observed in patients with traumatic brain injury (TBI). However, despite rehabilitation, the ability of making a choice often remains impaired. Risk taking is a daily activity involving numerous cognitive processes subserved by a complex neural network. In this work we investigated risk taking using the Balloon Analogue Risk Task (BART) in patients with acute TBI and healthy controls. We hypothesized that individuals with TBI will take less risk at the BART as compared to healthy individuals. We also predicted that within the TBI group factors such as the number of days since the injury, severity of the injury, and sites of the lesion will play a role in risk taking as assessed with the BART. Main findings revealed that participants with TBI displayed abnormally cautious risk taking at the BART as compared to healthy subjects. Moreover, healthy individuals showed increased risk taking throughout the task which is in line with previous work. However, individuals with TBI did not show this increased risk taking during the task. We also investigated the influence of three patients’ characteristics on their performance at the BART: Number of days post injury, Severity of the head injury, and Status of the frontal lobe. Results indicate that performance at the BART was influenced by the number of days post injury and the status of the frontal lobe, but not by the severity of the head injury. Reported findings are encouraging for risk taking seems to naturally improve with time postinjury. They support the need of conducting longitudinal prospective studies to ultimately identify impaired and intact cognitive skills that should be trained postinjury.
Collapse
Affiliation(s)
- Shirley Fecteau
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche Universitaire en Santé Mentale de Quebec, Medical School, Laval University, Quebec city, Quebec, Canada
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Jean Levasseur-Moreau
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche Universitaire en Santé Mentale de Quebec, Medical School, Laval University, Quebec city, Quebec, Canada
| | - Alberto García-Molina
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Hatiche Kumru
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Raúl Pelayo Vergara
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Monste Bernabeu
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Teresa Roig
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - José Maria Tormos
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| |
Collapse
|
18
|
Dennis M, Simic N, Bigler ED, Abildskov T, Agostino A, Taylor HG, Rubin K, Vannatta K, Gerhardt CA, Stancin T, Yeates KO. Cognitive, affective, and conative theory of mind (ToM) in children with traumatic brain injury. Dev Cogn Neurosci 2013; 5:25-39. [PMID: 23291312 PMCID: PMC3620837 DOI: 10.1016/j.dcn.2012.11.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 11/09/2012] [Accepted: 11/10/2012] [Indexed: 11/27/2022] Open
Abstract
We studied three forms of dyadic communication involving theory of mind (ToM) in 82 children with traumatic brain injury (TBI) and 61 children with orthopedic injury (OI): Cognitive (concerned with false belief), Affective (concerned with expressing socially deceptive facial expressions), and Conative (concerned with influencing another's thoughts or feelings). We analyzed the pattern of brain lesions in the TBI group and conducted voxel-based morphometry for all participants in five large-scale functional brain networks, and related lesion and volumetric data to ToM outcomes. Children with TBI exhibited difficulty with Cognitive, Affective, and Conative ToM. The perturbation threshold for Cognitive ToM is higher than that for Affective and Conative ToM, in that Severe TBI disturbs Cognitive ToM but even Mild-Moderate TBI disrupt Affective and Conative ToM. Childhood TBI was associated with damage to all five large-scale brain networks. Lesions in the Mirror Neuron Empathy network predicted lower Conative ToM involving ironic criticism and empathic praise. Conative ToM was significantly and positively related to the package of Default Mode, Central Executive, and Mirror Neuron Empathy networks and, more specifically, to two hubs of the Default Mode Network, the posterior cingulate/retrosplenial cortex and the hippocampal formation, including entorhinal cortex and parahippocampal cortex.
Collapse
Affiliation(s)
- Maureen Dennis
- Program in Neurosciences & Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Ornstein TJ, Max JE, Schachar R, Dennis M, Barnes M, Ewing-Cobbs L, Levin HS. Response inhibition in children with and without ADHD after traumatic brain injury. J Neuropsychol 2013; 7:1-11. [PMID: 23464806 PMCID: PMC4439416 DOI: 10.1111/j.1748-6653.2012.02027.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Children with attention-deficit hyperactivity disorder (ADHD) and traumatic brain injury (TBI) show deficient response inhibition. ADHD itself is a common consequence of TBI, known as secondary ADHD (S-ADHD). Similarity in inhibitory control in children with TBI, S-ADHD, and ADHD would implicate impaired frontal-striatal systems; however, it is first necessary to delineate similarities and differences in inhibitory control in these conditions. We compared performance of children with ADHD and those with TBI without pre-injury ADHD on a stop signal, response inhibition task. Participants were 274 children aged 6-14 years. There were 92 children with ADHD, 103 children with TBI, and 79 typically developing children who served as controls. Among the TBI participants, injury severity ranged from mild to severe. Children with ADHD and TBI showed deficient inhibition. The deficit in children with ADHD was as great as or greater than that in children with TBI, regardless of degree of TBI severity or the presence of S-ADHD. The finding indicates that TBI results in deficient inhibition regardless of the development of S-ADHD.
Collapse
|
20
|
Emotional expression and socially modulated emotive communication in children with traumatic brain injury. J Int Neuropsychol Soc 2013; 19:34-43. [PMID: 23158960 DOI: 10.1017/s1355617712000884] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Facial emotion expresses feelings, but is also a vehicle for social communication. Using five basic emotions (happiness, sadness, fear, disgust, and anger) in a comprehension paradigm, we studied how facial expression reflects inner feelings (emotional expression) but may be socially modulated to communicate a different emotion from the inner feeling (emotive communication, a form of affective theory of mind). Participants were 8- to 12-year-old children with TBI (n = 78) and peers with orthopedic injuries (n = 56). Children with mild-moderate or severe TBI performed more poorly than the OI group, and chose less cognitively sophisticated strategies for emotive communication. Compared to the OI and mild-moderate TBI groups, children with severe TBI had more deficits in anger, fear, and sadness; neutralized emotions less often; produced socially inappropriate responses; and failed to differentiate the core emotional dimension of arousal. Children with TBI have difficulty understanding the dual role of facial emotions in expressing feelings and communicating socially relevant but deceptive emotions, and these difficulties likely contribute to their social problems.
Collapse
|
21
|
Sinopoli KJ, Dennis M. Inhibitory control after traumatic brain injury in children. Int J Dev Neurosci 2012; 30:207-15. [PMID: 22100363 PMCID: PMC4712917 DOI: 10.1016/j.ijdevneu.2011.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 07/07/2011] [Accepted: 08/02/2011] [Indexed: 11/22/2022] Open
Abstract
Inhibitory control describes a number of distinct processes. Effortless inhibition refers to acts of control that are automatic and reflexive. Effortful inhibition refers to voluntary, goal-directed acts of control such as response flexibility, interference control, cancellation inhibition, and restraint inhibition. Disruptions to a number of inhibitory control processes occur as a consequence of childhood traumatic brain injury (TBI). This paper reviews the current knowledge of inhibition deficits following childhood TBI, and includes an overview of the inhibition construct and a discussion of the specific deficits shown by children and adolescents with TBI and the factors that mediate the expression of these deficits, including injury-related variables and the expression of pre- and post-injury attention-deficit/hyperactivity disorder. The review illustrates that inhibitory control processes differ in terms of measurement, assessment, and neurological underpinnings, and also that childhood TBI may selectively disrupt particular forms of inhibition.
Collapse
Affiliation(s)
- Katia J Sinopoli
- Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | | |
Collapse
|
22
|
Li H, Cheung SY, Chan JSY, Yan JH. Inhibitory Control Differentiates Rare Target Search Performance in Children. Percept Mot Skills 2012; 114:339-51. [DOI: 10.2466/04.10.22.pms.114.1.339-351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Age-related differences in rare-target search are primarily explained by the speed-accuracy trade-off, primed responses, or decision making. The goal was to examine how motor inhibition influences visual search. Children pressed a key when a rare target was detected. On no-target trials, children withheld reactions. Response time (RT), hits, misses, correct rejection, and false alarms were measured. Tapping tests assessed motor control. Older children tapped faster, were more sensitive to rare targets (higher d'), and reacted more slowly than younger ones. Girls outperformed boys in search sensitivity but not in RT. Motor speed was closely associated with hit rate and RT. Results suggest that development of inhibitory control plays a key role in visual detection. The potential implications for cognitive-motor development and individual differences are discussed.
Collapse
Affiliation(s)
- Hongting Li
- Department of Psychology, Zhejiang Sci-Tech University, Hangzhou, China
| | - Sui-Yin Cheung
- Department of Physical Education, Hong Kong Baptist University, Hong Kong SAR, China
| | - John S-Y. Chan
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jin H. Yan
- Department of Applied Psychology, Shanghai University of Sport, Shanghai, China
| |
Collapse
|
23
|
Gorman S, Barnes MA, Swank PR, Prasad M, Ewing-Cobbs L. The effects of pediatric traumatic brain injury on verbal and visual-spatial working memory. J Int Neuropsychol Soc 2012; 18:29-38. [PMID: 22014162 PMCID: PMC3707395 DOI: 10.1017/s1355617711001251] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to investigate the effects of pediatric traumatic brain injury (TBI) on verbal and visual-spatial working memory (WM). WM tasks examined memory span through recall of the last item of a series of stimuli. Additionally, both verbal and visual-spatial tests had a dual-task condition assessing the effect of increasing demands on the central executive (CE). Inhibitory control processes in verbal WM were examined through intrusion errors. The TBI group (n = 73) performed more poorly on verbal and visual-spatial WM tasks than orthopedic-injured children (n = 30) and non-injured children (n = 40). All groups performed more poorly on the dual-task conditions, reflecting an effect of increasing CE load. This effect was not greater for the TBI group. There were no group differences in intrusion errors on the verbal WM task, suggesting that problems in WM experienced by children with TBI were not primarily due to difficulties in inhibitory control. Finally, injury-related characteristics, namely days to follow commands, accounted for significant variance in WM performance, after controlling for relevant demographic variables. Findings suggest that WM impairments in TBI are general rather than modality-specific and that severity indices measured over time are better predictors of WM performance than those taken at a single time point.
Collapse
Affiliation(s)
| | - Marcia A. Barnes
- Department of Pediatrics and Children's Learning Institute, University of Texas Health Science Center at Houston, Houston, Texas
| | - Paul R. Swank
- Department of Pediatrics and Children's Learning Institute, University of Texas Health Science Center at Houston, Houston, Texas
| | - Mary Prasad
- Department of Pediatrics and Children's Learning Institute, University of Texas Health Science Center at Houston, Houston, Texas
| | - Linda Ewing-Cobbs
- Department of Pediatrics and Children's Learning Institute, University of Texas Health Science Center at Houston, Houston, Texas
| |
Collapse
|
24
|
Eckner JT, Richardson JK, Kim H, Lipps DB, Ashton-Miller JA. A novel clinical test of recognition reaction time in healthy adults. Psychol Assess 2011; 24:249-54. [PMID: 21859222 DOI: 10.1037/a0025042] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We evaluated a clinical "go/no-go" reaction time test (recognition RTclin) that is portable and does not require a computer, and used it to quantify the effect of age on recognition RTclin test scores. Fifty-two healthy adults 19-83 years old completed simple and recognition RTclin testing. Simple RTclin was measured as the elapsed time from initial release of a suspended vertical shaft by the examiner until its arrest by participant pinch grip. Recognition RTclin was similar except that a light on the apparatus randomly illuminated in 50% of the trials to signal the participant to arrest the device. To help interpret the RTclin results, we partitioned them into premovement time (PMT) and movement time (MT) using an optoelectronic camera system that is not ordinarily part of the RTclin test. Recognition RTclin scores were significantly slower than simple RTclin scores, with 71% of the prolongation attributable to PMT. While simple RTclin test scores correlated with age, recognition RTclin scores did not. A strong negative association between recognition RTclin accuracy and age was found. Recognition RTclin is feasible to measure in healthy adults and appears to represent a portable, computer-independent measure of cognitive processing speed and inhibitory capacity. Potential applications include assessment of brain injury, dementing illness, medication side effects, fall risk, and safe driving.
Collapse
Affiliation(s)
- James T Eckner
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor 48108, USA.
| | | | | | | | | |
Collapse
|
25
|
Catale C, Germain S, Meulemans T. Exploration of Perceptual and Motor Inhibition in Children with Traumatic Brain Injury. Percept Mot Skills 2011; 112:667-79. [DOI: 10.2466/04.15.22.25.pms.112.3.667-679] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Perceptual and motor inhibition were examined using conflict resolution tasks for 12 children with traumatic brain injury and 24 matched controls. Direct comparisons of inhibition performances between the two groups showed a specific and disproportionate impairment of motor inhibition (compared with perceptual inhibition) for the children with traumatic brain injury, which suggests that inhibition processes might be differentially impaired in children after traumatic brain injury.
Collapse
|
26
|
Sinopoli KJ, Schachar R, Dennis M. Traumatic brain injury and secondary attention-deficit/hyperactivity disorder in children and adolescents: the effect of reward on inhibitory control. J Clin Exp Neuropsychol 2011; 33:805-19. [PMID: 21598155 DOI: 10.1080/13803395.2011.562864] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Poor inhibitory control and abnormalities in responding to rewards are characteristic of the developmental or primary form of attention-deficit/hyperactivity disorder (P-ADHD). A secondary form of ADHD (S-ADHD) may occur as a consequence of childhood traumatic brain injury (TBI), but the similarities and differences between these two forms of ADHD have not been well characterized. To address these issues, we studied two inhibitory control tasks under different reward conditions in four groups of children and adolescents: TBI who did not exhibit S-ADHD, TBI who did exhibit S-ADHD, P-ADHD, and healthy controls. Participants with TBI exhibited poor cancellation inhibition relative to controls. Although reward facilitated both cancellation and restraint inhibition similarly across groups, poor performance persisted in the P-ADHD group, and participants with S-ADHD exhibited a selective deficit in cancellation inhibition.
Collapse
Affiliation(s)
- Katia J Sinopoli
- Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
| | | | | |
Collapse
|
27
|
Abstract
BACKGROUND While many children with brain conditions present with cognitive, behavioural, emotional, academic and social impairments, other children recover with seemingly few impairments. Animal studies and preliminary child studies have identified timing of brain lesion as a key predictor in determining functional outcome following early brain lesions. REVIEW This research suggests that knowledge of healthy developmental processes in brain structure and function is essential for better understanding functional recovery and outcome in children with brain lesions. This review paper aims to equip researchers with current knowledge of key principles of developmental processes in brain structure and function. Timetables for development of the prefrontal cortex (PFC), a brain region particularly vulnerable to lesions due to its protracted developmental course, are examined. In addition, timetables for development of executive skills, which emerge in childhood and have a prolonged developmental course that parallels development of the PFC, are also discussed. CONCLUSIONS Equipped with this knowledge, researchers are now in a better position to understand functional recovery and outcome in children with brain conditions.
Collapse
Affiliation(s)
- Megan Spencer-Smith
- Critical Care and Neurosciences, Murdoch Childrens Research Institute, Royal Children's Hospital, FlemingtonRoad, Parkville, VIC 3054, Australia.
| | | |
Collapse
|
28
|
Neurorehabilitation im Kindesund Jugendalter. NeuroRehabilitation 2010. [DOI: 10.1007/978-3-642-12915-5_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
29
|
Suskauer SJ, Huisman TAGM. Neuroimaging in pediatric traumatic brain injury: current and future predictors of functional outcome. ACTA ACUST UNITED AC 2009; 15:117-23. [PMID: 19489082 DOI: 10.1002/ddrr.62] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although neuroimaging has long played a role in the acute management of pediatric traumatic brain injury (TBI), until recently, its use as a tool for understanding and predicting long-term brain-behavior relationships after TBI has been limited by the relatively poor sensitivity of routine clinical imaging for detecting diffuse axonal injury (DAI). Newer magnetic resonance-based imaging techniques demonstrate improved sensitivity to DAI. Early research suggests that these techniques hold promise for identifying imaging predictors and correlates of chronic function, both globally and within specific neuropsychological domains. In this review, we describe the principles of new, advanced imaging techniques including diffusion weighted and diffusion tensor imaging, susceptibility weighted imaging, and (1)H-magnetic resonance spectroscopy. In addition, we summarize current research demonstrating their early success in establishing relationships between imaging measures and functional outcomes after TBI. With the ongoing research, these imaging techniques may allow earlier identification of possible chronic sequelae of tissue injury for each child with TBI, thereby facilitating efficacy and efficiency in delivering successful rehabilitation services.
Collapse
Affiliation(s)
- Stacy J Suskauer
- Department of Physical Medicine and Rehabilitation, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, 707 North Broadway, Baltimore, MD 21205, USA.
| | | |
Collapse
|
30
|
Activation of the pre-supplementary motor area but not inferior prefrontal cortex in association with short stop signal reaction time--an intra-subject analysis. BMC Neurosci 2009; 10:75. [PMID: 19602259 PMCID: PMC2719646 DOI: 10.1186/1471-2202-10-75] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 07/14/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our previous work described the neural processes of motor response inhibition during a stop signal task (SST). Employing the race model, we computed the stop signal reaction time (SSRT) to index individuals' ability in inhibitory control. The pre-supplementary motor area (preSMA), which shows greater activity in individuals with short as compared to those with long SSRT, plays a role in mediating response inhibition. In contrast, the right inferior prefrontal cortex (rIFC) showed greater activity during stop success as compared to stop error. Here we further pursued this functional differentiation of preSMA and rIFC on the basis of an intra-subject approach. RESULTS Of 65 subjects who participated in four sessions of the SST, we identified 30 individuals who showed a difference in SSRT but were identical in other aspects of stop signal performance between the first ("early") and last two ("late") sessions. By comparing regional brain activation between the two sessions, we confirmed greater preSMA but not rIFC activity during short as compared to long SSRT session within individuals. Furthermore, putamen, anterior cerebellum and middle/posterior cingulate cortex also showed greater activity in association with short SSRT. CONCLUSION These results are consistent with a role of medial prefrontal cortex in controlled action and inferior frontal cortex in orienting attention. We discussed these findings with respect to the process of attentional monitoring and inhibitory motor control during stop signal inhibition.
Collapse
|
31
|
Heffelfinger AK, Koop JI. A Description of Preschool Neuropsychological Assessment in the P.I.N.T. Clinic after the First 5 Years. Clin Neuropsychol 2009; 23:51-76. [DOI: 10.1080/13854040801945052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
32
|
Dennis M, Sinopoli KJ, Fletcher JM, Schachar R. Puppets, robots, critics, and actors within a taxonomy of attention for developmental disorders. J Int Neuropsychol Soc 2008; 14:673-90. [PMID: 18764966 PMCID: PMC2593155 DOI: 10.1017/s1355617708080983] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This review proposes a new taxonomy of automatic and controlled attention. The taxonomy distinguishes among the role of the attendee (puppet and robot, critic and actor), the attention process (stimulus orienting vs. response control), and the attention operation (activation vs. inhibition vs. adjustment), and identifies cognitive phenotypes by which attention is overtly expressed. We apply the taxonomy to four childhood attention disorders: attention deficit hyperactivity disorder, spina bifida meningomyelocele, traumatic brain injury, and acute lymphoblastic leukemia. Variations in attention are related to specific brain regions that support normal attention processes when intact, and produce disordered attention when impaired. The taxonomy explains group differences in behavioral inattention, hyperactivity, and impulsiveness, as well as medication response. We also discuss issues relevant to theories of the cognitive and neural architecture of attention: functional dissociations within and between automatic and controlled attention; the relative importance of type of brain damage and developmental timing to attention profile; cognitive-energetic models of attention and white matter damage; temporal processing deficits, attention deficits and cerebellar damage; and the issue of cognitive phenotypes as candidate endophenotypes.
Collapse
Affiliation(s)
- Maureen Dennis
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada.
| | | | | | | |
Collapse
|
33
|
Levin HS, Hanten G, Roberson G, Li X, Ewing-Cobbs L, Dennis M, Chapman S, Max JE, Hunter J, Schachar R, Luerssen TG, Swank P. Prediction of cognitive sequelae based on abnormal computed tomography findings in children following mild traumatic brain injury. J Neurosurg Pediatr 2008; 1:461-70. [PMID: 18518697 DOI: 10.3171/ped/2008/1/6/461] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The aim of this study was to determine whether the presence of intracranial pathophysiology on computed tomography (CT) scans obtained within 24 hours of mild traumatic brain injury (MTBI) in children adversely affects neuropsychological outcome during the 1st year postinjury. METHODS A prospective longitudinal design was used to examine the neuropsychological outcomes in children (ages 5-15 years) who had been treated for MTBI, which was defined as a loss of consciousness for up to 30 minutes and a lowest Glasgow Coma Scale (GCS) score of 13-15. Exclusion criteria included any preinjury neurological disorder. Outcome assessments were performed within 2 weeks and at 3, 6, and 12 months postinjury. Outcomes were compared between patients with MTBI whose postinjury CT scans revealed complications of brain pathophysiology (32 patients, CMTBI group) and those with MTBI but without complications (48 patients, MTBI group). RESULTS Significant interactions confirmed that the pattern of recovery over 12 months after injury differed depending on the intracranial pathology, presence and severity of injuries to body regions other than the head, preinjury attention-deficit hyperactivity disorder (ADHD), and socioeconomic status. Children in the CMTBI group had significantly poorer episodic memory, slower cognitive processing, diminished recovery in managing cognitive interference, and poorer performance in calculating and reading than patients in the MTBI group. Among the patients with mild or no extracranial injury, visuomotor speed was slower in those in the CMTBI group; and among patients without preinjury ADHD, working memory was worse in those in the CMTBI group. CONCLUSIONS Neuropsychological recovery during the 1st year following MTBI is related to the presence of radiographically detectable intracranial pathology. Children with intracranial pathology on acute CT performed more poorly in several cognitive domains when compared with patients whose CT findings were normal or limited to a linear skull fracture. Depending on the presence of preinjury ADHD and concomitant extracranial injury, working memory and visuomotor speed were also diminished in patients whose CT findings revealed complications following MTBI. Computed tomography within 24 hours postinjury appears to be useful for identifying children with an elevated risk for residual neuropsychological changes.
Collapse
Affiliation(s)
- Harvey S Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Kreipke CW, Morgan R, Kallakuri S, Rafols JA. Behavioral pre-conditioning enhances angiogenesis and cognitive outcome after brain trauma. Neurol Res 2007; 29:388-94. [PMID: 17626735 DOI: 10.1179/016164107x204710] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES In this study, we used Marmarou's model of traumatic brain injury (TBI) and sought to determine: (1) the effect of TBI on cognitive outcome measured on a radial arm maze; (2) the effect of behavioral conditioning before TBI, i.e. pre-conditioning, on cognitive outcome; (3) the effect of pre-conditioning on angiogenesis. METHODS Cognitive outcome was measured by performance on an eight-arm radial maze. Behavioral conditioning consisted of daily exposure of animals to the radial arm maze. Latency and number of errors were recorded as an index of overall performance and acquisition of the test. Extent of angiogenesis was measured by vascular endothelial growth factor receptor 2 (VEGFR2) immunofluorescence and by determining capillary density. RESULTS Our results indicated that trauma alone causes significant cognitive impairments. Pre-conditioning caused a marked improvement in radial arm maze performance following injury. These results coincide with both a significant increase in VEGFR2 expression and increased capillary density within the cortex and hippocampus. DISCUSSION TBI causes significant impairments in cognition. These deficits can be ameliorated using a pre-conditioning paradigm. While the precise mechanism has yet to be elucidated, our results indicate that angiogenesis may underlie the cognitive sparing seen in pre-conditioned animals.
Collapse
Affiliation(s)
- Christian W Kreipke
- Department of Anatomy and Cell Biology, Scott Hall, Room No. 9312, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI 48201, USA
| | | | | | | |
Collapse
|
35
|
Schachar R, Logan GD, Robaey P, Chen S, Ickowicz A, Barr C. Restraint and Cancellation: Multiple Inhibition Deficits in Attention Deficit Hyperactivity Disorder. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2007; 35:229-38. [PMID: 17351752 DOI: 10.1007/s10802-006-9075-2] [Citation(s) in RCA: 179] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 10/12/2006] [Indexed: 10/23/2022]
Abstract
We used variations of the stop signal task to study two components of motor response inhibition-the ability to withhold a strong response tendency (restraint) and the ability to cancel an ongoing action (cancellation)-in children with a diagnosis of attention deficit hyperactivity disorder (ADHD) and in non-ADHD controls of similar age (ages 7-14 years). The goal was to determine if restraint and cancellation were related and if both were deficient in ADHD. The stop signal task involved a choice reaction time task (go task) which required a rapid response. The demand for inhibitory control was invoked through the presentation of a stop signal on a subset of go trials which required that the ongoing response be suspended. The stop signal was presented either concurrently with the go signal (restraint version) or after a variable delay (cancellation version). In Study 1, we compared ADHD and control children on the cancellation version of the stop task; in Study 2, we compared ADHD and controls on the restraint version. In Study 3, a subset of ADHD and control participants completed both tasks so that we could examine convergence of these dimensions of inhibition. Compared to control participants, ADHD participants showed a deficit both in the ability to cancel and to restrain a speeded motor response. Performance on the restraint version was significantly correlated with performance on the cancellation version in controls, but not in ADHD participants. We conclude that ADHD is associated with deficits in both restraint and cancellation subcomponents of inhibition.
Collapse
Affiliation(s)
- Russell Schachar
- Psychiatry Research Unit, Department of Psychiatry, Brain and Behavior Programme, Research Institute, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|