Quality-of-life after brain injury in childhood: time, not severity, is the significant factor

Perfectionism, Big Five and biopsychosocial functioning among parents of children with and without acquired brain injury (ABI)

BACKGROUND AND OBJECTIVE

Personality factors are often investigated in the context of parenting but are rarely studied in relation to coping with child disabilities like pediatric acquired brain injury (pABI). This study (1) compares Biopsychosocial functioning (BPSF), Big Five personality traits, and dimensions of perfectionism of parents of children with and without pABI, and (2) examines the role personality factors play in parental BPSF in each group.

METHOD

57 parents of children who sustained a significant pABI and 50 parents of typically developing children participated in this cross-sectional study. Parents completed scales measuring Multidimensional Perfectionism, Big Five inventory, and BPSF.

RESULTS

Among the pABI group, multivariate analysis indicated significantly poorer BPSF, higher levels of neuroticism, socially prescribed perfectionism, and lower levels of openness, than controls. Regression analysis showed that personality explained 60.5% of the variance in parental BPSF post pABI. In both samples, neuroticism and socially prescribed perfectionism appeared as two prominent personality factors with a significant negative effect on parental BPSF, while self-perfectionism appeared prominent only in the pABI group, indicating a significant positive effect.

IMPLICATIONS

pABI may result in changes to parents` personality. Personality characteristics significantly contribute to parental BPSF post-injury and should be addressed in clinical practice.

Understanding the relationship between family functioning and health-related quality of life in very young children with moderate-to-severe TBI

Objective: To investigate the relationship of pre-injury and concurrent family functioning with health-related quality of life (HR QoL) following traumatic brain injury (TBI) or orthopedic injury (OI) in very young children. Method: Prospective enrollment of children ages 0-4 years who presented to the emergency department after sustaining either acute TBI or OI. This is a sub-analysis of children who completed at least one post-injury follow-up visit. At time of study enrollment, parents rated pre-injury family functioning (Family Assessment Device-General Functioning Scale) and the child's HR QoL (Pediatric Quality of Life Inventory^TM). Family functioning and HR QoL were assessed at one and six months post-injury. Mixed models were used to examine family functioning as a moderator of a child's HR QoL following injury. Results: Data were analyzed for 42 children with TBI and 24 children with OI. For both groups, better pre-injury family functioning was significantly associated with better HR QoL over time. A triple interaction of injury type by time since injury by concurrent family functioning indicated that children with TBI and poor family functioning had significantly worse HR QoL at six months post-injury relative to other groups. Conclusion: Despite a small sample size, current results underscore the importance of family functioning to recovery following early childhood TBI and support the need for continued research and development of interventions to improve outcomes in this population.

Childhood Traumatic Brain Injury and the Associations With Risk Behavior in Adolescence and Young Adulthood: A Systematic Review

OBJECTIVE

To systematically review the evidence that childhood traumatic brain injury (TBI) is associated with risk behavior in adolescence and young adulthood. Risk behavior included one or more of the following: use of substances, including alcohol, tobacco, and illicit substances; involvement in criminal behavior; and behavioral issues with conduct.

METHODS

A literature search was conducted using these terms: child, pediatric, traumatic brain injury, head injury, adolescent, psychosocial, antisocial, conduct, substance use. Studies describing original research were included if they reported outcomes over the age of 13 years in participants who sustained a TBI between birth and age 13 years.

RESULTS

Six journal articles were reviewed based on 4 separate studies. Three articles indicated a relationship between childhood TBI and increased problematic substance use in adolescence and young adulthood. Three articles supported an association between childhood TBI and later externalizing behavior; however, 2 articles did not support this link.

CONCLUSION

More research is warranted to explore the association between childhood TBI and later risk behavior as the relationship is not currently understood. Future research should build on existing longitudinal research with continued use of medical records for identifying TBI and inclusion of a non-brain-related trauma group to control for general injury effects.

Heart Rate Variability Among Children With Acquired Brain Injury

Objective

To find evidence of autonomic imbalance and present the heart rate variability (HRV) parameters that reflect the severity of paroxysmal sympathetic hyperactivity (PSH) in children with acquired brain injury (ABI).

Methods

Thirteen children with ABI were enrolled and age- and sex-matched children with cerebral palsy were selected as the control group (n=13). The following HRV parameters were calculated: time-domain indices including the mean heart rate, standard deviation of all average R-R intervals (SDNN), root mean square of the successive differences (RMSSD), physical stress index (PSI), approximate entropy (ApEn); successive R-R interval difference (SRD), and frequency domain indices including total power (TP), high frequency (HF), low frequency (LF), normalized HF, normalized LF, and LF/HF ratio.

Results

There were significant differences between the ABI and control groups in the mean heart rate, RMSSD, PSI and all indices of the frequency domain analysis. The mean heart rate, PSI, normalized LF, and LF/HF ratio increased in the ABI group. The presence of PSH symptoms in the ABI group demonstrated a statistically significant decline of the SDNN, TP, ln TP.

Conclusion

The differences in the HRV parameters and presence of PSH symptoms are noted among ABI children compared to an age- and sex-matched control group with cerebral palsy. Within the ABI group, the presence of PSH symptoms influenced the parameters of HRV such as SDNN, TP and ln TP.

Pediatric Canadian Triage and Acuity Scale (PaedsCTAS) as a Measure of Injury Severity

This research explored whether the pediatric version of the Canadian Triage Acuity Scale (PaedsCTAS) represented a valid alternative indicator for surveillance of injury severity. Every patient presenting in a Canadian emergency department is assigned a CTAS or PaedsCTAS score in order to prioritize access to care and to predict the nature and scope of care that is likely to be required. The five-level PaedsCTAS score ranges from I (resuscitation) to V (non-urgent). A total of 256 children, 0 to 17-years-old, who attended a pediatric hospital for an injury were followed longitudinally. Of these children, 32.4% (n = 83) were hospitalized and 67.6% (n = 173) were treated in the emergency department and released. They completed the PedsQL(TM), a validated measure of health related quality of life, at baseline (pre-injury status), one-month, four- to six-months, and 12-months post-injury. In this secondary data analysis, PaedsCTAS was found to be significantly associated with hospitalization and length of stay, sensitive to the differences between PaedsCTAS II and III, and related to physical but not psychosocial HRQoL. The findings suggest that PaedsCTAS may be a useful proxy measure of injury severity to supplement or replace hospitalization status and/or length of stay, currently proxy measures.

Parent-Reported Health-Related Quality of Life in Children With Traumatic Brain Injury: A Prospective Study

OBJECTIVE

To identify which specific aspects of health-related quality of life (HRQL) are affected by traumatic brain injury (TBI) injury severity (Severity), time since injury (Time), and the interaction between Severity and Time, in a pediatric sample. It was hypothesized that Severity would decrease HRQL, Time would increase HRQL, and time to recover would be protracted for children with severe TBI.

METHODS

This study followed a pediatric sample (n = 182, aged 6-14 years, recruited through three Australian hospitals) who sustained a mild or moderate-severe TBI across 3, 6, 12, and 18 months post-TBI. 12 specific HRQL outcomes were assessed via the Child Health Questionnaire-Parent Form 50 questionnaire.

RESULTS

Dimensions of HRQL were differentially affected. Children with moderate-severe TBI generally experienced greater initial dysfunction than children with mild TBI; however, this difference disappeared by 18 months post-TBI.

CONCLUSIONS

Specific time points where HRQL outcomes may remediate are identified, and clinical recommendations regarding intervention strategies are discussed.

A Balanced Protocol for Return to School for Children and Youth Following Concussive Injury

BACKGROUND

Few protocols exist for returning children/youth to school after concussion. Childhood concussion can significantly affect school performance, which is vital to social development, academic learning, and preparation for future roles. The goal of this knowledge translation research was to develop evidence based materials to inform physicians about pediatric concussion.

METHODS

The Return to School (RTS) concussion protocol was developed following the National Institute for Health and Care Excellence procedures.

RESULTS

Based on a scoping review, and stakeholder opinions, an RTS protocol was developed for children/youth. This unique protocol focuses on school adaptation in 4 main areas: (a) timetable/attendance, (b) curriculum, (c) environmental modifications, and (d) activity modifications.

CONCLUSION

A balance of cognitive rest and timely return to school need to be considered for returning any student to school after a concussion. Implementation of these new recommendations may be an important tool in prevention of prolonged absence from school and academic failure while supporting brain recovery.