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Studer M, Heussler M, Romano F, Lidzba K, Bigi S. Processing speed and its association with working memory and episodic memory 3-6 months after pediatric mild traumatic brain injury. Brain Inj 2024; 38:928-937. [PMID: 38819316 DOI: 10.1080/02699052.2024.2361626] [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: 05/08/2023] [Revised: 05/01/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE Following mild traumatic brain injury (mTBI), children show reduced processing speed (PS). Evidence suggests that slowed PS after TBI is associated with working memory deficits. Our aim was to investigate several forms of PS and to examine its impact on working and episodic memory performance in children after mTBI. METHOD We included data of 64 children after mTBI and 57 healthy control children aged 8-16 years. PS (Color Naming, Coding, Symbol Search, Alertness) was compared between groups 1 week (T1) and 3-6 months (T2) after the injury; working and episodic memory outcome was compared between groups at T2. RESULTS Alertness at T1 and Color Naming at T1 and T2 were significantly reduced following mTBI compared to controls, although most group differences in PS disappeared when patients with previous impairments and mTBI were excluded. PS was predictive for episodic and working memory performance 3-6 months after injury, whereas group was a significant predictor of working memory. CONCLUSIONS Compared to healthy controls, children after mTBI showed reduced performance in verbal PS, which was associated with working memory. In children who are symptomatic after mTBI, diagnostic screening of PS could be helpful in identifying patients that could profit from speed-improving strategies.
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Affiliation(s)
- Martina Studer
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel UKBB, Basel, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Milena Heussler
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Fabrizio Romano
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Karen Lidzba
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sandra Bigi
- Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital of Central Switzerland, Lucerne, Switzerland
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
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2
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Chadwick L, Marbil MG, Madigan S, Callahan BL, Yeates KO. The Relationship Between Parental and Family Functioning and Post-Concussive Symptoms After Pediatric Mild Traumatic Brain Injury: A Scoping Review. J Neurotrauma 2024; 41:305-318. [PMID: 37565282 DOI: 10.1089/neu.2023.0201] [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: 08/12/2023] Open
Abstract
This scoping review aimed to address the following questions: (1) Does mild traumatic brain injury (mTBI) result in more parental distress or poorer family functioning than other injuries? (2) Does pre-injury or acute parental distress and family functioning predict post-concussive symptoms (PCS) after mTBI? and (3) Do acute PCS predict later parental distress and family functioning? The subjects of this review were children/adolescents who had sustained an mTBI before age 18 and underwent assessment of PCS and parent or family functioning. MEDLINE®, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and CENTRAL databases were searched to identify original, empirical, peer-reviewed research published in English. PCS measures included parent- and child-reported symptom counts and continuous scales. Parent and family measures assessed parental stress, psychological adjustment, anxiety, psychiatric history, parent-child interactions, family burden, and general family functioning. A total of 11,163 articles were screened, leading to the inclusion of 15 studies, with 2569 participants (mTBI = 2222; control = 347). Collectively, the included articles suggest that mTBI may not result in greater parental distress or poorer family functioning than other types of injuries. Pre-injury or acute phase parental and family functioning appears to predict subsequent PCS after mTBI, depending on the specific family characteristic being studied. Early PCS may also predict subsequent parental and family functioning, although findings were mixed in terms of predicting more positive or negative family outcomes. The available evidence suggests that parent and family functioning may have an important, perhaps bidirectional, association with PCS after pediatric mTBI. However, further research is needed to provide a more thorough understanding of this association.
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Affiliation(s)
- Leah Chadwick
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, and University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mica Gabrielle Marbil
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, and University of Calgary, Calgary, Alberta, Canada
| | - Sheri Madigan
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, and University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Brandy L Callahan
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, and University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Sy EHCN, Atakla HG, Mbaye M, Thioub M, Nguepnang MP, Thiam AB, Ba MC, Badiane S. Severe brain injury in children aged 0-5 years in urban areas: the role of socio-economic development and parental responsibility. Neurosurg Rev 2023; 46:162. [PMID: 37401965 DOI: 10.1007/s10143-023-02074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/25/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
Cranioencephalic trauma is a transient or permanent cerebral dysfunction resulting from a direct or indirect shock applied to the skull and its contents. The aim of this study was to establish the aetiological and favourable factors for the occurrence of cranioencephalic trauma in children under 5 years of age in an urban environment, in order to expose the implication of socio-economic development and parental responsibility. This was a 5-year mixed-methods analytical study from 10/07/2017 to 10/07/2022. It included 50 children, who were hospitalised at the neurosurgery department of Fann Hospital in Dakar for cranioencephalic trauma (CET) with a Blantyre score ≤ 2/5 and a GCS ≤ 8. During the study period, we had collected 50 children with severe CET. The mean age of the patients was 30.25 months with extremes of 01 months and 60 months. At 1 year post-CET, 8 children, i.e., 16% of the children, were seen with neurological after-effects such as motor disorders, with a p value of 0.041 ˂ 0.05. We are living in a period where the technological revolution is taking a big step forward every day. The misuse of NICT and the socio-economic stability of parents seem to influence the occurrence of severe CET in small children. It is becoming more and more frequent with the lack of supervision of children in favour of communication and leisure tools.
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Affiliation(s)
| | | | - Maguette Mbaye
- Neurosurgery Department, Fann's National Teaching Hospital, Dakar, Senegal
| | - Mbaye Thioub
- Neurosurgery Department, Fann's National Teaching Hospital, Dakar, Senegal
| | | | | | - Momar Code Ba
- Neurosurgery Department, Fann's National Teaching Hospital, Dakar, Senegal
| | - Seydou Badiane
- Neurosurgery Department, Fann's National Teaching Hospital, Dakar, Senegal
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Riemann L, Mikolic A, Maas A, Unterberg A, Younsi A. Computed Tomography Lesions and Their Association with Global Outcome in Young People with Mild Traumatic Brain Injury. J Neurotrauma 2023. [PMID: 36578216 DOI: 10.1089/neu.2022.0055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Mild traumatic brain injury (mTBI) can be accompanied by structural damage to the brain. Here, we investigated how the presence of intracranial traumatic computed tomography (CT) pathologies relates to the global functional outcome in young patients one year after mTBI. All patients with mTBI (Glasgow Coma Scale: 13-15) ≤24 years in the multi-center, prospective, observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study were included. Patient demographics and CT findings were assessed at admission, and the Glasgow Outcome Scale Extended (GOSE) was evaluated at 12 months follow-up. The association between a "positive CT" (at least one of the following: epidural hematoma, subdural hematoma, traumatic subarachnoid hemorrhage (tSAH), intraventricular hemorrhage, subdural collection mixed density, contusion, traumatic axonal injury) and functional outcome (GOSE) was assessed using multi-variable mixed ordinal and logistic regression models. A total of 462 patients with mTBI and initial brain CT from 46 study centers were included. The median age was 19 (17-22) years, and 322 (70%) were males. CT imaging showed a traumatic intracranial pathology in 171 patients (37%), most commonly tSAH (48%), contusions (40%), and epidural hematomas (37%). Patients with a positive CT scan were less likely to achieve a complete recovery 12 months post-injury. The presence of any CT abnormality was associated with both lower GOSE scores (odds ratio [OR]: 0.39 [0.24-0.63]) and incomplete recovery (GOSE <8; OR: 0.41 [0.25-0.68]), also when adjusted for demographical and clinical baseline factors. The presence of intracranial traumatic CT pathologies was predictive of outcome 12 months after mTBI in young patients, which might help to identify candidates for early follow-up and additional care.
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Affiliation(s)
- Lennart Riemann
- Department of Neurosurgery, University Hospital Heidelberg, Germany
| | - Ana Mikolic
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Andrew Maas
- Department of Neurosurgery, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | | | - Alexander Younsi
- Department of Neurosurgery, University Hospital Heidelberg, Germany
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5
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Käckenmester W, Güthoff C, Mroß D, Wietholt G, Zappel K, Schmehl I. Evaluation of Post-Hospital Care of Traumatic Brain Injury in Children, Adolescents and Young Adults—A Survey among General Practitioners and Pediatricians in Germany. Diagnostics (Basel) 2022; 12:diagnostics12092265. [PMID: 36140665 PMCID: PMC9498187 DOI: 10.3390/diagnostics12092265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/21/2022] Open
Abstract
Background: The long-term effects of mild Traumatic Brain Injury (TBI) in children and adolescents are increasingly discussed due to their potential impact on psycho-social development and education. This study aims to evaluate post-hospital care of children and adolescents after mild TBI using a physician survey. Methods: A self-developed, pre-tested questionnaire on diagnostics and treatment of TBI in outpatient care was sent to a representative sample of general practitioners and pediatricians in Germany. Results: Datasets from 699 general practitioners, 334 pediatricians and 24 neuropediatricians were available and included in the analysis. Nearly half of the general practitioners and most pediatricians say they treat at least one acute pediatric TBI per year. However, a substantive proportion of general practitioners are not familiar with scales assessing TBI severity and have difficulties assessing the symptoms correctly. Pediatricians seem to have better knowledge than general practitioners when it comes to treatment and outpatient care of TBI. Conclusions: To increase knowledge about TBI in outpatient physicians, targeted training courses should be offered, especially for general practitioners. Moreover, handing out written information about long-term effects and reintegration after TBI should be encouraged in outpatient practice.
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Affiliation(s)
- Wiebke Käckenmester
- Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany
| | - Claas Güthoff
- Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany
- Correspondence:
| | - Dana Mroß
- Kinderneurologie-Hilfe Berlin, Brandenburg am Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany
| | - Gertrud Wietholt
- Bundesverband Kinderneurologie-Hilfe e.V., Tannenbergstraße 1, 48147 Münster, Germany
| | - Kristina Zappel
- Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany
| | - Ingo Schmehl
- Department of Neurology, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany
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6
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Chadwick L, Peckham SB, Yeates KO. Adult Cognitive Outcomes Following Childhood Mild Traumatic Brain Injury: A Scoping Review. J Head Trauma Rehabil 2022; 37:285-292. [PMID: 35452023 DOI: 10.1097/htr.0000000000000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This review aimed to (1) summarize the existing literature regarding cognitive outcomes in adults with a history of pediatric mild traumatic brain injury (mTBI) and (2) identify gaps in the literature to provide directions for future research. PARTICIPANTS Participants sustained mTBI in childhood (0-17 years of age) and underwent cognitive assessment in adulthood (older than 18 years) at least 1 year postinjury. DESIGN MEDLINE Ovid and PsycINFO Ovid databases were searched to identify original research studies that examined adult cognitive outcomes after childhood mTBI. MAIN MEASURES Cognitive outcome measures assessed memory, attention, visuospatial abilities, processing speed, comprehension, reasoning, intellectual functioning, and executive functioning. Outcome measures ranged from self-reported cognitive symptoms to objective testing. RESULTS A total of 4216 articles were screened, leading to the inclusion of 6 published studies for review (3 prospective cohort and 3 retrospective cohort), with 131 537 participants (mTBI = 6724; controls = 123 823). Review of the included articles suggests that adults with a history of childhood mTBI perform within the average range expected for adult cognitive functioning, although they may perform more poorly than non-head-injured comparison groups on a variety of cognitive measures. Injury-related factors, such as requiring electroencephalography within 24 hours of injury and posttraumatic amnesia lasting longer than 30 minutes, may be associated with variability in adult cognitive outcomes. CONCLUSION The weight of the available evidence suggests that childhood mTBI does not have a significant impact on adult cognitive functioning. However, further research is needed to provide a more comprehensive understanding of the long-term cognitive outcomes of childhood mTBI and to identify predictors of those outcomes in adulthood.
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Affiliation(s)
- Leah Chadwick
- Departments of Psychology (Ms Chadwick, Mr Peckham, and Dr Yeates) and Pediatrics and Clinical Neurosciences (Dr Yeates), University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada (Ms Chadwick and Dr Yeates); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (Ms Chadwick, Mr Peckham, and Dr Yeates)
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7
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Omer M, Posti JP, Gissler M, Merikukka M, Bärnighausen T, Wilson ML. Birth order and pediatric traumatic brain injury. Sci Rep 2022; 12:14451. [PMID: 36002560 PMCID: PMC9402548 DOI: 10.1038/s41598-022-18742-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 08/18/2022] [Indexed: 11/22/2022] Open
Abstract
Pediatric traumatic brain injury (TBI) is a significant problem of public health importance worldwide. Large population-based studies on the effect of birth order on health phenomena are exceedingly rare. This study examines the relationship between birth order and risk for pediatric TBI among sibling groups. We performed a retrospective cohort study following 59,469 Finnish newborns from 1987 until age 18 years. Data on first diagnosis of TBI was recorded within the 1987 Finnish Birth Cohort (FBC). Compared with first born siblings, later born siblings had an increased risk of TBI during the follow-up period (hazard ratio [HR] 1.02; 95% confidence interval [CI] 0.91–1.14 for second born, HR 1.09; 95% CI 0.95 1.26 for third born, HR 1.28; 95% CI 1.08–1.53 for fourth or higher). When adjusted for sex and maternal age at child’s birth, HRs (95% CIs) for TBI during the follow-up period were 1.12 (0.99–1.26) for second born, 1.31 (1.12–1.53) for third born and 1.61 (1.33–1.95) for fourth born or higher children, respectively. Within this large register-based population-wide study, order of birth modified risk for pediatric TBI among sibling groups. Taken together, these study findings may serve to stimulate further inquiry into genetic, psychological, or psychosocial factors which underlie differences in risk and depth of effect within and between sibling groups.
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Affiliation(s)
- Mazin Omer
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany. .,Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland.
| | - Jussi P Posti
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, National Institute for Health and Welfare (THL), Helsinki, Finland.,Academic Primary Health Care Centre, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Marko Merikukka
- Children, Adolescents and Families, National Institute for Health and Welfare (THL), Oulu, Finland.,ITLA Children's Foundation, Helsinki, Finland
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany
| | - Michael Lowery Wilson
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany
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8
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Hageman G, Nihom J. A Child Presenting with a Glasgow Coma Scale Score of 13: Mild or Moderate Traumatic Brain Injury? A Narrative Review. Neuropediatrics 2022; 53:83-95. [PMID: 34879424 DOI: 10.1055/s-0041-1740455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this article was to compare children with traumatic brain injury (TBI) and Glasgow Coma Scale score (GCS) 13 with children presenting with GCS 14 and 15 and GCS 9 to 12. DATA SOURCE We searched PubMed for clinical studies of children of 0 to 18 years of age with mild TBI (mTBI) and moderate TBI, published in English language in the period of 2000 to 2020. STUDY SELECTION We selected studies sub-classifying children with GCS 13 in comparison with GCS 14 and 15 and 9 to 12. We excluded reviews, meta-analyses, non-U.S./European population studies, studies of abusive head trauma, and severe TBI. DATA SYNTHESIS Most children (>85%) with an mTBI present at the emergency department with an initial GCS 15. A minority of only 5% present with GCS 13, 40% of which sustain a high-energy trauma. Compared with GCS 15, they present with a longer duration of unconsciousness and of post-traumatic amnesia. More often head computerized tomography scans show abnormalities (in 9-16%), leading to neurosurgical intervention in 3 to 8%. Also, higher rates of severe extracranial injury are reported. Admission is indicated in more than 90%, with a median length of hospitalization of more than 4 days and 28% requiring intensive care unit level care. These data are more consistent with children with GCS 9 to 12. In children with GCS 15, all these numbers are much lower. CONCLUSION We advocate classifying children with GCS 13 as moderate TBI and treat them accordingly.
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Affiliation(s)
- Gerard Hageman
- Department of Neurology, Medical Spectrum Enschede, Hospital Enschede, Enschede, The Netherlands
| | - Jik Nihom
- Department of Neurology, Medical Spectrum Enschede, Hospital Enschede, Enschede, The Netherlands
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Holthe IL, Dahl HM, Rohrer-Baumgartner N, Eichler S, Elseth MF, Holthe Ø, Berntsen T, Yeates KO, Andelic N, Løvstad M. Neuropsychological Impairment, Brain Injury Symptoms, and Health-Related Quality of Life After Pediatric TBI in Oslo. Front Neurol 2022; 12:719915. [PMID: 35153967 PMCID: PMC8831895 DOI: 10.3389/fneur.2021.719915] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022] Open
Abstract
Descriptions of clinical outcomes in pediatric traumatic brain injury (pTBI) in Scandinavia are sparse. The Oslo site of the European CENTER-TBI study has performed a pTBI outcome study in a hospitalized population. The main objective was to investigate neuropsychological outcomes, self- and parent-reported symptoms associated with brain injury, and quality of life in children aged 1–15 years, 5–8 months after injury. Fifty-two children were included, and 45 completed the assessments. The sample consisted of 15.4% severe, 21.2% moderate, and 63.4% mild TBI. Subjectively experienced problems with concentration and fatigue were reported by the parents of nearly half of the children. Higher brain injury symptom load was associated with lower quality of life, but was unrelated to injury severity. Group average scores of the sample on neuropsychological testing appeared unimpaired relative to normative means aside from lower performance in working memory. However, based on an impairment index (i.e., 2 or more tests being >1.5 SD below the normative mean), the presence of weak cognitive performance was evident in as many as 45.4% of the sample. Two-thirds of the sample also showed abnormally large intraindividual variability in cognitive functioning (i.e., significant WISC-IV index discrepancies). The findings highlight the need to look beyond group averages on neuropsychological testing. Utilizing an impairment index and considering intraindividual performance variability conveyed deficits that may warrant clinical follow-up. The association of brain injury symptoms with quality of life but not injury severity emphasizes the need to consider symptoms after TBI within a biopsychosocial framework. Clinical Trial Registration:ClinicalTrials.gov; identifier: NCT02210221.
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Affiliation(s)
- Ingvil Laberg Holthe
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
- *Correspondence: Ingvil Laberg Holthe
| | - Hilde Margrete Dahl
- Section for Child Neurology, Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | | | - Sandra Eichler
- Department of Traumatic Brain Injury, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | | | - Øyvor Holthe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Torhild Berntsen
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
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What About the Little Ones? Systematic Review of Cognitive and Behavioral Outcomes Following Early TBI. Neuropsychol Rev 2022; 32:906-936. [PMID: 34994947 DOI: 10.1007/s11065-021-09517-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 06/07/2021] [Indexed: 10/19/2022]
Abstract
There is increasing empirical focus on the effects of early traumatic brain injuries (TBI; i.e., before the age of six years) on child development, but this literature has never been synthetized comprehensively. This systematic review aimed to document the cognitive, academic, behavioral, socio-affective, and adaptive consequences of early TBI. Four databases (Medline, PsycNET, CINAHL, PubMed) were systematically searched from 1990 to 2019 using key terms pertaining to TBI and early childhood. Of 12, 153 articles identified in the initial search, 43 were included. Children who sustain early TBI are at-risk for a range of difficulties, which are generally worse when injury is sustained at a younger age, injury severity is moderate to severe, and injury mechanisms are non-accidental. Early childhood is a sensitive period for the emergence and development of new skills and behaviors, and brain disruption during this time is not benign. Research, clinical management, intervention, and prevention efforts should be further developed with consideration of the unique characteristics of the early childhood period.
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Quality of family environment predicts child perceptions of competence 12 months after pediatric traumatic brain injury. Ann Phys Rehabil Med 2021; 65:101606. [PMID: 34780994 DOI: 10.1016/j.rehab.2021.101606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 10/12/2021] [Accepted: 10/17/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND . Demographic and environmental factors can affect child recovery after traumatic brain injury (TBI); however, little is known about their role in predicting child perceptions of competence (i.e., subjective judgments of ability or a sense of adequacy). OBJECTIVES . This prospective, cohort study examined the contribution of participant sex, age at assessment, socioeconomic status, parent-reported change in academic performance post-injury, and the quality of a child's relationship with their family (i.e., family affective involvement, intimacy, integration, and the nature of family roles) to child perceptions of global and academic competence 12 months after pediatric TBI. METHODS . Participants included 127 children, 84 with a TBI (53 mild, 31 moderate-severe TBI; injury age: 5-15 years) and 43 age-matched typically developing (TD) controls. Children rated their perceptions of global and academic competence and degree of family intimacy and integration. Parents completed questionnaires measuring socioeconomic status, family affective involvement, and the nature of family roles. Parents also indicated whether they perceived a change in their child's post-injury academic performance. RESULTS . Child perceptions of academic competence were significantly lower for children with moderate-severe TBI relative to TD children. In contrast, child perceptions of global competence were comparable between TBI and TD control groups. Socioeconomic status, age at assessment, parent-reported relative change in academic performance post-TBI, and family roles were associated with child perceptions of academic competence. Degree of family integration was the sole predictor of child perceptions of global competence. CONCLUSIONS . Child perceptions of academic competence are vulnerable to the effects of moderate-severe TBI, particularly among older children and those from low socioeconomic backgrounds. Well-defined family roles for handling family functions and greater integration of family units might enhance perceptions of global and academic competence in children with TBI.
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12
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You Only Get One Brain: Adult Reflections on the Long-Term Impacts of Traumatic Brain Injury in Adolescence. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background:
This research adds to scarce literature regarding adolescent experiences of traumatic brain injury (TBI). Retrospective accounts of young adults who had sustained a TBI in adolescence were analysed to explore the perceived impact this had on their lives and forming identities during this important developmental stage.
Methods:
Thirteen adults (aged 20–25 years; mean 23 years) who sustained a mild or moderate TBI during adolescence (i.e. aged 13–17 years at injury), approximately 7.7 years (range = 6.7–8.0 years) prior, participated in the research. Semi-structured individual interviews, analysed using thematic analysis, explored participants’ experiences following their TBIs.
Results:
Thematic analysis of interview data produced two categories of themes: (1) Impacts on Important Areas of Life, which included: schoolwork suffered, career opportunities became limited, struggling with work and missing out socially; and (2) Impacts on Identity: with themes including feeling ‘stupid’, feeling self-conscious, loss of social identity and being dependent.
Conclusions:
TBI sustained during adolescence can have broad impacts on important areas of life and on developing identity.
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Chadwick L, Roth E, Minich NM, Taylor HG, Bigler ED, Cohen DM, Bacevice A, Mihalov LK, Bangert BA, Zumberge NA, Yeates KO. Cognitive Outcomes in Children with Mild Traumatic Brain Injury: An Examination Using the National Institutes of Health Toolbox Cognition Battery. J Neurotrauma 2021; 38:2590-2599. [PMID: 33906429 PMCID: PMC8403208 DOI: 10.1089/neu.2020.7513] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This study is the first to examine cognitive outcomes after pediatric mild TBI using the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB), a computerized cognitive test battery. The NIHTB-CB includes two complex measures of attention and executive function that allow differentiation of accuracy and response speed. We compared performance on the NIHTB-CB among children 8-16 years of age with mild TBI (n = 143) versus children with orthopedic injuries (OIs; n = 74) recruited in emergency departments and followed for 6 months post-injury. Mixed-model analyses showed that the mild TBI group showed significantly lower Fluid Cognition composite scores than the OI group at 10 days (group intercept, p = 0.018); the magnitude of group differences declined modestly over time (group × time interaction, p = 0.055). Effect sizes were d = 0.34 at 10 days post-injury, d = 0.27 at 3 months, and d = 0.10 at 6 months. No significant effects of group or time were found for the Crystallized Cognition composite. Analyses of Fluid Cognition subtests indicated that children with mild TBI displayed deficits for as long as 3 months on measures of attention and executive function (e.g., cognitive flexibility, inhibitory control), but not on measures of explicit memory, working memory, or processing speed. The poorer performance of the mild TBI group on measures of attention and executive function was attributable largely to slowed reaction time, not decreased accuracy. The findings suggest that children with mild TBI demonstrate persistent deficits in fluid cognition that are most apparent on tasks that combine demands for both speed and executive function.
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Affiliation(s)
- Leah Chadwick
- Department of Psychology and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Elizabeth Roth
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nori M. Minich
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - H. Gerry Taylor
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Erin D. Bigler
- Departments of Psychology and Neuroscience, Brigham Young University, Provo, Utah, USA
| | - Daniel M. Cohen
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ann Bacevice
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
- Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Leslie K. Mihalov
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Barbara A. Bangert
- Departments of Radiology and Neurosurgery, University Hospitals Health System, Cleveland, Ohio, USA
| | | | - Keith Owen Yeates
- Department of Psychology and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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14
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Zamani A, Ryan NP, Wright DK, Caeyenberghs K, Semple BD. The Impact of Traumatic Injury to the Immature Human Brain: A Scoping Review with Insights from Advanced Structural Neuroimaging. J Neurotrauma 2021; 37:724-738. [PMID: 32037951 DOI: 10.1089/neu.2019.6895] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Traumatic brain injury (TBI) during critical periods of early-life brain development can affect the normal formation of brain networks responsible for a range of complex social behaviors. Because of the protracted nature of brain and behavioral development, deficits in cognitive and socioaffective behaviors may not become evident until late adolescence and early adulthood, when such skills are expected to reach maturity. In addition, multiple pre- and post-injury factors can interact with the effects of early brain insult to influence long-term outcomes. In recent years, with advancements in magnetic-resonance-based neuroimaging techniques and analysis, studies of the pediatric population have revealed a link between neurobehavioral deficits, such as social dysfunction, with white matter damage. In this review, in which we focus on contributions from Australian researchers to the field, we have highlighted pioneering longitudinal studies in pediatric TBI, in relation to social deficits specifically. We also discuss the use of advanced neuroimaging and novel behavioral assays in animal models of TBI in the immature brain. Together, this research aims to understand the relationship between injury consequences and ongoing brain development after pediatric TBI, which promises to improve prediction of the behavioral deficits that emerge in the years subsequent to early-life injury.
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Affiliation(s)
- Akram Zamani
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Nicholas P Ryan
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Victoria, Australia.,Brain & Mind Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - David K Wright
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Bridgette D Semple
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
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15
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Haarbauer-Krupa J, Pugh MJ, Prager EM, Harmon N, Wolfe J, Yaffe K. Epidemiology of Chronic Effects of Traumatic Brain Injury. J Neurotrauma 2021; 38:3235-3247. [PMID: 33947273 PMCID: PMC9122127 DOI: 10.1089/neu.2021.0062] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although many patients diagnosed with traumatic brain injury (TBI), particularly mild TBI, recover from their symptoms within a few weeks, a small but meaningful subset experience symptoms that persist for months or years after injury and significantly impact quality of life for the person and their family. Factors associated with an increased likelihood of negative TBI outcomes include not only characteristics of the injury and injury mechanism, but also the person’s age, pre-injury status, comorbid conditions, environment, and propensity for resilience. In this article, as part of the Brain Trauma Blueprint: TBI State of the Science framework, we examine the epidemiology of long-term outcomes of TBI, including incidence, prevalence, and risk factors. We identify the need for increased longitudinal, global, standardized, and validated assessments on incidence, recovery, and treatments, as well as standardized assessments of the influence of genetics, race, ethnicity, sex, and environment on TBI outcomes. By identifying how epidemiological factors contribute to TBI outcomes in different groups of persons and potentially impact differential disease progression, we can guide investigators and clinicians toward more-precise patient diagnosis, along with tailored management, and improve clinical trial designs, data evaluation, and patient selection criteria.
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Affiliation(s)
- Juliet Haarbauer-Krupa
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City, Salt Lake City, Utah, USA.,Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | | | - Kristine Yaffe
- Department of Neurology, University of California San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Departments of Epidemiology/Biostatistics and Psychiatry, University of California San Francisco, San Francisco, California, USA
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16
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Ahorsu DK, Adjaottor ES, Lam BYH. Intervention Effect of Non-Invasive Brain Stimulation on Cognitive Functions among People with Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Brain Sci 2021; 11:brainsci11070840. [PMID: 34202739 PMCID: PMC8301762 DOI: 10.3390/brainsci11070840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/14/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022] Open
Abstract
This systematic review and meta-analysis aggregated and examined the treatment effect of non-invasive brain stimulation (NIBS) (transcranial direct current stimulation and transcranial magnetic stimulation) on cognitive functions in people with traumatic brain injury (TBI). A systematic search was conducted using databases (PubMed, Web of Science, Scopus, PsycINFO, EMBASE) for studies with keywords related to non-randomized and randomized control trials of NIBS among people with TBI. Nine out of 1790 NIBS studies with 197 TBI participants (103 active vs. 94 sham) that met the inclusion and exclusion criteria of the present study were finally selected for meta-analysis using Comprehensive Meta-Analysis software (version 3). Results showed that the overall effect of NIBS on cognition in people with TBI was moderately significant (g = 0.304, 95% CI = 0.055 to 0.553) with very low heterogeneity across studies (I2 = 0.000, Tau = 0.000). Specifically, significant and marginally significant moderate effect sizes were found for cognitive sub-domains including attention, memory, and executive function. The present findings suggest that NIBS is moderately effective in improving cognitive functions among people with TBI. In particular, NIBS may be used as an alternative and/or an adjunct treatment to the traditional approach in rehabilitating cognitive functions in people with TBI.
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Affiliation(s)
- Daniel Kwasi Ahorsu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China;
| | - Emma Sethina Adjaottor
- Department of Behavioural Sciences, Kwame Nkrumah University of Science and Technology, Ashanti, Ghana;
| | - Bess Yin Hung Lam
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
- Correspondence:
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17
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Saarinen M, Erkinjuntti N, Koskinen S, Himanen L, Vahlberg T, Tenovuo O, Lähdesmäki T. Prolonged injury symptoms and later visits to psychiatric care after mild traumatic brain injury in school-age. Brain Inj 2021; 35:690-697. [PMID: 33678108 DOI: 10.1080/02699052.2021.1895316] [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: 10/22/2022]
Abstract
OBJECTIVE To investigate demographic and pre-injury factors in Finnish school-aged children admitted to pediatric neurology services after mild traumatic brain injury (mTBI). The relation of these factors to prolonged injury symptoms and later visits into psychiatric care was assessed. METHODS Demographic information, pre-injury learning status, and neuropsychological test results of 120 patients aged 7-16 years were retrospectively collected from the hospital medical records. Data were compared with self- or parent-reported injury symptoms at 1-3 months post-injury and later visits to psychiatric care. RESULTS According to medical records, 14.2% of the children with mTBI had a diagnosed neurobehavioral or psychiatric condition pre-injury. Additionally, 53.3% of the children had some neurobehavioral or psychiatric concerns or traits prior to the injury. Over half (56.7%) of the children studied were symptomatic at 1-3 months following the injury. Female gender and presence of prolonged symptoms were predictive for later visit into psychiatric care. CONCLUSIONS Pre-injury neurobehavioral or psychiatric problems may predict prolonged injury symptoms following pediatric mTBI. In this retrospective patient series, prolonged symptoms and female gender seem to predict the need for later psychiatric care. Monitoring the recovery of children with mTBI and pre-injury risk factors is important for timely interventions.
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Affiliation(s)
- M Saarinen
- Department of Pediatric Neurology, University of Turku, Turku, Finland
| | - N Erkinjuntti
- Department of Pediatric Neurology, University of Turku, Turku, Finland.,Department of Pediatric Neurology, Turku University Hospital, Turku, Finland
| | - S Koskinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - L Himanen
- Department of Psychology, University of Turku, Turku, Finland
| | - T Vahlberg
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - O Tenovuo
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - T Lähdesmäki
- Department of Pediatric Neurology, University of Turku, Turku, Finland.,Department of Pediatric Neurology, Turku University Hospital, Turku, Finland
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18
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Dahl HM, Andelic N, Løvstad M, Holthe IL, Hestnes M, Diseth TH, Myhre MC. Epidemiology of traumatic brain injury in children 15 years and younger in South-Eastern Norway in 2015-16. Implications for prevention and follow-up needs. Eur J Paediatr Neurol 2021; 31:70-77. [PMID: 33647532 DOI: 10.1016/j.ejpn.2021.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This retrospective study aimed to describe the volume, severity, and injury mechanism of all hospital-admitted pediatric traumatic brain injury (pTBI) at Oslo University Hospital (OUH), emphasizing consequences for prevention and factors indicating a need for follow-up programs. METHOD Data were extracted from the OUH Trauma registry on 176 children, 0-15 years old, admitted to OUH in 2015 and 2016 with a pTBI diagnosis. The dataset contains demographic data, injury mechanism, type, and severity (Glasgow coma scale, GCS; abbreviated injury scale, AIS; injury severity score, ISS), ICD-10 diagnosis codes, level of treatment, and destination of discharge. RESULTS 79.5% had mild, 9% moderate, and 11.4% severe TBI. The incidence of hospital-treated pTBI in Oslo was 29 per 100,000 per year. The boy: girl ratio was 1.9:1, but in the young teenage group (14-15 years), the ratio was 1:1. Intracranial injury (ICI) identified on CT/MRI was associated with extended hospital stays, with a median of 6 days compared to 1 day for patients without ICI. 27% of the patients assessed as mild TBI at admission had ICI. Children below eight years of age had a higher incidence of moderate and severe ICI from trauma (53% v.s. 28% in children ≥ eight years). CONCLUSION The injury characteristics of hospital-treated pTBI are in line with other European countries, but we find the boy-girl ratio different as young teenage girls seem to be catching up with the boys. ICI and length of stay should be considered when deciding which patients need follow-up and rehabilitation.
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Affiliation(s)
- Hilde Margrete Dahl
- Dept. of Clinical Neurosciences for Children, Section for Child Neurology, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
| | - Nada Andelic
- Dept. of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Norway.
| | - Marianne Løvstad
- Dept. of Psychology, Faculty of Social Sciences, University of Oslo, Norway; Dept. of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway.
| | - Ingvil Laberg Holthe
- Dept. of Psychology, Faculty of Social Sciences, University of Oslo, Norway; Dept. of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway.
| | - Morten Hestnes
- Division of Emergencies and Critical Care, Department of Research and Development,Oslo University Hospital, Norway; Oslo University Hospital Trauma Registry, Oslo University Hospital, Oslo, Norway.
| | - Trond H Diseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Dept. of Clinical Neurosciences for Children, Section for Psychosomatics and CL-child Psychiatry,Oslo University Hospital, Norway.
| | - Mia Cathrine Myhre
- Norwegian Centre for Violence and Traumatic Stress Studies, Nydalen, Oslo, Norway; Dept. of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway.
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19
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Sherry N, Trbovich A, Holland C, Eagle S, Bitzer H, Kontos AP. Predictors of poor reading performance in student-athletes following sport-related concussion. APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:364-372. [PMID: 33428451 DOI: 10.1080/21622965.2020.1850449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The goal of the current study was to determine which sport/recreation-related concussion (SRC) assessments predict academic reading performance following SRC. The study included 70 concussed students aged 14-22 years (M = 16.21, SD = 1.90) evaluated 2-30 days (M = 8.41, SD = 5.88) post-injury. SRC assessments included: Post-Concussion Symptom Scale, Immediate Post-Concussion Assessment and Cognitive Testing, Vestibular/Ocular Motor Screening, and King-Devick test. The Nelson-Denny Reading Test (NDRT) comprehension subtest measured academic reading accuracy and rate. Pearson correlations examined relationships among SRC assessments and reading accuracy/rate; those assessments that significantly correlated with the NDRT were included in multiple regressions (MRs) predicting reading accuracy and reading rate. Results supported positive correlations between visual motor speed and reading accuracy (r = .31, p = .01), and near point of convergence (NPC) and reading rate (r = .30, p = .01). The MRs for reading accuracy (F = 4.61, p = .01) and reading rate (F = 4.61, p = .01) were significant, and predicted approximately 40% of the variance, with visual motor speed and NPC as the only significant predictors in both models. Symptoms were not predictive of reading accuracy or rate. The present study indicates that visual motor speed and NPC are predictive of academic reading performance after SRC, suggesting clinicians should consider these clinical outcomes to better inform academic accommodations.
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Affiliation(s)
- Natalie Sherry
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alicia Trbovich
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cyndi Holland
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawn Eagle
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hannah Bitzer
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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20
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Willing AE, Das M, Howell M, Mohapatra SS, Mohapatra S. Potential of mesenchymal stem cells alone, or in combination, to treat traumatic brain injury. CNS Neurosci Ther 2020; 26:616-627. [PMID: 32157822 PMCID: PMC7248546 DOI: 10.1111/cns.13300] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/17/2020] [Accepted: 02/23/2020] [Indexed: 12/13/2022] Open
Abstract
Traumatic brain injury (TBI) causes death and disability in the United States and around the world. The traumatic insult causes the mechanical injury of the brain and primary cellular death. While a comprehensive pathological mechanism of TBI is still lacking, the focus of the TBI research is concentrated on understanding the pathophysiology and developing suitable therapeutic approaches. Given the complexities in pathophysiology involving interconnected immunologic, inflammatory, and neurological cascades occurring after TBI, the therapies directed to a single mechanism fail in the clinical trials. This has led to the development of the paradigm of a combination therapeutic approach against TBI. While there are no drugs available for the treatment of TBI, stem cell therapy has shown promising results in preclinical studies. But, the success of the therapy depends on the survival of the stem cells, which are limited by several factors including route of administration, health of the administered cells, and inflammatory microenvironment of the injured brain. Reducing the inflammation prior to cell administration may provide a better outcome of cell therapy following TBI. This review is focused on different therapeutic approaches of TBI and the present status of the clinical trials.
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Affiliation(s)
- Alison E Willing
- Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Mahasweta Das
- Department of Molecular Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Mark Howell
- Department of Molecular Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Shyam S Mohapatra
- James A. Haley Veterans Hospital, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Subhra Mohapatra
- Department of Molecular Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,James A. Haley Veterans Hospital, Tampa, FL, USA
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21
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Stockbridge MD, Newman RS, Zukowski A, Slawson KK, Doran A, Ratner NB. Language profiles in children with concussion. Brain Inj 2020; 34:567-574. [DOI: 10.1080/02699052.2020.1725836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Melissa D. Stockbridge
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland, USA
| | - Rochelle S. Newman
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland, USA
| | - Andrea Zukowski
- Department of Linguistics, University of Maryland, College Park, Maryland, USA
| | - Kristin K. Slawson
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland, USA
| | - Anthony Doran
- Head First Sports Injury and Concussion Care, Waugh Chapel, Maryland, USA
| | - Nan Bernstein Ratner
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland, USA
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22
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Hsia RY, Mannix RC, Guo J, Kornblith AE, Lin F, Sokolove PE, Manley GT. Revisits, readmissions, and outcomes for pediatric traumatic brain injury in California, 2005-2014. PLoS One 2020; 15:e0227981. [PMID: 31978188 PMCID: PMC6980591 DOI: 10.1371/journal.pone.0227981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/04/2020] [Indexed: 01/23/2023] Open
Abstract
Long-term outcomes related to emergency department revisit, hospital readmission, and all-cause mortality, have not been well characterized across the spectrum of pediatric traumatic brain injury (TBI). We evaluated emergency department visit outcomes up to 1 year after pediatric TBI, in comparison to a referent group of trauma patients without TBI. We performed a longitudinal, retrospective study of all pediatric trauma patients who presented to emergency departments and hospitals in California from 2005 to 2014. We compared emergency department visits, dispositions, revisits, readmissions, and mortality in pediatric trauma patients with a TBI diagnosis to those without TBI (Other Trauma patients). We identified 208,222 pediatric patients with an index diagnosis of TBI and 1,314,064 patients with an index diagnosis of Other Trauma. Population growth adjusted TBI visits increased by 5.6% while those for Other Trauma decreased by 40.7%. The majority of patients were discharged from the emergency department on their first visit (93.2% for traumatic brain injury vs. 96.5% for Other Trauma). A greater proportion of TBI patients revisited the emergency department (33.4% vs. 3.0%) or were readmitted to the hospital (0.9% vs. 0.04%) at least once within a year of discharge. The health burden within a year after a pediatric TBI visit is considerable and is greater than that of non-TBI trauma. These data suggest that outpatient strategies to monitor for short-term and longer-term sequelae after pediatric TBI are needed to improve patient outcomes, lessen the burden on families, and more appropriately allocate resources in the healthcare system.
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Affiliation(s)
- Renee Y Hsia
- Department of Emergency Medicine, University of California, San Francisco, California, United States of America.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, United States of America
| | - Rebekah C Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Joanna Guo
- Department of Emergency Medicine, University of California, San Francisco, California, United States of America
| | - Aaron E Kornblith
- Department of Emergency Medicine, University of California, San Francisco, California, United States of America
| | - Feng Lin
- Department of Biostatistics and Epidemiology, University of California, San Francisco, California, United States of America
| | - Peter E Sokolove
- Department of Emergency Medicine, University of California, San Francisco, California, United States of America
| | - Geoffrey T Manley
- Brain and Spinal Injury Center (BASIC), University of California, San Francisco, California, United States of America.,Department of Neurological Surgery, University of California, San Francisco, California, United States of America
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23
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Head and Neck Trauma in a Rapidly Growing African Metropolis: A Two-Year Audit of Hospital Admissions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244930. [PMID: 31817489 PMCID: PMC6950021 DOI: 10.3390/ijerph16244930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/25/2019] [Accepted: 12/02/2019] [Indexed: 02/01/2023]
Abstract
Understanding injury-related burdens is an essential part of trauma quality improvement programs aimed at decreasing morbidity and mortality. This is especially the case in low and middle-income country settings where data on injuries remains limited. The aim of this study was to audit the types of head and neck injuries, which have been diagnosed among patients admitted to a major national hospital in the context of a rapidly growing sub Saharan city. Data were collected retrospectively for head and neck trauma from the Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania from the years 2016 and 2017. Distribution of ICD-10 codes by age and sex for the five most common diagnoses were determined using frequencies and percentages. The most common diagnosis was ICD-10-S02 (fracture of skull and facial bones) with 277 cases (44.1%), which was followed by S05 (injury of the eye and orbit), 114 cases (18.2%), and S09 (other and unspecified injuries of head) 77 cases (12.3%). The mean ages of admission for these three diagnoses were 28.1 (SD: 11.6), 23.8 (SD: 18.9), and 30.8 (SD: 18.0) years, respectively. This study provides information on the overall burden of head and neck trauma at a major regional tertiary care facility. It provides an initial understanding of the burden of head and neck trauma and suggests follow-up in the form of clarification of injury mechanisms and contextual factors for future work.
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24
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Pediatric Traumatic Brain Injury and Exercise Medicine: A Narrative Review. Pediatr Exerc Sci 2019; 31:393-400. [PMID: 30955443 DOI: 10.1123/pes.2017-0286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/10/2019] [Accepted: 01/28/2019] [Indexed: 11/18/2022]
Abstract
The multidisciplinary field of pediatric traumatic brain injury (TBI) and exercise medicine is of growing importance. There is active study into the diagnostic and therapeutic potential of exercise in pediatric TBI as well as the effects of TBI on postinjury fitness. With the evidence-based growing, a literature review can help establish the state of the science and inform future research. Therefore, the authors performed a narrative review (based on a search of 6 health sciences databases) to summarize evidence on pediatric TBI and cardiorespiratory fitness, muscular fitness and neuromotor control, and obesity. To date, studies related to cardiorespiratory fitness have centered on exercise tolerance and readiness to return to play, and indicate that protracted rest may not facilitate symptom recovery; this suggests a role for exercise in concussion management. Furthermore, strength and gait may be impaired following pediatric brain injury, and interventions designed to train these impairments may lead to their improvement. Pediatric brain injury can also lead to changes in body composition (which may be related to poorer cognitive recovery), but additional research is required to better understand such associations. This narrative review of pediatric TBI and exercise medicine can serve as a reference for researchers and clinicians alike.
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25
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Ferraracci J, Anzalone C, Bridges RM, Moore RD, Decker SL. QEEG correlates of cognitive processing speed in children and adolescents with traumatic brain injuries. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:247-257. [PMID: 31613642 DOI: 10.1080/21622965.2019.1675523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Both quantitative electroencephalography (qEEG) and cognitive measures have been used to understand the underlying brain changes that occur in individuals after experiencing a traumatic brain injury, however, research exploring the relationship between qEEG patterns and cognitive test performance is scarcely studied in school-aged populations. The purpose of the present study was to explore first, the neuropsychological and academic deficits in young individuals with TBI; and second, the underlying relationship between qEEG patterns and cognitive test performance. Analyses included 21 school-aged participants whom have experienced a recent TBI and 15 school-aged participants whom have never experienced a TBI. Mean subtest and composite scores were compared and regression analyses were used to determine whether alpha band and beta band qEEG coherence values predicted processing speed measures. Results suggest that young individuals who experienced a recent TBI exhibit general deficits in cognition and academic skills beyond what would be expected in the general population. Further, beta band coherence with the frontal brain regions significantly predicted processing speed scores, providing evidence of a relationship between qEEG patterns and processing speed. This outlines a relatively inexpensive method for utilizing neural connectivity to verify cognitive deficits for school-aged individuals with a recent TBI.
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Affiliation(s)
- Joseph Ferraracci
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | | | - Rachel M Bridges
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - R Davis Moore
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States of America
| | - Scott L Decker
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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Racial Disparities in Outpatient Mental Health Service Use Among Children Hospitalized for Traumatic Brain Injury. J Head Trauma Rehabil 2019; 33:177-184. [PMID: 29194176 DOI: 10.1097/htr.0000000000000348] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine racial differences in mental health service utilization after hospitalization for traumatic brain injury (TBI) among children with Medicaid insurance. DESIGN AND MAIN MEASURES Retrospective analysis of the MarketScan Multi-State Medicaid database from 2007 to 2012 was performed. Outpatient mental health service utilization (psychiatric and psychological individual and group services) was compared at TBI hospitalization, from discharge to 3 months and from 4 to 12 months after discharge, between children of non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and "Other" racial groups. Multivariable mixed-effects Poisson regression models with robust standard errors were utilized. RESULTS A total of 5674 children (aged <21 years) were included in the study. There were no differences by race/ethnicity in mental health service utilization during hospitalization. At 3 months postdischarge, NHB children and children in the "Other" racial category were significantly less likely to receive outpatient mental health services than NHW children (NHB relative risk [RR] = 0.84; 95% confidence interval [CI], 0.72-0.98; Other RR = 0.72; 95% CI, 0.57-0.90). At 12 months, all racial minority children were significantly less likely to receive outpatient mental health services than NHW children (NHB RR = 0.84; 95% CI, 0.75-0.94; Hispanic RR = 0.72; 95% CI, 0.55-0.94; Other RR = 0.71; 95% CI, 0.60-0.84). CONCLUSIONS Racial disparities in utilization of outpatient mental health services exist for minority children hospitalized for TBI and insured by Medicaid. Future research should focus on improving transitions of care from inpatient to outpatient services for these children.
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Bellesi G, Barker ED, Brown L, Valmaggia L. Pediatric traumatic brain injury and antisocial behavior: are they linked? A systematic review. Brain Inj 2019; 33:1272-1292. [DOI: 10.1080/02699052.2019.1641621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Giulia Bellesi
- King’s College London, Institute of Psychology, Psychiatry, and Neuroscience, Department of Psychology, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Edward D. Barker
- King’s College London, Institute of Psychology, Psychiatry, and Neuroscience, Department of Psychology, London, UK
| | - Laura Brown
- King’s College London, Institute of Psychology, Psychiatry, and Neuroscience, Department of Psychology, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Lucia Valmaggia
- King’s College London, Institute of Psychology, Psychiatry, and Neuroscience, Department of Psychology, London, UK
- South London and Maudsley NHS Trust, London, UK
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De Netto RK, McKinlay A. Impact of childhood traumatic brain injury on educational outcomes and adult standard of living. Disabil Rehabil 2019; 42:2444-2450. [DOI: 10.1080/09638288.2019.1637948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Riana K. De Netto
- Melbourne School of Psychological Science, The University of Melbourne, Melbourne, Australia
| | - Audrey McKinlay
- Melbourne School of Psychological Science, The University of Melbourne, Melbourne, Australia
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
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Jones KM, Prah P, Starkey N, Theadom A, Barker-Collo S, Ameratunga S, Feigin VL. Longitudinal patterns of behavior, cognition, and quality of life after mild traumatic brain injury in children: BIONIC study findings. Brain Inj 2019; 33:884-893. [PMID: 31010355 DOI: 10.1080/02699052.2019.1606445] [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: 10/27/2022]
Abstract
Background: Research following mild traumatic brain injury (mTBI) during childhood predominantly examines recovery up to 12 months post-injury. Objectives: To determine children's longer-term (4 years) patterns and predictors of recovery. Methods: Parents of 196 children (aged 1-15 years) completed the Behaviour Assessment System for Children and Pediatric Quality of Life Inventory at baseline, 1, 6, 12, and 48 months post-injury. Children aged ≥8 years at each assessment completed a computerized neurocognitive testing battery. At 1 month, parents completed the Hospital Anxiety and Depression Scale. Multilevel modeling accounted for repeated measures. Results: Children had significantly fewer child behavior problems, better adaptability, and improved quality of life after 12 months. Concurrent improvements in overall neurocognitive function were no longer significant once adjusted for age, gender, and socio-economic status. From 12 to 48 months, quality of life reduced significantly while child behavior and neurocognition plateaued. Child behavior problems and worse quality of life were associated with parental anxiety and lower socio-economic status. Conclusions: Children's recovery in the year following mTBI appears to plateau from 12 to 48 months, with a concomitant reduction in quality of life. Identification and treatment of parent mental health issues may reduce the exacerbation of negative child outcomes following mTBI.
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Affiliation(s)
- Kelly M Jones
- a National Institute for Stroke and Applied Neurosciences, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Studies , Auckland University of Technology , Auckland , New Zealand
| | - Philip Prah
- a National Institute for Stroke and Applied Neurosciences, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Studies , Auckland University of Technology , Auckland , New Zealand
| | - Nicola Starkey
- b School of Psychology, Faculty of Arts & Social Sciences , The University of Waikato , Hamilton , New Zealand
| | - Alice Theadom
- a National Institute for Stroke and Applied Neurosciences, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Studies , Auckland University of Technology , Auckland , New Zealand
| | - Suzanne Barker-Collo
- c Department of Psychology , The University of Auckland , Auckland , New Zealand
| | - Shanthi Ameratunga
- d School of Population Health, Faculty of Medical & Health Sciences , The University of Auckland , Auckland , New Zealand
| | - Valery L Feigin
- a National Institute for Stroke and Applied Neurosciences, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Studies , Auckland University of Technology , Auckland , New Zealand
| | -
- e BIONIC Study Group members listed below
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Nurse practitioners' recommendations for pharmacotherapy in the management of adolescent concussion. J Am Assoc Nurse Pract 2019; 30:499-510. [PMID: 30113534 DOI: 10.1097/jxx.0000000000000070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Nurse practitioners (NPs) frequently treat acute conditions presenting in children and adolescents in the outpatient setting. No evidence-based guidance exists pertaining to the treatment of concussion with medications. The purpose of this study was to examine recommendations by NPs for pharmacotherapy of acute symptoms for adolescent concussion. METHODS This is a secondary analysis of data from a web-based census survey of all licensed NPs in Oregon and Washington State, where they practice as independent providers with prescriptive authority. Based on a standardized adolescent patient scenario video, NPs were asked to indicate prescription or nonprescription medication recommendations for concussion symptoms. Open-ended descriptions of medication recommendations were coded, summarized, and described. CONCLUSIONS In narrative text, 78.4% of the 991 respondents recommended at least one type of prescription or nonprescription medication. Prescription medications (recommended by 17.2%) included antiemetics and antimigraine medications; nonprescription medications (recommended by 75.5%) included nonsteroidal anti-inflammatory drugs, over-the-counter pain relievers, and herbal medications. Pharmacotherapy recommendations varied by NP practice setting and rurality. IMPLICATIONS FOR PRACTICE Nurse practitioners have full prescriptive authority in many states. No guidelines inform medication use in managing acute concussion symptoms, yet many providers recommend their use.
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Starkey NJ, Jones K, Case R, Theadom A, Barker-Collo S, Feigin V. Post-concussive symptoms after a mild traumatic brain injury during childhood and adolescence. Brain Inj 2018; 32:617-626. [PMID: 29446658 DOI: 10.1080/02699052.2018.1439533] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Mild traumatic brain injury (mTBI) is common injury during childhood and adolescence but the long-term outcomes are poorly understood. This study examined post-concussive symptoms and behavioural outcomes in children and adolescents up to 24 months post-mTBI. METHOD Parents of children aged 8-15 years with mTBI completed the BASC-2 and Rivermead Post-Concussion Symptoms Questionnaire at baseline, 1-, 6-, 12- and 24 months post-injury. An age-matched traumatic brain injury-free cohort was recruited and assessed at 12- and 24 months. RESULTS PCSs decreased significantly over the first 12 months post-injury. At 12- and 24 months post-injury, the mTBI group reported more PCSs and behavioural symptoms compared to controls. Parents of children with mTBI were more likely to report ≥4 problematic PCS symptoms (28% at both time points) compared to controls (7.7% and 1.7% at 12 and 24 months, respectively). The mTBI group was 4.63 times more likely to have four or more ongoing PCS symptoms at 12 months post-injury compared to controls. Headache was the most common acute post-injury symptom (55%), while the most commonly reported persistent symptoms were irritability, frustration, forgetfulness and fatigue. CONCLUSIONS PCSs are common 2 years post-mTBI in childhood or adolescence. Given this, additional intervention and support is needed for families post-injury.
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Affiliation(s)
- Nicola J Starkey
- a School of Psychology , University of Waikato , Hamilton , New Zealand
| | - Kelly Jones
- b National Institute for Stroke and Applied Neurosciences , AUT University , Auckland , New Zealand
| | - Rosalind Case
- c School of Psychology Counselling and Psychotherapy , Cairn Miller Institute , Melbourne , Australia
| | - Alice Theadom
- b National Institute for Stroke and Applied Neurosciences , AUT University , Auckland , New Zealand
| | | | - Valery Feigin
- b National Institute for Stroke and Applied Neurosciences , AUT University , Auckland , New Zealand
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Stockbridge MD, Doran A, King K, Newman RS. The effects of concussion on rapid picture naming in children. Brain Inj 2018; 32:506-514. [DOI: 10.1080/02699052.2018.1429660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Melissa D Stockbridge
- Department of Hearing and Speech Sciences, University of Maryland, College Park, MD, USA
| | - Anthony Doran
- HeadFirst Sports Injury and Concussion Care, Waugh Chapel, MD, USA
| | | | - Rochelle S Newman
- Department of Hearing and Speech Sciences, University of Maryland, College Park, MD, USA
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Crowe LM, Hearps S, Anderson V, Borland ML, Phillips N, Kochar A, Dalton S, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Lyttle MD, Bressan S, Donath S, Molesworth C, Oakley E, Dalziel SR, Babl FE. Investigating the Variability in Mild Traumatic Brain Injury Definitions: A Prospective Cohort Study. Arch Phys Med Rehabil 2018; 99:1360-1369. [PMID: 29407521 DOI: 10.1016/j.apmr.2017.12.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To prospectively compare the proportion of traumatic brain injuries (TBIs) that would be classified as mild by applying different published definitions of mild TBI to a large prospectively collected dataset, and to examine the variability in the proportions included by various definitions. DESIGN Prospective observational study. SETTING Hospital emergency departments. PARTICIPANTS Children (N=11,907) aged 3 to 16 years (mean age, 8.2±3.9y). Of the participants, 3868 (32.5%) were girls, and 7374 (61.9%) of the TBIs were the result of a fall. Median Glasgow Coma Scale score was 15. MAIN OUTCOME MEASURES We applied 17 different definitions of mild TBI, identified through a published systematic review, to children aged 3 to 16 years. Adjustments and clarifications were made to some definitions. The number and percentage identified for each definition is presented. RESULTS Adjustments had to be made to the 17 definitions to apply to the dataset: none in 7, minor to substantial in 10. The percentage classified as mild TBI across definitions varied from 7.1% (n=841) to 98.7% (n=11,756) and varied by age group. CONCLUSIONS When applying the 17 definitions of mild TBI to a large prospective multicenter dataset of TBI, there was wide variability in the number of cases classified. Clinicians and researchers need to be aware of this variability when examining literature concerning children with mild TBI.
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Affiliation(s)
- Louise M Crowe
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Melbourne School of Psychological Science, University of Melbourne, Melbourne, VIC, Australia; Psychology Department, Royal Children's Hospital, Melbourne, VIC, Australia.
| | - Stephen Hearps
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Melbourne School of Psychological Science, University of Melbourne, Melbourne, VIC, Australia; Psychology Department, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Meredith L Borland
- Emergency Department, Princess Margaret Hospital for Children, Perth, WA, Australia; Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Natalie Phillips
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Amit Kochar
- Emergency Department, Women's & Children's Hospital, Adelaide, SA, Australia
| | - Sarah Dalton
- Emergency Department, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - John A Cheek
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Emergency Department, Royal Children's Hospital, Melbourne, VIC, Australia; Monash Medical Centre, Melbourne, VIC, Australia
| | - Yuri Gilhotra
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Jeremy Furyk
- Emergency Department, The Townsville Hospital, Townsville, QLD, Australia
| | - Jocelyn Neutze
- Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand
| | - Mark D Lyttle
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Bristol Royal Hospital for Children, Bristol, United Kingdom; Academic Department of Emergency Care, University of the West of England, Bristol, United Kingdom
| | - Silvia Bressan
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Susan Donath
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Charlotte Molesworth
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Ed Oakley
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Emergency Department, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Stuart R Dalziel
- Starship Children's Health, Auckland, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Franz E Babl
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Emergency Department, Royal Children's Hospital, Melbourne, VIC, Australia
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Lowery Wilson M, Tenovuo O, Gissler M, Saarijärvi S. Association between parent mental health and paediatric TBI: epidemiological observations from the 1987 Finnish Birth Cohort. Inj Prev 2018; 25:283-289. [DOI: 10.1136/injuryprev-2017-042624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/27/2017] [Accepted: 12/29/2017] [Indexed: 11/04/2022]
Abstract
BackgroundThis study examined whether parental mental illness has implications for child risk for traumatic brain injuries (TBI).MethodData on 60 069 Finnish children born in 1987 and their parents were examined for demographic and mental health-related variables in relationship with paediatric TBI. Altogether, 15 variables were derived from the cohort data with ICD-10 F-codes being available for mental health diagnoses for all parents. Bivariate and multivariate analyses were carried out using inpatient and outpatient diagnoses of child TBI.ResultsPaternal disorders due to psychoactive substance use (F10–F19) was associated with an increased inpatient TBI (OR=1.51; CI=1.07 to 2.14). Mood disorders (F30–F39) were associated with higher rates of outpatient TBI (OR=1.42; CI=1.06 to 1.90). Paternal personality and behavioural disorders (F60–F69) were linked with a twofold increase in risk across both categories of child TBI (OR=2.35; CI=1.41 to 3.90) and (OR=2.29; CI=1.45 to 3.61), respectively. Among the maternal mental health factors associated with child TBI, schizophrenia and other non-mood psychotic disorders (F20–F29) were associated with an increase in inpatient traumatic brain injuries (iTBI) (OR=1.78; 1.22 to 2.59). Mothers having mood disorders (F30–F39) were more likely to have had a child who experienced an iTBI (OR=1.64; CI=1.20 to 2.22). Mothers with personality and behavioural disorders (F60–F69) were also found to have had children with an increased risk for iTBI (OR=2.30; CI=1.14 to 3.65).ConclusionTaken together, these data should call attention to methods and strategies designed to augment and support caregiving environments with modalities that can foster mutually supportive households in cooperation with parents who have been diagnosed with a mental disorder.
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Sharma B, Lawrence DW, Hutchison MG. Branched Chain Amino Acids (BCAAs) and Traumatic Brain Injury: A Systematic Review. J Head Trauma Rehabil 2018; 33:33-45. [DOI: 10.1097/htr.0000000000000280] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Volpe DSJ, Oliveira NCAC, Santos AC, Linhares MBM, Carlotti APCP. Neuropsychological outcome of children with traumatic brain injury and its association with late magnetic resonance imaging findings: A cohort study. Brain Inj 2017; 31:1689-1694. [PMID: 28872351 DOI: 10.1080/02699052.2017.1358398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate neuropsychological outcome after traumatic brain injury (TBI) and its association with trauma severity and late magnetic resonance imaging (MRI) findings. METHODS Prospective cohort study of patients with TBI admitted to the paediatric intensive care unit over 5 years. Trauma severity was determined by Glasgow Coma Scale (GCS), neurological outcome by King's Outcome Scale for Childhood Head Injury (KOSCHI) and neuropsychological outcome by Wechsler Intelligence Scale for Children - Fourth Edition. RESULTS Twenty-five children (median age 6 years at trauma) were included. Patients were divided into Disability (DIS)(n = 10) and Good Recovery (GR)(n = 15) groups. Initial GCS score was not significantly different in both groups (median 6 vs. 10; p = 0.34). DIS group had lower values of working memory index (WMI)(median 74 vs. 94; p = 0.004), perceptual reasoning index (PRI)(75 vs. 96; p = 0.03), verbal comprehension index (VCI)(65 vs. 84; p = 0.02), processing speed index (PSI)(74 vs. 97; p = 0.01) and full-scale intelligence quotient (FSIQ)(65 vs. 87; p = 0.008). In the GR group, 60% of patients had normal or minimally altered MRI versus 10% of patients in the DIS group (p = 0.018). Fractional anisotropy positively correlated with WMI(r = 0.65; p = 0.005), PRI(r = 0.52; p = 0.03) and FSIQ(r = 0.50; p = 0.04). CONCLUSIONS Neuropsychological impairment was observed in 40% of children who suffered a TBI and was associated with late MRI abnormalities.
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Affiliation(s)
- Daniele S J Volpe
- a Division of Pediatric Critical Care, Department of Pediatrics, Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto , Brazil
| | - Nátali C A C Oliveira
- b Division of Psychology, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto , Brazil
| | - A Carlos Santos
- c Division of Neuroradiology, Department of Internal Medicine, Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto , Brazil
| | - Maria B M Linhares
- b Division of Psychology, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto , Brazil
| | - Ana P C P Carlotti
- a Division of Pediatric Critical Care, Department of Pediatrics, Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto , Brazil
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Rozbacher A, Selci E, Leiter J, Ellis M, Russell K. The Effect of Concussion or Mild Traumatic Brain Injury on School Grades, National Examination Scores, and School Attendance: A Systematic Review. J Neurotrauma 2017; 34:2195-2203. [PMID: 28084891 DOI: 10.1089/neu.2016.4765] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Concussion often results in symptoms, including difficulty concentrating, focusing, and remembering, that are typically managed with cognitive and physical rest. Often, the school environment is not conducive to cognitive rest and may lead to worsening or prolonged symptoms that can contribute to impaired academic performance. The objective of the review was to identify and summarize literature concerning the effects of concussion or mild traumatic brain injury (mTBI) on academic outcomes. MEDLINE, Embase, Scopus, and CINAHL were searched until June 1, 2016. Studies must have been primary literature examining students enrolled in primary, secondary, or post-secondary education, have received a physician diagnosis of concussion or mTBI, and have post-injury academic outcomes assessed in numeric or alphabet grade/grade point average (GPA), school attendance records, or national examination scores. Data were extracted and checked by a second reviewer for accuracy and completeness. Nine studies were included. Among four studies that examined grades, one found a significant difference in pre- and post-grades only in the subject Afrikaans. Three examined national test scores and no significant differences were found between cases and controls. Four examined school absenteeism and found that students who developed post-concussion syndrome missed significantly more school days and took longer to return to school than students with extremity injuries. Although mTBI or concussion is associated with missed school, the results demonstrate minimal impact on school grades and national examination scores at a group level. Further research is needed to identify risk factors for impaired school functioning following mTBI and concussion in individual patients.
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Affiliation(s)
- Adrian Rozbacher
- 1 Max Rady College of Medicine, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Erin Selci
- 3 Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada
- 6 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada
| | - Jeff Leiter
- 2 Department of Surgery, University of Manitoba , Winnipeg, Manitoba, Canada
- 5 Pan Am Concussion Program , Winnipeg, Manitoba, Canada
- 7 Canada North Concussion Network , Winnipeg, Manitoba, Canada
| | - Michael Ellis
- 1 Max Rady College of Medicine, University of Manitoba , Winnipeg, Manitoba, Canada
- 2 Department of Surgery, University of Manitoba , Winnipeg, Manitoba, Canada
- 3 Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada
- 4 Section of Neurosurgery, University of Manitoba , Winnipeg, Manitoba, Canada
- 5 Pan Am Concussion Program , Winnipeg, Manitoba, Canada
- 6 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada
- 7 Canada North Concussion Network , Winnipeg, Manitoba, Canada
| | - Kelly Russell
- 3 Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada
- 6 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada
- 7 Canada North Concussion Network , Winnipeg, Manitoba, Canada
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Yu K, Seal ML, Reyes J, Godfrey C, Anderson V, Adamson C, Ryan NP, Hearps SJC, Catroppa C. Brain volumetric correlates of inhibition and cognitive flexibility 16 years following childhood traumatic brain injury. J Neurosci Res 2017; 96:642-651. [PMID: 28675465 DOI: 10.1002/jnr.24087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/06/2017] [Accepted: 05/01/2017] [Indexed: 01/08/2023]
Abstract
Executive functions (EFs), such as inhibition and cognitive flexibility, are essential for everyday functioning, including regulation of socially appropriate emotional responses. These skills develop during childhood and continue maturing into early adulthood. The current study aimed to investigate the very long-term impact of childhood traumatic brain injury (TBI) on inhibition and cognitive flexibility, and to examine whether global white matter is associated with these abilities. Twenty-eight young adult survivors of childhood TBI (mean age at 16-year follow-up = 21.67 years, SD = 2.70) and 16 typically developing controls (TDCs), group-matched for age, sex, and socioeconomic status, completed tests of inhibition and cognitive flexibility and underwent structural MRI. Survivors of childhood TBI did not significantly differ from TDCs on EF or white matter volume. However, the relationship between EF and white matter volume differed between survivors of TBI and TDCs. Survivors of TBI did not mimic the brain behavior relationship that characterized EF in TDCs. The inverse brain behavior relationship, exhibited by childhood TBI survivors, suggests disruptions in the whole brain underpinning EF following childhood TBI.
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Affiliation(s)
- Kelleynne Yu
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Marc L Seal
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jonathan Reyes
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Celia Godfrey
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Psychology, Royal Children's Hospital, Parkville, Victoria, Australia.,Melbourne School of Psychological Sciences (MSPS), University of Melbourne, Parkville, Victoria, Australia
| | - Chris Adamson
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Nicholas P Ryan
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Melbourne School of Psychological Sciences (MSPS), University of Melbourne, Parkville, Victoria, Australia
| | - Stephen J C Hearps
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Cathy Catroppa
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Psychology, Royal Children's Hospital, Parkville, Victoria, Australia.,Melbourne School of Psychological Sciences (MSPS), University of Melbourne, Parkville, Victoria, Australia
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Brunner M, Hemsley B, Togher L, Palmer S. Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI). Brain Inj 2017; 31:1028-1043. [DOI: 10.1080/02699052.2017.1292429] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Melissa Brunner
- Speech Pathology, Faculty of Education and Arts, University of Newcastle, Newcastle, Australia
| | - Bronwyn Hemsley
- Speech Pathology, Faculty of Education and Arts, University of Newcastle, Newcastle, Australia
| | - Leanne Togher
- Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, Australia
| | - Stuart Palmer
- Faculty of Science, Engineering & Built Environment, Deakin University, Geelong, Australia
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Butterfield DA, Reed TT. Lipid peroxidation and tyrosine nitration in traumatic brain injury: Insights into secondary injury from redox proteomics. Proteomics Clin Appl 2016; 10:1191-1204. [PMID: 27588567 DOI: 10.1002/prca.201600003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/12/2016] [Accepted: 08/29/2016] [Indexed: 12/17/2022]
Abstract
Traumatic brain injury (TBI) is a spontaneous event in which sudden trauma and secondary injury cause brain damage. Symptoms of TBI can range from mild to severe depending on extent of injury. The outcome can span from complete patient recovery to permanent memory loss and neurological decline. Currently, there is no known cure for TBI; however, immediate medical attention after injury is most beneficial for patient recovery. It is a well-established concept that imbalances in the production of reactive oxygen species (ROS), reactive nitrogen species (RNS), and native antioxidant mechanisms have been shown to increase oxidative stress. Over the years, proteomics has been used to identify specific biomarkers in diseases such as cancers and neurological disorders such as Alzheimer disease and Parkinson disease. As TBI is a risk factor for a multitude of neurological diseases, biomarkers for this phenomenon are a likely field of study in order to confirm diagnosis. This review highlights the current proteomics studies that investigated excessively nitrated proteins and those altered by lipid peroxidation in TBI. This review also highlights possible diagnostic measures and provides insights for future treatment strategies.
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Affiliation(s)
- D Allan Butterfield
- Department of Chemistry, University of Kentucky, Lexington, KY, USA.,Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY, USA.,Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Tanea T Reed
- Department of Chemistry, Eastern Kentucky University, Richmond, KY, USA
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Predictors of Post-concussive Symptoms in Young Children: Injury versus Non-injury Related Factors. J Int Neuropsychol Soc 2016; 22:793-803. [PMID: 27619107 DOI: 10.1017/s1355617716000709] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES A notable minority of children will experience persistent post-concussive symptoms (PCS) following mild traumatic brain injury (mTBI), likely maintained by a combination of injury and non-injury related factors. Adopting a prospective longitudinal design, this study aimed to investigate the relative influence of child, family, and injury factors on both acute and persistent PCS in young children. METHODS Participants were 101 children aged 2-12 who presented to an Emergency Department, with either mTBI or minor bodily trauma (control). PCS were assessed at time of injury, 1 week, and 1, 2, and 3 months post-injury. Predictors included injury and demographic variables, premorbid child behavior, sleep hygiene, and parental stress. Random effects ordinal logistic regression models were used to analyze the relative influence of these predictors on PCS at early (acute - 1 week) and late (1-3 month) post-injury phases. RESULTS Presence of mTBI was a stronger predictor of PCS in the early [odds ratio (OR)=18.2] compared with late (OR=7.3) post-injury phase. Older age at injury and pre-existing learning difficulties were significant predictors of PCS beyond 1 month post-injury. Family factors, including higher levels of parental stress, higher socio-economic status, and being of Anglo-Saxon descent, consistently predicted greater PCS. CONCLUSIONS Injury characteristics were significantly associated with PCS for 3 months following mTBI but the association weakened over time. On the other hand, pre-existing child and family factors displayed an increasingly strong association with PCS over time. Follow-up for these "at-risk" children which also addresses family stress may minimize longer-term complications. (JINS, 2016, 22, 793-803).
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Kolman S, Spiegel D, Namdari S, Hosalkar H, Keenan MA, Baldwin K. What's New in Orthopaedic Rehabilitation. J Bone Joint Surg Am 2015; 97:1892-8. [PMID: 26582622 DOI: 10.2106/jbjs.o.00827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - David Spiegel
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Surena Namdari
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harish Hosalkar
- Center for Hip Preservation and Children's Orthopedics, Vista, California
| | - Mary Ann Keenan
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith Baldwin
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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