1
|
Yumul JN, McKinlay A, Anderson V, Catroppa C. Behaviour outcomes three months after mild TBI in preschool children. Neuropsychol Rehabil 2024; 34:600-618. [PMID: 37354534 DOI: 10.1080/09602011.2023.2224030] [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: 12/01/2022] [Accepted: 06/02/2023] [Indexed: 06/26/2023]
Abstract
This study examined parents' report of behaviour in preschoolers after a mild traumatic brain injury (mTBI), compared the proportion of preschoolers with elevated behaviour ratings between the mTBI and limb injury (LI) groups, and explored injury, premorbid child, and parent variables that may be associated with parents' report of behaviour at three months post-injury. Children aged 2-5 years with a mTBI (n = 13) or mild LI (n = 6) were recruited from the emergency department. Behaviour was assessed using the Child Behaviour Checklist. Preliminary findings showed that post-injury behaviour ratings remained in the normal range. The mTBI group had higher scores than the LI group at three months post-injury in terms of sleep; however, this may have been pre-existing. Two children with mTBI received borderline-clinically significant ratings on diagnostic-level anxiety problems at the three-month follow-up, while none of the limb-injured controls obtained elevated behaviour ratings. Parent-rated post-injury behaviour was significantly associated with premorbid child functioning and parental stress, which needs to be explored in greater detail using larger preschool mTBI samples.
Collapse
Affiliation(s)
- Joy Noelle Yumul
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Audrey McKinlay
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| |
Collapse
|
2
|
Feldman SJ, Beslow LA, Felling RJ, Malone LA, Waak M, Fraser S, Bakeer N, Lee JEM, Sherman V, Howard MM, Cavanaugh BA, Westmacott R, Jordan LC. Consensus-Based Evaluation of Outcome Measures in Pediatric Stroke Care: A Toolkit. Pediatr Neurol 2023; 141:118-132. [PMID: 36812698 PMCID: PMC10042484 DOI: 10.1016/j.pediatrneurol.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
Following a pediatric stroke, outcome measures selected for monitoring functional recovery and development vary widely. We sought to develop a toolkit of outcome measures that are currently available to clinicians, possess strong psychometric properties, and are feasible for use within clinical settings. A multidisciplinary group of clinicians and scientists from the International Pediatric Stroke Organization comprehensively reviewed the quality of measures in multiple domains described in pediatric stroke populations including global performance, motor and cognitive function, language, quality of life, and behavior and adaptive functioning. The quality of each measure was evaluated using guidelines focused on responsiveness and sensitivity, reliability, validity, feasibility, and predictive utility. A total of 48 outcome measures were included and were rated by experts based on the available evidence within the literature supporting the strengths of their psychometric properties and practical use. Only three measures were found to be validated for use in pediatric stroke: the Pediatric Stroke Outcome Measure, the Pediatric Stroke Recurrence and Recovery Questionnaire, and the Pediatric Stroke Quality of Life Measure. However, multiple additional measures were deemed to have good psychometric properties and acceptable utility for assessing pediatric stroke outcomes. Strengths and weaknesses of commonly used measures including feasibility are highlighted to guide evidence-based and practicable outcome measure selection. Improving the coherence of outcome assessment will facilitate comparison of studies and enhance research and clinical care in children with stroke. Further work is urgently needed to close the gap and validate measures across all clinically significant domains in the pediatric stroke population.
Collapse
Affiliation(s)
- Samantha J Feldman
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ryan J Felling
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura A Malone
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, Maryland
| | - Michaela Waak
- Pediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Queensland, Australia; Pediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Australia
| | - Stuart Fraser
- Division of Vascular Neurology, Department of Pediatrics, University of Texas Health Science Center, Houston, Texas
| | - Nihal Bakeer
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana
| | - Jo Ellen M Lee
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Melissa M Howard
- Casa Colina Hospital and Centers for Healthcare, Pomona, California
| | - Beth Anne Cavanaugh
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
| |
Collapse
|
3
|
Collins A, D'Cruz K, Jackman A, Anderson V, Jenkin T, Scheinberg A, Muscara F, Knight S. Engaging children and adolescents with acquired brain injury and their families in goal setting: The family perspective. Neuropsychol Rehabil 2023; 33:1-23. [PMID: 34538207 DOI: 10.1080/09602011.2021.1977154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study explored the experiences of goal setting in paediatric rehabilitation from the perspectives of children and adolescents with acquired brain injury (ABI) and their parents in paediatric rehabilitation. Using a qualitative research design, 15 semi-structured interviews were conducted with 13 parents and 8 young people with ABI aged between 9 and 18 years who were engaged in outpatient rehabilitation. Interview transcripts were analysed using constructivist grounded theory methods. Two main themes and several sub-themes emerged: Experiences of goal setting: The role of professionals; The role of the young person; and The role of the parents. Working as a team: Understanding each other and building trust; Communicating, sharing knowledge and different perspectives; and Being flexible. These themes reflect parent's and young people's experience of goal setting during paediatric rehabilitation for ABI and suggest clinicians play an important role in educating young people and their families about goal setting in the outpatient rehabilitation context. Young people and their parents also perceive the focus of outpatient rehabilitation as working collaboratively with clinicians to gain knowledge to manage the consequences of ABI. Our findings emphasize the importance of the therapeutic consumer-clinician relationship and the need to actively engage young people in goal setting.
Collapse
Affiliation(s)
- Alana Collins
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | | | - Angie Jackman
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Psychology Service, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Taylor Jenkin
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Adam Scheinberg
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
| | - Frank Muscara
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Psychology Service, Royal Children's Hospital, Melbourne, Australia
| | - Sarah Knight
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
| |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW Mild traumatic brain injury (mTBI) is a significant public health concern for children. This review summarizes recent literature on early symptoms and neuropsychiatric and neuropsychological outcomes following pediatric mTBI and highlights factors that predict prolonged recovery. Evidence-based recommendations for assessment and treatment are also discussed. RECENT FINDINGS Whereas most children recover within 1 month after mTBI, 10-30% of children experience lingering neuropsychiatric or neuropsychological symptoms 3 months or more after injury. For the subset who experience prolonged recovery, new or worsening emotional and behavioral symptoms are the most frequent concerns. Recent research has suggested that specific factors, including preinjury mental health concerns, female sex, and family characteristics, are associated with increased risk of experiencing prolonged recovery. Early management includes reassurance, brief rest (1-3 days), and gradual return to typical activities. When symptoms linger for more than 4 weeks, evaluation in a specialty clinic is recommended and multimodal therapies are considered. Active recovery models, which include gradual return to aerobic exercise and cognitive behavioral approaches, are promising for the management of prolonged symptoms. SUMMARY A minority of children with mTBI experience prolonged neuropsychiatric or neuropsychological concerns. While our understanding of pediatric mTBI is growing, and recommendations for assessment and management have been developed, many gaps remain.
Collapse
|
5
|
Sood NT, Godfrey C, Chavez Arana C, Anderson V, Catroppa C. Paediatric traumatic brain injury and the dysregulation profile: The mediating role of decision-making. Neuropsychol Rehabil 2022; 33:440-453. [PMID: 35040743 DOI: 10.1080/09602011.2022.2025861] [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: 10/19/2022]
Abstract
Decision-making is often impacted by paediatric traumatic brain injury (TBI). However, there are few tools available to assess these skills in children, with even less research on the consequences of decision-making deficits on dysregulation following TBI. This prospective preliminary study investigated whether decision-making mediated the effect of TBI on dysregulation in children. The performance of school-aged children aged between 7 and 15 years with TBI (n = 49) and that of typically developing controls (n = 22) was compared on The Decision-making Task, and on parent ratings of the dysregulation profile as characterized by the Child Behaviour Checklist-Dysregulation Profile. Relative to the Control group, the TBI group performed more poorly on the decision-making task, and parents of the TBI group rated their children to be more poorly on the dysregulation profile. Mediation analyses indicated that decision-making mediated the relationship between TBI and the dysregulation profile. Our preliminary findings suggest the need for further research in the area of decision-making, and its impact on dysregulated behaviours in children following TBI.
Collapse
Affiliation(s)
- Nikita Tuli Sood
- Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Celia Godfrey
- Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Clara Chavez Arana
- Department of Psychology, Education, & Child Studies, Erasmus School of Social and Behavioural Sciences, Rotterdam, Netherlands
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| |
Collapse
|
6
|
Treble-Barna A, Wade SL, Pilipenko V, Martin LJ, Yeates KO, Taylor HG, Kurowski BG. Brain-Derived Neurotrophic Factor Val66Met and Behavioral Adjustment after Early Childhood Traumatic Brain Injury. J Neurotrauma 2022; 39:114-121. [PMID: 33605167 PMCID: PMC8785712 DOI: 10.1089/neu.2020.7466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The present study examined the differential effect of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism on behavioral adjustment in children with traumatic brain injury (TBI) relative to children with orthopedic injury (OI). Participants were drawn from a prospective, longitudinal study of children who sustained a TBI (n = 69) or OI (n = 72) between 3 and 7 years of age. Parents completed the Child Behavior Checklist (CBCL) at the immediate post-acute period, 6, 12, and 18 months after injury, and an average of 3.5 and 7 years after injury. Longitudinal mixed models examined the BDNF Val66Met allele status (Met carriers vs. Val/Val homozygotes) × injury group (TBI vs. OI) interaction in association with behavioral adjustment. After adjusting for continental ancestry, socioeconomic status, time post-injury, and pre-injury functioning, the allele status × injury group interaction was statistically significant for Internalizing, Externalizing, and Total Behavior problems. Post hoc within-group analysis suggested a consistent trend of poorer behavioral adjustment in Met carriers relative to Val/Val homozygotes in the TBI group; in contrast, the opposite trend was observed in the OI group. These within-group differences, however, did not reach statistical significance. The results support a differential effect of the BDNF Val66Met polymorphism on behavioral adjustment in children with early TBI relative to OI, and suggest that the Met allele associated with reduced activity-dependent secretion of BDNF may impart risk for poorer long-term behavioral adjustment in children with TBI.
Collapse
Affiliation(s)
- Amery Treble-Barna
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shari L. Wade
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Valentina Pilipenko
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Lisa J. Martin
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - H. Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Brad G. Kurowski
- Division of Pediatric Rehabilitation Medicine and Departments of Pediatrics and Neurology and Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
7
|
Fisher ER, Montroy JJ, Duque G, Cox CS, Ewing-Cobbs L. Post-Concussion and Post-Traumatic Stress Symptoms after Pediatric Traumatic Brain Injury: Shared Vulnerability Factors? J Neurotrauma 2021; 38:2600-2609. [PMID: 33899522 PMCID: PMC8403207 DOI: 10.1089/neu.2020.7541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Following pediatric traumatic brain injury (TBI), post-concussion symptoms (PCS) and post-traumatic stress symptoms (PTSS) occur commonly; however, it is unknown to what degree they overlap. The study examined PCS and PTSS persisting 7 weeks after injury in children and adolescents ages 8-15 years with TBI (n = 89) or extracranial injury (EI; n = 40) after vehicle collisions. TBI was divided into mild, complicated-mild/moderate, and severe groups. Parents retrospectively rated children's pre-injury symptoms and behavior problems, and children completed self-report measures after injury. PCS and PTSS total scores were significantly correlated in TBI and EI groups, respectively, for child (rs = 0.75; rs = 0.44), and adolescent (rs = 0.61; rs = 0.67) cohorts. Generalized linear models examined whether injury type and severity, age, sex, and pre-injury symptom ratings predicted PCS and PTSS total scores and factor scores. Specific PCS and PTSS factor scores were elevated in different TBI severity groups, with most frequent problems following mild or severe TBI. PCS did not differ by age; however, girls had more emotional symptoms than boys. Only PTSS were predicted by pre-injury externalizing behavior. Significant age by sex interactions indicated that adolescent girls had more total, avoidance, and hyperarousal PTSS symptoms than younger girls or all boys. PCS and PTSS significantly overlapped in both TBI and EI groups, highlighting shared persistent symptoms after injury. Shared vulnerability factors included female sex, milder TBI, and poorer pre-injury adjustment. Older age was a unique vulnerability factor for PTSS. Psychological health interventions after injury should be customized to address comorbid symptoms.
Collapse
Affiliation(s)
- Emily R. Fisher
- Children's Learning Institute and Department of Pediatrics, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Janelle J. Montroy
- Children's Learning Institute and Department of Pediatrics, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Gerardo Duque
- Children's Learning Institute and Department of Pediatrics, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Charles S. Cox
- Department of Pediatric Surgery, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Linda Ewing-Cobbs
- Children's Learning Institute and Department of Pediatrics, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| |
Collapse
|
8
|
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: 65] [Impact Index Per Article: 21.7] [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.
Collapse
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
| |
Collapse
|
9
|
Gornall A, Takagi M, Morawakage T, Liu X, Anderson V. Mental health after paediatric concussion: a systematic review and meta-analysis. Br J Sports Med 2021; 55:1048-1058. [PMID: 33926965 DOI: 10.1136/bjsports-2020-103548] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis sought to rigorously examine mental health outcomes following paediatric concussion. To date, heterogeneous findings and methodologies have limited clinicians' and researchers' ability to meaningfully synthesise existing literature. In this context, there is a need to clarify mental health outcomes in a homogeneous sample, controlling for key methodological differences and applying a consistent definition of concussion across studies. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched Medline, Embase, PsycINFO, CINAHL, SportDiscus, Scopus and PubMed. ELIGIBILITY Peer-reviewed studies published between 1980 and June 2020 that prospectively examined mental health outcomes after paediatric concussion, defined as per the Berlin Consensus Statement on Concussion in Sport. RESULTS Sixty-nine articles characterising 60 unique samples met inclusion criteria, representing 89 114 children with concussion. Forty articles (33 studies) contributed to a random effects meta-analysis of internalising (withdrawal, anxiety, depression, post-traumatic stress), externalising (conduct problems, aggression, attention, hyperactivity) and total mental health difficulties across three time points post-injury (acute, persisting and chronic). Overall, children with concussion (n=6819) experienced significantly higher levels of internalising (g=0.41-0.46), externalising (g=0.25-0.46) and overall mental health difficulties compared with controls (g=0.18-0.49; n=56 271), with effects decreasing over time. SUMMARY/CONCLUSIONS Our review highlights that mental health is central to concussion recovery. Assessment, prevention and intervention of mental health status should be integrated into standard follow-up procedures. Further research is needed to clarify the mechanisms underlying observed relationships between mental health, post-concussion symptoms and other psychosocial factors. Results suggest that concussion may both precipitate and exacerbate mental health difficulties, thus impacting delayed recovery and psychosocial outcomes.
Collapse
Affiliation(s)
- Alice Gornall
- Psychological Sciences, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia.,Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Michael Takagi
- Psychological Sciences, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia.,Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Psychology, The University of Melbourne, Melbourne School of Psychological Sciences, Melbourne, Victoria, Australia
| | - Thilanka Morawakage
- Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Xiaomin Liu
- Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Vicki Anderson
- Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia .,Psychology, The University of Melbourne, Melbourne School of Psychological Sciences, Melbourne, Victoria, Australia.,Psychology Service, The Royal Children's Hospital, Mebourne, Victoria, Australia
| |
Collapse
|
10
|
Crichton A, Ignjatovic V, Babl FE, Oakley E, Greenham M, Hearps S, Delzoppo C, Beauchamp MH, Guerguerian AM, Boutis K, Hubara E, Hutchison J, Anderson V. Interleukin-8 Predicts Fatigue at 12 Months Post-Injury in Children with Traumatic Brain Injury. J Neurotrauma 2021; 38:1151-1163. [PMID: 31880977 DOI: 10.1089/neu.2018.6083] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Despite many children experiencing fatigue after childhood brain injury, little is known about the predictors of this complaint. To date, traditional indices of traumatic brain injury (TBI) severity have not predicted reliably persisting fatigue (up to three years post-injury). This study aimed to establish whether persisting fatigue is predicted by serum biomarker concentrations in child TBI. We examined whether acute serum biomarker expression would improve prediction models of 12-month fatigue based on injury severity. Blood samples were collected from 87 children (1-17 years at injury) sustaining mild to severe TBI (Glasgow Coma Scale [GCS] range 3-15; mean 12.43; classified as mild TBI [n = 50, 57%] vs. moderate/severe TBI [n = 37, 43%]), and presenting to the emergency departments (ED) and pediatric intensive care units (PICU) at one of three tertiary pediatric hospitals (Royal Children's Hospital (RCH); Hospital for Sick Children (HSC), Toronto; St Justine Children's Hospital (SJH), Montreal). Six serum biomarker concentrations were measured within 24 h of injury (interleukin-6, interleukin-8 [IL-8], soluble vascular cell adhesion molecule [SVCAM], S100 calcium binding protein B [S100B], neuron specific enolase [NSE], and soluble neural cell adhesion molecule [sNCAM]). Fatigue at 12 months post-injury was measured using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (parent report), classified as present/absent using previously derived cut-points. At 12 months post-injury, 22% of participants experienced fatigue. A model including IL-8 was the best serum biomarker for estimating the probability of children experiencing fatigue at 12 months post-injury. The IL-8 also significantly improved predictive models of fatigue based on severity.
Collapse
Affiliation(s)
- Alison Crichton
- Murdoch Children's Research Institute, Melbourne, Australia.,Monash University Faculty of Medicine Nursing and Health Sciences, School of Clinical Sciences, The Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Ed Oakley
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Mardee Greenham
- Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Stephen Hearps
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Carmel Delzoppo
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Canada.,Research Center, Ste-Justine Hospital, Montreal, Canada
| | - Anne-Marie Guerguerian
- Critical Care Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada.,Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute, Toronto, Canada.,The Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | - Kathy Boutis
- Paediatric Emergency Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Evyatar Hubara
- Critical Care Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Jamie Hutchison
- Critical Care Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada.,Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute, Toronto, Canada.,The Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| |
Collapse
|
11
|
A Systematic Review of Cognitive Functioning After Traumatic Brain Injury in Individuals Aged 10-30 Years. Cogn Behav Neurol 2021; 33:233-252. [PMID: 33264151 DOI: 10.1097/wnn.0000000000000236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Given the importance of the period of life from 10 to 30 years in terms of cognitive development and education, combined with the high incidence of traumatic brain injury (TBI) during this period, and limited consensus as to the pattern and degree of cognitive impairment post TBI during this period, we conducted a systematic review to investigate cognitive performance across a range of domains among individuals between the ages of 10 and 30 years who had sustained a TBI. We searched five databases and identified 799 unique records; 52 met our inclusion criteria. These studies reported cognitive function for intelligence, attention, memory, processing speed, and executive function. The majority of the studies reported significant effects, suggesting that TBI is associated with cognitive impairments in these domains. Nine of the studies used physiological tests (EEG and fMRI), the outcomes of which supported behaviorally demonstrated cognitive deficits. In the studies we reviewed, individuals aged 10-30 years who had experienced a TBI performed worse than healthy controls on cognitive function measures-specifically for attention, memory, processing speed, and executive function. In the studies that subjected the individuals with TBI to EEG and fMRI, atypical activation in associated brain regions was demonstrated while the individuals were undergoing cognitive tasks. However, caution should be taken when interpreting the overall results due to the high risk of bias across the majority of the studies. The broader implications of reduced cognitive performance after TBI across this age range are yet to be fully understood.
Collapse
|
12
|
Beauchamp MH, Séguin M, Gagner C, Lalonde G, Bernier A. The PARENT model: a pathway approach for understanding parents’ role after early childhood mild traumatic brain injury. Clin Neuropsychol 2020; 35:846-867. [DOI: 10.1080/13854046.2020.1834621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- M. H. Beauchamp
- Department of Psychology, University of Montreal, Canada
- Sainte-Justine Hospital Research Center, Montreal, Canada
| | - M. Séguin
- Department of Psychology, University of Montreal, Canada
- Sainte-Justine Hospital Research Center, Montreal, Canada
| | - C. Gagner
- Department of Psychology, University of Montreal, Canada
- Sainte-Justine Hospital Research Center, Montreal, Canada
| | - G. Lalonde
- Department of Psychology, University of Montreal, Canada
- Sainte-Justine Hospital Research Center, Montreal, Canada
| | - A. Bernier
- Department of Psychology, University of Montreal, Canada
| |
Collapse
|
13
|
Soo C, Kiernan M, Anderson V. Trait Mindfulness as a Mediator of Anxiety and Psychosocial Functioning in Young People with Acquired Brain Injury. Dev Neurorehabil 2020; 23:231-239. [PMID: 31362568 DOI: 10.1080/17518423.2019.1645225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Following acquired brain injury (ABI), young people may experience increased anxiety as well as difficulties with their psychosocial functioning. This study examined trait mindfulness as a mediator of the relationship between anxiety and psychosocial domains of School and Leisure Activities (SLA), Interpersonal Relationships (IR) and Daily Living Skills (DLS).Method: Participants were adolescents with ABI (aged 12-19 years, N = 38). Standardised measures were used to assess anxiety, trait mindfulness, and psychosocial functioning.Results: Higher levels of anxiety were found to be associated with reduced IR (p < .05) and DLS (p < .05). Increased trait mindfulness was found to be associated with lowered anxiety (p < .01), as well as with better IR (p < .05) and DLS (p <.01). Mediation analyses found a significant indirect effect for the relationship between anxiety and DLS through trait mindfulness.Conclusion: Findings highlight the contribution of trait mindfulness as a mediator between anxiety and psychosocial functioning, such that increased mindfulness and lower levels of anxiety are related to better DLS.
Collapse
Affiliation(s)
- Cheryl Soo
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | | | - Vicki Anderson
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| |
Collapse
|
14
|
Gornall A, Takagi M, Clarke C, Babl FE, Davis GA, Dunne K, Anderson N, Hearps SJ, Demaneuf T, Rausa V, Anderson V. Behavioral and Emotional Difficulties after Pediatric Concussion. J Neurotrauma 2020; 37:163-169. [DOI: 10.1089/neu.2018.6235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alice Gornall
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E. Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Gavin A. Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Thibaut Demaneuf
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vanessa Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
15
|
Fischer JT, Hannay HJ, Alfano CA, Swank PR, Ewing-Cobbs L. Sleep disturbances and internalizing behavior problems following pediatric traumatic injury. Neuropsychology 2019. [PMID: 29528681 DOI: 10.1037/neu0000420] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This prospective longitudinal study investigated sleep disturbance (SD) and internalizing problems after traumatic injury, including traumatic brain injury (TBI) or extracranial/bodily injury (EI) in children and adolescents, relative to typically developing (TD) children. We also examined longitudinal relations between SD and internalizing problems postinjury. METHOD Participants (N = 87) ages 8-15 included youth with TBI, EI, and TD children. Injury groups were recruited from a Level 1 trauma center after sustaining vehicle-related injuries. Parent-reported SD and internalizing problems were assessed at preinjury/baseline, and 6 and 12 months postinjury. Linear mixed models evaluated the relation of group and time of assessment on outcomes. RESULTS Controlling for age, the combined traumatic injury group experienced significantly higher postinjury levels of SD (p = .042) and internalizing problems (p = .024) than TD children; however, TBI and EI injury groups did not differ from each other. Injury severity was positively associated with SD in the EI group only, but in both groups SD was associated with additional postinjury sequelae, including fatigue and externalizing behavior problems. Internalizing problems predicted subsequent development of SD but not vice versa. The relation between injury and SD 1 year later was consistent with mediation by internalizing problems at 6 months postinjury. CONCLUSIONS Children with both types of traumatic injury demonstrated higher SD and internalizing problems than healthy children. Internalizing problems occurring either prior to or following pediatric injury may be a risk factor for posttraumatic SD. Consequently, internalizing problems may be a promising target of intervention to improve both SD and related adjustment concerns. (PsycINFO Database Record
Collapse
Affiliation(s)
| | - H Julia Hannay
- Texas Institute For Measurement, Evaluation, And Statistics, University of Houston
| | | | - Paul R Swank
- School of Public Health, University of Texas Health Science Center at Houston
| | | |
Collapse
|
16
|
Ryan NP, Reyes J, Crossley L, Beauchamp MH, Catroppa C, Anderson VA. Unraveling the Association between Pediatric Traumatic Brain Injury and Social Dysfunction: The Mediating Role of Self-Regulation. J Neurotrauma 2019; 36:2895-2903. [DOI: 10.1089/neu.2018.6308] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Nicholas P. Ryan
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cognitive Neuroscience Unit, Deakin University, Geelong, Victoria, Australia
- Psychology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Reyes
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Louise Crossley
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Miriam H. Beauchamp
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
- Research Centre, Ste-Justine Hospital, Montreal, Quebec, Canada
| | - Cathy Catroppa
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Psychology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Vicki A. Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Psychology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
17
|
Self- and parent-reported Quality of Life 7 years after severe childhood traumatic brain injury in the Traumatisme Grave de l'Enfant cohort: associations with objective and subjective factors and outcomes. Qual Life Res 2019; 29:515-528. [PMID: 31549364 DOI: 10.1007/s11136-019-02305-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate self- and parent-reported Health-Related Quality-of-Life (HRQoL) and their associations after severe childhood traumatic brain injury (TBI) in the Traumatisme Grave de l'Enfant (TGE) cohort. METHODS Self- (n = 34) and/or parent-reports (n = 25) of HRQoL were collected for 38 participants (age 7-22 years) 7 years after severe childhood TBI. The collected data included sociodemographic characteristics, injury severity indices, and overall disability and functional outcome at 3-months, 1- and 2-years post-injury. At 7-years post-injury, data were collected in the TBI group and in a control group (n = 33): overall disability (Glasgow Outcome Scale Extended), intellectual ability (IQ), and questionnaires assessing HRQoL (Pediatric Quality of Life Inventory), executive functions (Behavior Rating Inventory of Executive Functions), behavior (Child Behavior Checklist), fatigue (Multidimensional Fatigue Scale) and participation (Child and Adolescent Scale of Participation). RESULTS Parent- and self-reports of HRQoL were significantly lower in the TBI group than in the control group. Parent-rated HRQoL was not associated with objectively assessed factors, whereas self-reported HRQoL was associated with gender (worse in females) and initial functional outcome. All questionnaire scores completed by the same informant (self or parent) were strongly inter-correlated. CONCLUSIONS Reported HRQoL 7-years after severe childhood TBI is low compared to controls, weakly or not-related to objective factors, such as injury severity indices, clinically assessed functional outcomes, or IQ, but strongly related to reports by the same informant of executive deficits, behavior problems, fatigue, and participation.
Collapse
|
18
|
Mah K, Gladstone B, King G, Reed N, Hartman LR. Researching experiences of childhood brain injury: co-constructing knowledge with children through arts-based research methods. Disabil Rehabil 2019; 42:2967-2976. [PMID: 30973787 DOI: 10.1080/09638288.2019.1574916] [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
Objective: In the knowledge base examining experiences of childhood brain injury, the perspectives of children with brain injury are notably lacking. This failure to represent the voices of pediatric clients has resulted in an incomplete knowledge base from which to inform evidence-based rehabilitation practice. In this paper, we examine why the perspectives of children with brain injury are rarely sought and propose a new way forward.Methods: We draw upon current evidence and practices in related fields and present an exemplar from an in-progress qualitative arts-based research project with children with brain injury.Results: Assumptions ingrained in research practices, particularly those surrounding the capacity of 'doubly vulnerable' children with brain injury to produce knowledge, have resulted in the relative exclusion of this group from research that concerns them. For the field to evolve, research practices must value children's first-hand accounts, engage them in co-constructing knowledge about their lives, and invite methods that meet their interests and abilities.Conclusion: By reframing how we think about the capacities of children with disabilities and shifting our research practices to include children with brain injury as knowledgeable participants, it becomes possible to expand the knowledge base upon which clinical rehabilitation practices are built.Implications for RehabilitationCurrent research practices preclude 'doubly vulnerable' pediatric populations, including children with brain injury, from actively contributing to research that concerns them.As a result, the perspectives of children with brain injury are virtually absent from research, rendering the evidence base upon which rehabilitative practices are built incomplete.Reframing how we think about the capacities of children with brain injury can shift how we engage with them, both in research and clinic, and may subsequently impact the knowledge available to us.Implications for client-centred rehabilitation are discussed, including the need to understand children as capable of insight into their own experience, as able to contribute to a more complete understanding of the health phenomena that affect them, and as invaluable and active participants in research and clinical care.
Collapse
Affiliation(s)
- Katie Mah
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Brenda Gladstone
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Canada
| | - Gillian King
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Laura R Hartman
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| |
Collapse
|
19
|
Lambregts SAM, Van Markus-Doornbosch F, Catsman-Berrevoets CE, Berger MAM, De Kloet AJ, Hilberink SR, Roebroeck ME. Neurological outcome in children and youth with acquired brain injury 2-year post-injury. Dev Neurorehabil 2018; 21:465-474. [PMID: 29652209 DOI: 10.1080/17518423.2018.1460770] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine neurological outcome in children and youth with acquired brain injury (ABI) and explore associated factors. DESIGN Cross-sectional study, two-years post-injury. PATIENTS Hospital-based sample (n=112) aged 6-22 years. METHODS Neurological outcome and participation were assessed with a multidimensional neurological examination and the Child and Adolescent Scale of Participation. Logistic regression analyses were used to explore the relationships. RESULTS Both sensorimotor and cognitive deficits were found in 30-31%, language deficits and behavioural deficits in 10-17%. Non-traumatic injury had a negative impact on neurological outcome, specifically regarding sensorimotor and language deficits. Lower education level showed a significantly poorer neurological outcome. High levels of age-expected participation were reported, with a significant relation between deficits and participation restrictions, especially at school. CONCLUSION One out of three have a poor neurological outcome, related to type of injury and lower level of education. The amount of deficits is associated with participation restrictions.
Collapse
Affiliation(s)
- Suzanne A M Lambregts
- a Department of Rehabilitation Medicine , Erasmus MC University Medical Centre, Rotterdam , The Netherlands.,b Department of Pediatric Rehabilitation , Revant Rehabilitation Centres , Breda , The Netherlands
| | | | | | - Monique A M Berger
- e Department of Acquired Brain Injury Rehabilitation , The Hague University of applied sciences, Expert Group Rehabilitation , The Hague , The Netherlands
| | - Arend J De Kloet
- c Department of Pediatric and Youth Rehabilitation , Sophia Rehabilitation Centre , The Hague , The Netherlands.,e Department of Acquired Brain Injury Rehabilitation , The Hague University of applied sciences, Expert Group Rehabilitation , The Hague , The Netherlands
| | - Sander R Hilberink
- a Department of Rehabilitation Medicine , Erasmus MC University Medical Centre, Rotterdam , The Netherlands
| | - Marij E Roebroeck
- a Department of Rehabilitation Medicine , Erasmus MC University Medical Centre, Rotterdam , The Netherlands.,f Department of Rehabilitation Medicine , Rijndam Rehabilitation Institute , Rotterdam , The Netherlands
| |
Collapse
|
20
|
Dégeilh F, Bernier A, Gravel J, Beauchamp MH. Developmental trajectories of adaptive functioning following early mild traumatic brain injury. Dev Psychobiol 2018; 60:1037-1047. [PMID: 30276812 DOI: 10.1002/dev.21786] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/03/2018] [Accepted: 08/24/2018] [Indexed: 01/05/2023]
Abstract
Adaptive behavior impairments have been reported in children with severe traumatic brain injury (TBI) but are not typically found following mild TBI. It is possible that mild TBI induces subtle changes in adaptive functioning that are not captured in conventional group comparisons. This study aimed to explore time course changes in adaptive functioning following early mild TBI. Parents of 63 children with mild TBI and 53 children with orthopedic injuries aged between 1.5 and 5 years at the time of injury completed the Adaptive Behavior Assessment System-II at three time points: retrospectively to assess pre-injury functioning, then at 6 and 18 months post-injury. Developmental trajectories of adaptive functioning domains (practical, conceptual, and social) reported by parents were modeled using linear mixed-model analyses. Findings suggest that mild TBI may disrupt the expected developmental progression of children's social adaptive behavior, but does not appear to alter practical and conceptual domains.
Collapse
Affiliation(s)
- Fanny Dégeilh
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada.,Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Annie Bernier
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada.,Sainte-Justine Research Center, Montreal, Quebec, Canada
| |
Collapse
|
21
|
Mohamed AZ, Cumming P, Srour H, Gunasena T, Uchida A, Haller CN, Nasrallah F. Amyloid pathology fingerprint differentiates post-traumatic stress disorder and traumatic brain injury. Neuroimage Clin 2018; 19:716-726. [PMID: 30009128 PMCID: PMC6041560 DOI: 10.1016/j.nicl.2018.05.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 05/01/2018] [Accepted: 05/13/2018] [Indexed: 11/29/2022]
Abstract
Introduction Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are risk factors for early onset of Alzheimer's disease (AD) and may accelerate the progression rate of AD pathology. As amyloid-beta (Aβ) plaques are a hallmark of AD pathology, we hypothesized that TBI and PTSD might increase Aβ accumulation in the brain. Methods We examined PET and neuropsychological data from Vietnam War veterans compiled by the US Department of Defense Alzheimer's Disease Neuroimaging Initiative, to examine the spatial distribution of Aβ in male veterans' who had experienced a TBI and/or developed PTSD. Subjects were classified into controls, TBI only, PTSD only, and TBI with PTSD (TBI_PTSD) groups and data were analyzed using both voxel-based and ROI-based approaches. Results Compared to controls, all three clinical groups showed a pattern of mainly increased referenced standard uptake values (SUVR) for the amyloid tracer [18F]-AV45 PET, with rank order PTSD > TBI_PTSD > TBI > Control, and same rank order was seen in the deficits of cognitive functions. SUVR increase was observed in widespread cortical regions of the PTSD group; in white matter of the TBI_PTSD group; and cerebellum and precuneus area of the TBI group, in contrast with controls. The [18F]-AV45 SUVR correlated negatively with cerebrospinal fluid (CSF) amyloid levels and positively with the CSF tau concentrations. Conclusion These results suggest that both TBI and PTSD are substantial risk factors for cognition decline and increased Aβ deposition resembling that in AD. In addition, both PTSD and TBI_PTSD have a different pathways of Aβ accumulation.
Collapse
Affiliation(s)
- Abdalla Z Mohamed
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Paul Cumming
- School of Psychology and Counselling and IHBI, Queensland University of Technology, Brisbane, QLD 4059, Australia; QIMR-Berghofer Institute, Brisbane, QLD 4006, Australia
| | - Hussein Srour
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Tamara Gunasena
- School of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Aya Uchida
- School of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia
| | | | - Fatima Nasrallah
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia.
| |
Collapse
|
22
|
Pastore V, Galbiati S, Recla M, Colombo K, Beretta E, Strazzer S. Psychological and behavioural difficulties following severe TBI in adolescence: a comparison with a sample of peers with brain lesions of other origin and with a control group. Brain Inj 2018; 32:1011-1020. [PMID: 29738269 DOI: 10.1080/02699052.2018.1469041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe behavioural and adjustment problems in a group of 57 adolescents with severe traumatic brain injury (TBI) and compare them with a clinical group of peers with brain lesions of other origin (N = 33) and a control group of healthy adolescents (N = 48). METHODS All subjects received an age-appropriate assessment, including the child behaviour checklist (CBCL) 4/18, the strengths and difficulties questionnaire (SDQ) and the vineland adaptive behaviour scales (VABS). RESULTS Compared with healthy peers, adolescents with TBI presented with more marked behavioural problems on most CBCL scales (Internalization and Externalization domains were both affected) and on the SDQ Hyperactivity and Peer problems scales. They also showed a more impaired functioning in most VABS domains. Compared with adolescents with brain lesions of other aetiology, patients with TBI showed more conduct problems on the SDQ scale, but no significant differences were found on the CBCL scales. Regarding the VABS, patients with other lesions presented with the worst outcome in the Motor and Daily Living Skills domains. CONCLUSIONS Adolescents with TBI are exposed at a very high risk to develop behavioural and psychological disturbances with the potential to severely affect their social re-entry. Further knowledge is needed to plan early and well-timed interventions.
Collapse
Affiliation(s)
- Valentina Pastore
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Susanna Galbiati
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Monica Recla
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Katia Colombo
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Elena Beretta
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Sandra Strazzer
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| |
Collapse
|
23
|
Predicting Fatigue 12 Months after Child Traumatic Brain Injury: Child Factors and Postinjury Symptoms. J Int Neuropsychol Soc 2018; 24:224-236. [PMID: 28974281 DOI: 10.1017/s1355617717000893] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Fatigue is a common and persisting symptom after childhood brain injury. This study examined whether child characteristics and symptomatology preinjury or 6 months postinjury (pain, sleep, and mood, inattention) predicted fatigue at 12months postinjury. METHODS Parents of 79 children (0-18 years) rated fatigue at 12 months after injury on a multidimensional scale (general, sleep/rest, and cognitive). Demographic and clinical data were collected at injury. Parents rated child sleep, pain, physical/motor function, mood, and inattention at injury (preinjury description), and 6 months postinjury. Children were divided into two traumatic brain injury severity groups: mild TBI (n=57) and moderate/severe TBI (n=27). Hierarchical regression models were used to examine (i) preinjury factors and (ii) symptoms 6 months postinjury predictive of fatigue (general, sleep/rest, and cognitive) at 12 months postinjury. RESULTS Sleep/rest fatigue was predicted by preinjury fatigue (7% of variance) and psychological symptoms preinjury (10% of variance). General fatigue was predicted by physical/motor symptoms (27%), sleep (10%) and mood symptoms (9%) 6 months postinjury. Sleep/rest fatigue was predicted by physical/motor symptoms (10%), sleep symptoms (13%) and mood symptoms (9%) 6 months postinjury. Cognitive fatigue was predicted by physical/motor symptoms (17%) 6 months postinjury. CONCLUSIONS Preinjury fatigue and psychological functioning identified those at greatest risk of fatigue 12 months post-TBI. Predictors of specific fatigue domains at 12 months differed across each of the domains, although consistently included physical/motor function as well as sleep and mood symptoms postinjury. (JINS, 2018, 24, 224-236).
Collapse
|
24
|
Narad ME, Treble-Barna A, Peugh J, Yeates KO, Taylor HG, Stancin T, Wade SL. Recovery Trajectories of Executive Functioning After Pediatric TBI: A Latent Class Growth Modeling Analysis. J Head Trauma Rehabil 2018; 32:98-106. [PMID: 27455434 DOI: 10.1097/htr.0000000000000247] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify latent trajectories of executive functioning (EF) recovery overtime after childhood traumatic brain injury (TBI) and examine the predictive value of known risk factors within and across recovery trajectories using latent class growth modeling (LCGM). METHOD A total of 206 children between the ages of 3 and 7 years with a moderate to severe TBI or orthopedic injury (OI) were included. LCGM was applied to identify longitudinal trajectories of postinjury EF as assessed by the Behavior Rating Inventory of Executive Functioning General Executive Composite (GEC). Separate models were estimated for the TBI and OI groups. RESULTS Two TBI trajectories-normal limits (70.8%) and clinically elevated (29.2%)-and 3 OI trajectories-normal limits (20.9%), subclinical (49.0%), and clinically elevated (30.17%)-were identified. Baseline GEC was the only predictor of class membership for all models. Both TBI trajectories demonstrated an increase in GEC over time, whereas only 1 of the 3 OI classes demonstrated this pattern. Family variables were associated with GEC across trajectories. CONCLUSION The lack of association of injury characteristics with trajectory class membership highlights the heterogeneity in recovery after pediatric TBI. Associations of EF trajectories with family factors underscore the importance of involving the family in interventions for children with traumatic injuries.
Collapse
Affiliation(s)
- Megan E Narad
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Drs Narad, Treble-Barna, Peugh, and Wade); Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (Dr Yeates); Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (Dr Taylor); MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio (Dr Stancin); and The University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Wade)
| | | | | | | | | | | | | |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Austin D, Frater T, Wales L, Dunford C. Measuring changes in functional ability in older children and young people with acquired brain injury using the UK FIM + FAM. Br J Occup Ther 2017. [DOI: 10.1177/0308022617735036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction There is a need for validated and responsive measurement tools to demonstrate changes in functional ability. Existing outcome measurement tools have significant limitations for children and young people with acquired brain injury (ABI). Aim This study examines the potential of the UK Functional Independence Measure + Functional Assessment Measure (UK FIM + FAM) to detect clinical change in older children and young people with ABI. Method This is a secondary retrospective pretest–post test analysis of 72 children and young people age 8–17 years. Internal responsiveness was examined using Wilcoxon signed-rank tests and effect sizes indices; external responsiveness was examined in relation to the Neurological Impairment Scale (NIS) using Spearman’s correlation coefficient. Results Highly significant changes were detected from admission to discharge on motor, cognitive and total UK FIM + FAM scores ( p < 0.001). Medium to large effect sizes were found on the total scale indicating good internal responsiveness. There was a significant, negative correlation between UK FIM + FAM change scores and NIS change scores ( p < 0.01) indicating good external responsiveness. Conclusion The UK FIM + FAM was able to detect clinically meaningful change in functional ability in children and young people with ABI over 8 years. Further validity and reliability must be established before recommending its use in this client group.
Collapse
Affiliation(s)
- Dalya Austin
- Occupational Therapist, Imperial College NHS Trust, London, UK
| | | | - Lorna Wales
- Research Professional Lead, The Children’s Trust, London, UK
| | - Carolyn Dunford
- Head of Therapy & Research, The Children’s Trust, London, UK
| |
Collapse
|
27
|
Ireland PJ, Francis A, Jackman S, McLennan K. Exploring functional outcomes and allied health staffing levels in an inpatient paediatric rehabilitation unit. Disabil Rehabil 2017; 41:293-298. [PMID: 28994623 DOI: 10.1080/09638288.2017.1387293] [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: 10/18/2022]
Abstract
PURPOSE This study provides data from a paediatric tertiary hospital on the length of stay, functional improvement and allied health workload for children and adolescents on active inpatient rehabilitation programs. METHODS An audit was conducted of records of patients managed through an inpatient rehabilitation program at a 359 bed tertiary children's hospital in Brisbane, Australia between December 2014 and December 2015. Data relating to diagnosis, length of stay, functional change, occasions of allied health service and hours of patient attributable allied health professional time were collected. RESULTS Data on 94 children and adolescents with a total of 102 rehabilitation episodes of care were sourced. The greatest average length of stay was for the "Stroke" group. The highest average allied health professional contact hours were for the "Brain Dysfunction - Traumatic" group. The greatest average functional change was observed in the "Brain Dysfunction- Traumatic group." Physiotherapy accounted for the largest proportion of allied health professional service time, with an average of 32% of total time. CONCLUSIONS This review from a tertiary hospital-based inpatient paediatric rehabilitation service provides information regarding the length of stay, functional change and allied health workload for children and adolescents on active inpatient rehabilitation programs. As expected, total and rehabilitation episode length of stay, functional improvement and allied health contact and input varied according to diagnostic groups. This information is likely to be of value to other Paediatric Rehabilitation Medicine inpatient units when developing staffing for services and benchmarking service delivery. Implications for Rehabilitation Paediatric Rehabilitation Medicine supports children and adolescents to achieve the highest level possible of physical, cognitive, psychological and social functioning following accident or injury. There are little data in the literature to inform the optimal allied health staffing levels required for intensive inpatient multidisciplinary for children and adolescents suffering acquired neurological impairments. Data from this tertiary hospital-based paediatric inpatient rehabilitation program provide information on the length of stay, functional improvement and allied health professional contact for patients across broad diagnostic groupings. This information is useful for other paediatric rehabilitation services when planning for allied health staffing in service development.
Collapse
Affiliation(s)
- Penelope J Ireland
- a Queensland Paediatric Rehabilitation Service , Lady Cilento Children's Hospital , Brisbane , Australia
| | - Amanda Francis
- a Queensland Paediatric Rehabilitation Service , Lady Cilento Children's Hospital , Brisbane , Australia
| | - Shani Jackman
- a Queensland Paediatric Rehabilitation Service , Lady Cilento Children's Hospital , Brisbane , Australia
| | - Kim McLennan
- a Queensland Paediatric Rehabilitation Service , Lady Cilento Children's Hospital , Brisbane , Australia
| |
Collapse
|
28
|
Treble-Barna A, Zang H, Zhang N, Taylor HG, Stancin T, Yeates KO, Wade SL. Observed parent behaviors as time-varying moderators of problem behaviors following traumatic brain injury in young children. Dev Psychol 2017; 52:1777-1792. [PMID: 27786528 DOI: 10.1037/dev0000208] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Parent behaviors moderate the adverse consequences of pediatric traumatic brain injury (TBI); however, it is unknown how these moderating effects change over time. This study examined the moderating effect of observed parent behaviors over time since injury on the relation between TBI and behavioral outcomes. Participants included children, ages 3-7 years, hospitalized for moderate (n = 52) or severe (n = 20) TBI or orthopedic injury (OI; n = 95). Parent-child dyads were videotaped during structured task and free play conditions, and parents completed child behavior ratings. Linear mixed models using a lagged, time-varying moderator analysis examined the relationship of observed parent behaviors at the baseline, 6-month, and 12-month assessments to child behavior problems at 6 months, 12 months, and 18 months postinjury, after controlling for preinjury levels of child behavior problems. The effect of TBI on behavior was exacerbated by less favorable parent behaviors, and buffered by more favorable parent behaviors, in children with severe TBI over the first 12 months postinjury. By 18 months postinjury, however, the moderating effect of parent behaviors diminished, such that children with severe TBI showed more behavior problems relative to children with moderate TBI or OI regardless of parent behaviors or in response to parent behaviors that were initially protective. The results suggest that the moderating effects of the family environment are complex and likely vary in relation to both recovery and developmental factors, with potentially important implications for targets and timing of intervention. (PsycINFO Database Record
Collapse
Affiliation(s)
- Amery Treble-Barna
- Division of Physical Medicine & Rehabilitation, Cincinnati Children's Hospital Medical Center
| | - Huaiyu Zang
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center
| | - Nanhua Zhang
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center
| | - H Gerry Taylor
- Division of Developmental and Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital
| | - Terry Stancin
- Department of Psychiatry, Case Western Reserve University School of Medicine
| | | | - Shari L Wade
- Division of Physical Medicine & Rehabilitation, Cincinnati Children's Hospital Medical Center
| |
Collapse
|
29
|
Treble-Barna A, Wade SL, Martin LJ, Pilipenko V, Yeates KO, Taylor HG, Kurowski BG. Influence of Dopamine-Related Genes on Neurobehavioral Recovery after Traumatic Brain Injury during Early Childhood. J Neurotrauma 2017; 34:1919-1931. [PMID: 28323555 DOI: 10.1089/neu.2016.4840] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The present study examined the association of dopamine-related genes with short- and long-term neurobehavioral recovery, as well as neurobehavioral recovery trajectories over time, in children who had sustained early childhood traumatic brain injuries (TBI) relative to children who had sustained orthopedic injuries (OI). Participants were recruited from a prospective, longitudinal study evaluating outcomes of children who sustained a TBI (n = 68) or OI (n = 72) between the ages of 3 and 7 years. Parents completed ratings of child executive function and behavior at the immediate post-acute period (0-3 months after injury); 6, 12, and 18 months after injury; and an average of 3.5 and 7 years after injury. Thirty-two single nucleotide polymorphisms (SNPs) in dopamine-related genes (dopamine receptor D2 [DRD2], solute carrier family 6 member 3 [SLC6A3], solute carrier family 18 member A2 [SLC18A2], catechol-o-methyltransferase [COMT], and ankyrin repeat and kinase domain containing 1 [ANKK1]) were examined in association with short- and long-term executive function and behavioral adjustment, as well as their trajectories over time. After controlling for premorbid child functioning, genetic variation within the SLC6A3 (rs464049 and rs460000) gene was differentially associated with neurobehavioral recovery trajectories over time following TBI relative to OI, with rs464049 surviving multiple testing corrections. In addition, genetic variation within the ANKK1 (rs1800497 and rs2734849) and SLC6A3 (rs464049, rs460000, and rs1042098) genes was differentially associated with short- and long-term neurobehavioral recovery following TBI, with rs460000 and rs464049 surviving multiple testing corrections. The findings provide preliminary evidence that genetic variation in genes involved in DRD2 expression and density (ANKK1) and dopamine transport (SLC6A3) plays a role in neurobehavioral recovery following pediatric TBI.
Collapse
Affiliation(s)
- Amery Treble-Barna
- 1 Division of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Shari L Wade
- 2 Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Lisa J Martin
- 3 Division of Human Genetics, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Valentina Pilipenko
- 3 Division of Human Genetics, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Keith Owen Yeates
- 4 Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - H Gerry Taylor
- 5 Division of Developmental and Behavioral Pediatrics and Psychology, Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital , Cleveland, Ohio
| | - Brad G Kurowski
- 2 Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| |
Collapse
|
30
|
Age at injury is associated with the long-term cognitive outcome of traumatic brain injuries. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 6:196-200. [PMID: 28337475 PMCID: PMC5352716 DOI: 10.1016/j.dadm.2017.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The association between age at injury (AAI) and long-term cognitive outcome of traumatic brain injuries (TBI) is debatable. METHODS Eligible participants with a history of TBI from Alzheimer's Disease Neuroimaging Initiative were divided into a childhood TBI (cTBI) group (the AAI ≤ 21 years old) and an adult TBI (aTBI) group (the AAI > 21 years old). RESULTS The cTBI group has a higher Everyday Cognition total score than the aTBI group. All perceived cognitive functions are worse for the cTBI group than for the aTBI group except memory. By contrast, the cTBI group has higher assessment scores on either the Boston Naming Test or Rey Auditory Verbal Learning Test than the aTBI group. DISCUSSION The AAI is associated with the long-term cognitive outcomes in older adults with a history of TBI.
Collapse
|
31
|
Soo C, Tate RL, Anderson V, Beauchamp MH, Brookes N, Catroppa C, Galvin J, Muscara F. Assessing psychosocial functioning following childhood acquired brain injury: The Sydney Psychosocial Reintegration Scale for Children. Dev Neurorehabil 2016; 19:356-364. [PMID: 25756540 DOI: 10.3109/17518423.2014.1000504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The Sydney Psychosocial Reintegration Scale for Children (SPRS-C) assesses psychosocial functioning in children with acquired brain injury (ABI). This article aims to: (1) describe normative data for the parent-rated SPRS-C and, (2) evaluate the discriminant validity of the SPRS-C. METHODS For Aim 1, participants were parents of typically developing children (TDC) aged 5-14 years (N = 200). For Aim 2, participants with ABI were aged 5-14 years (n = 26). A matched group of TDC was sampled from the larger normative sample to serve as a control group (n = 26). RESULTS For Aim 1, SPRS-C scores across the 10 age-bands were in the higher ranges. Correlation coefficients of SPRS-C total score with child's age and parent occupational skill level were not statistically significant. For Aim 2, SPRS-C scores for the ABI group were significantly lower than the control group. CONCLUSIONS These data provide a guide for clinical interpretation of the SPRS-C for measuring psychosocial functioning in children with ABI.
Collapse
Affiliation(s)
- Cheryl Soo
- a Australian Centre for Child Neuropsychology Studies, Murdoch Children's Research Institute, Royal Children's Hospital , Melbourne , Australia.,b John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School - Northern, University of Sydney, Royal North Shore Hospital , Sydney , Australia
| | - Robyn L Tate
- b John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School - Northern, University of Sydney, Royal North Shore Hospital , Sydney , Australia
| | - Vicki Anderson
- a Australian Centre for Child Neuropsychology Studies, Murdoch Children's Research Institute, Royal Children's Hospital , Melbourne , Australia
| | - Miriam H Beauchamp
- c Sainte-Justine Hospital Research Center, University of Montreal , Montreal , Quebec , Canada
| | - Naomi Brookes
- d Brain Injury Rehabilitation Program, Sydney Children's Hospital , Sydney , Australia , and
| | - Cathy Catroppa
- a Australian Centre for Child Neuropsychology Studies, Murdoch Children's Research Institute, Royal Children's Hospital , Melbourne , Australia
| | - Jane Galvin
- a Australian Centre for Child Neuropsychology Studies, Murdoch Children's Research Institute, Royal Children's Hospital , Melbourne , Australia.,e Victorian Paediatric Rehabilitation Service , Melbourne , Australia
| | - Frank Muscara
- a Australian Centre for Child Neuropsychology Studies, Murdoch Children's Research Institute, Royal Children's Hospital , Melbourne , Australia
| |
Collapse
|
32
|
Fineblit S, Selci E, Loewen H, Ellis M, Russell K. Health-Related Quality of Life after Pediatric Mild Traumatic Brain Injury/Concussion: A Systematic Review. J Neurotrauma 2016; 33:1561-8. [PMID: 26916876 DOI: 10.1089/neu.2015.4292] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Health-related quality of life (HRQOL) is an emerging method to quantify the consequences of pediatric mild traumatic brain injury (mTBI)/concussion in both clinical practice and research. However, to utilize HRQOL measurements to their full potential in the context of mTBI/concussion recovery, a better understanding of the typical course of HRQOL after these injuries is needed. The objective of this study was to summarize current knowledge on HRQOL after pediatric mTBI/concussion and identify areas in need of further research. The following databases from their earliest date of coverage through June 1, 2015 were used: MEDLINE(®), PubMed, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SPORTDiscus, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), and Child Development and Adolescent Studies (CDAS). Studies must have examined and reported HRQOL in a pediatric population after mTBI/concussion, using a validated HRQOL measurement tool. Eight of 1660 records identified ultimately met inclusion criteria. Comprehensive data were extracted and checked by a second reviewer for accuracy and completeness. There appears to be a small but important subgroup of patients who experience poor HRQOL outcomes up to a year or longer post-injury. Potential predictors of poor HRQOL include older age, lower socioeconomic status, or a history of headaches or trouble sleeping. Differing definitions of mTBI precluded meta-analysis. HRQOL represents an important outcome measure in mTBI/concussion clinical practice and research. The evidence shows that a small but important proportion of patients have diminished HRQOL up to a year or longer post-injury. Further study on this topic is warranted to determine the typical longitudinal progression of HRQOL after pediatric concussion.
Collapse
Affiliation(s)
- Samuel Fineblit
- 1 College of Medicine, University of Manitoba , Winnipeg, Canada
| | - Erin Selci
- 2 Department of Pediatrics and Child Health, University of Manitoba , Winnipeg, Canada
- 3 Children's Hospital Research Institute of Manitoba , Winnipeg, Canada
| | - Hal Loewen
- 4 Neil John Maclean Health Sciences Library, University of Manitoba , Winnipeg, Canada
| | - Michael Ellis
- 3 Children's Hospital Research Institute of Manitoba , Winnipeg, Canada
- 5 Department of Surgery, University of Manitoba , Winnipeg, Canada
- 6 Canada North Concussion Network , Winnipeg, Canada
| | - Kelly Russell
- 2 Department of Pediatrics and Child Health, University of Manitoba , Winnipeg, Canada
- 3 Children's Hospital Research Institute of Manitoba , Winnipeg, Canada
- 6 Canada North Concussion Network , Winnipeg, Canada
| |
Collapse
|
33
|
Netson KL, Ashford JM, Skinner T, Carty L, Wu S, Merchant TE, Conklin HM. Executive dysfunction is associated with poorer health-related quality of life in pediatric brain tumor survivors. J Neurooncol 2016; 128:313-21. [PMID: 27033060 DOI: 10.1007/s11060-016-2113-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/22/2016] [Indexed: 11/29/2022]
Abstract
Children with a brain tumor (BT) are at risk for a number of physical and cognitive problems that may lower their health-related quality of life (HRQoL). Executive functioning (EF) and intellectual ability are hypothesized to associate with HRQoL and deficits in these areas may be amenable to interventions. This study aimed to investigate intellectual function, EF, and HRQoL following conformal radiation therapy (CRT) for pediatric BT. Forty-five BT survivors (age 12.68 ± 2.56) treated with CRT participated. Thirty-six siblings of BT patients (age 12.36 ± 2.13) and 33 survivors of non-CNS solid tumors (ST; age 12.18 ± 2.88) were comparison groups. IQ estimate (Wechsler Abbreviated Scale of Intelligence; WASI), EF ratings (Behavior Rating Inventory of Executive Function; BRIEF), and HRQoL ratings (KINDL-R) were obtained. BT survivors reported lower overall HRQoL than ST survivors (p = .012). Parents reported lower overall HRQoL for BT survivors than siblings (p = .014). Parent-report on individual areas of HRQoL was higher than self-report for most subscales. IQ and HRQoL ratings were not related (Parent r = .17, p = .27; Child r = .11, p = .49). EF ratings correlated with Parent (r = -.15 to -.73) but not Child HRQoL ratings. Children with BT experienced poorer HRQoL than controls. Children's HRQoL was consistently rated higher by parent- than self-report across all domains. HRQoL was associated with EF, but not with IQ. These findings identify interventions targeting EF (e.g., cognitive rehabilitation, medication) as a possible avenue for improving HRQoL in childhood BT survivors.
Collapse
Affiliation(s)
- Kelli L Netson
- Department of Psychiatry & Behavioral Sciences, KU School of Medicine-Wichita, Wichita, KS, USA
| | - Jason M Ashford
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | - Shengjie Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Heather M Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
| |
Collapse
|
34
|
Donders J, DeWit C. Parental ratings of daily behavior and child cognitive test performance after pediatric mild traumatic brain injury. Child Neuropsychol 2016; 23:554-570. [DOI: 10.1080/09297049.2016.1161015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
35
|
Brown EA, Kenardy J, Chandler B, Anderson V, McKinlay L, Le Brocque R. Parent-Reported Health-Related Quality of Life in Children With Traumatic Brain Injury: A Prospective Study. J Pediatr Psychol 2015; 41:244-55. [PMID: 26395759 DOI: 10.1093/jpepsy/jsv090] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/20/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify which specific aspects of health-related quality of life (HRQL) are affected by traumatic brain injury (TBI) injury severity (Severity), time since injury (Time), and the interaction between Severity and Time, in a pediatric sample. It was hypothesized that Severity would decrease HRQL, Time would increase HRQL, and time to recover would be protracted for children with severe TBI. METHODS This study followed a pediatric sample (n = 182, aged 6-14 years, recruited through three Australian hospitals) who sustained a mild or moderate-severe TBI across 3, 6, 12, and 18 months post-TBI. 12 specific HRQL outcomes were assessed via the Child Health Questionnaire-Parent Form 50 questionnaire. RESULTS Dimensions of HRQL were differentially affected. Children with moderate-severe TBI generally experienced greater initial dysfunction than children with mild TBI; however, this difference disappeared by 18 months post-TBI. CONCLUSIONS Specific time points where HRQL outcomes may remediate are identified, and clinical recommendations regarding intervention strategies are discussed.
Collapse
Affiliation(s)
- Erin A Brown
- Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland,
| | - Justin Kenardy
- Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland
| | - Bronwyn Chandler
- Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland
| | - Vicki Anderson
- Murdoch Children's Research Institute, Royal Children's Hospital, and
| | - Lynne McKinlay
- Queensland Paediatric Rehabilitation Service, Royal Children's Hospital
| | - Robyne Le Brocque
- Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland
| |
Collapse
|
36
|
Longaud-Valès A, Chevignard M, Dufour C, Grill J, Puget S, Sainte-Rose C, Valteau-Couanet D, Dellatolas G. Assessment of executive functioning in children and young adults treated for frontal lobe tumours using ecologically valid tests. Neuropsychol Rehabil 2015; 26:558-83. [DOI: 10.1080/09602011.2015.1048253] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
37
|
Ciccia AH, Threats T. Role of contextual factors in the rehabilitation of adolescent survivors of traumatic brain injury: emerging concepts identified through modified narrative review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2015; 50:436-451. [PMID: 25721403 DOI: 10.1111/1460-6984.12153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/01/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Recently research in traumatic brain injury (TBI) intervention has identified the benefits of contextualized, embedded, functionally based approaches to maximize treatment outcomes. An essential component of contextualized intervention is the direct and purposeful consideration of the broader context, in which the person with TBI functions. However, systematic consideration of contextual factors remains limited both in research and clinical practice. AIMS The purposes of this modified narrative review were (1) to provide a succinct review of the available literature regarding the contextual factors that are specific to adolescent survivors of TBI, one of highest incidence groups for brain injury; (2) to connect these contextual factors to the direct long-term management of TBI and to identify their potential impact on outcome; and (3) to highlight areas that are open to research and clinical advances that could enhance positive outcomes for adolescent survivors of TBI. The framework of the World Health Organization's (WHO) International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY; 2007) was used as a foundation for this review. METHODS & PROCEDURES A systematic literature search was conducted using databases and hand searches. A total of 102 articles were originally identified. Twenty-five original research articles, eight review papers and four expert opinion papers met inclusion and exclusion criteria and were included in the final review. MAIN CONTRIBUTION The body of research specifically focused on contextual factors is an emerging area. Early findings indicate that a focus on the direct modification of contextual factors is promising for the facilitation of positive outcomes long into the chronic phase of management for adolescences who have survived a TBI. The contextual factors included in this review were the overall ability of the school to support a student post-TBI, family psychosocial risk (sibling/sibling relationships/stress/burden/support), coping style (TBI survivor and their caregivers), and socioeconomic status of the family. Given the promise of these findings, research and clinical application efforts should be focused on identifying well-prescribed rehabilitation paradigms that capitalize on the modification of contextual factors throughout the recovery process. CONCLUSIONS & IMPLICATIONS The results of this modified narrative review provide an initial summary of the available evidence for addressing contextual factors in the rehabilitation process for adolescents with TBI. This is an area that is wide open for both systematic research and clinical application and holds potential to improve long-term outcome for survivors of adolescent TBI.
Collapse
Affiliation(s)
- Angela Hein Ciccia
- Department of Psychological Sciences, Program in Communication Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Travis Threats
- Department of Communication Sciences and Disorders, McGannon Hall, St. Louis, MO, USA
| |
Collapse
|
38
|
Pastore V, Colombo K, Maestroni D, Galbiati S, Villa F, Recla M, Locatelli F, Strazzer S. Psychological problems, self-esteem and body dissatisfaction in a sample of adolescents with brain lesions: A comparison with a control group. Brain Inj 2015; 29:937-45. [DOI: 10.3109/02699052.2015.1008045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
39
|
Polinder S, Haagsma JA, van Klaveren D, Steyerberg EW, van Beeck EF. Health-related quality of life after TBI: a systematic review of study design, instruments, measurement properties, and outcome. Popul Health Metr 2015; 13:4. [PMID: 25722656 PMCID: PMC4342191 DOI: 10.1186/s12963-015-0037-1] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/02/2015] [Indexed: 12/03/2022] Open
Abstract
Measurement of health-related quality of life (HRQL) is essential to quantify the subjective burden of traumatic brain injury (TBI) in survivors. We performed a systematic review of HRQL studies in TBI to evaluate study design, instruments used, methodological quality, and outcome. Fifty-eight studies were included, showing large variation in HRQL instruments and assessment time points used. The Short Form-36 (SF-36) was most frequently used. A high prevalence of health problems during and after the first year of TBI was a common finding of the studies included. In the long term, patients with a TBI still showed large deficits from full recovery compared to population norms. Positive results for internal consistency and interpretability of the SF-36 were reported in validity studies. The Quality of Life after Brain Injury instrument (QOLIBRI), European Brain Injury Questionnaire (EBIQ), Child Health Questionnaire (CHQ), and the World Health Organization Quality of Life short version (WHOQOL-BREF) showed positive results, but evidence was limited. Meta-analysis of SF-36 showed that TBI outcome is heterogeneous, encompassing a broad spectrum of HRQL, with most problems reported in the physical, emotional, and social functioning domain. The use of SF-36 in combination with a TBI-specific instrument, i.e., QOLIBRI, seems promising. Consensus on preferred methodologies of HRQL measurement in TBI would facilitate comparability across studies, resulting in improved insights in recovery patterns and better estimates of the burden of TBI.
Collapse
Affiliation(s)
- Suzanne Polinder
- Erasmus MC, Department of Public Health, PO Box 2040, 3000 Rotterdam, CA The Netherlands
| | - Juanita A Haagsma
- Erasmus MC, Department of Public Health, PO Box 2040, 3000 Rotterdam, CA The Netherlands
| | - David van Klaveren
- Erasmus MC, Department of Public Health, PO Box 2040, 3000 Rotterdam, CA The Netherlands
| | - Ewout W Steyerberg
- Erasmus MC, Department of Public Health, PO Box 2040, 3000 Rotterdam, CA The Netherlands
| | - Ed F van Beeck
- Erasmus MC, Department of Public Health, PO Box 2040, 3000 Rotterdam, CA The Netherlands
| |
Collapse
|
40
|
Abstract
OBJECTIVE To investigate significant new morbidities associated with pediatric critical care. DESIGN Randomly selected, prospective cohort. SETTING PICU patients from eight medical and cardiac PICUs. PATIENTS This was a randomly selected, prospective cohort of PICU patients from eight medical and cardiac PICUs. MEASUREMENTS AND MAIN RESULTS The main outcomes measures were hospital discharge functional status measured by Functional Status Scale scores and new morbidity defined as an increase in the Functional Status Scale of more than or equal to 3. Of the 5,017 patients, there were 242 new morbidities (4.8%), 99 PICU deaths (2.0%), and 120 hospital deaths (2.4%). Both morbidity and mortality rates differed (p < 0.001) among the sites. The worst functional status profile was on PICU discharge and improved on hospital discharge. On hospital discharge, the good category decreased from a baseline of 72% to 63%, mild abnormality increased from 10% to 15%, moderate abnormality status increased from 13% to 14%, severe status increased from 4% to 5%, and very severe was unchanged at 1%. The highest new morbidity rates were in the neurological diagnoses (7.3%), acquired cardiovascular disease (5.9%), cancer (5.3%), and congenital cardiovascular disease (4.9%). New morbidities occurred in all ages with more in those under 12 months. New morbidities involved all Functional Status Scale domains with the highest proportions involving respiratory, motor, and feeding dysfunction. CONCLUSIONS The prevalence of new morbidity was 4.8%, twice the mortality rate, and occurred in essentially all types of patients, in relatively equal proportions, and involved all aspects of function. Compared with historical data, it is possible that pediatric critical care has exchanged improved mortality rates for increased morbidity rates.
Collapse
|
41
|
DeMatteo CA, Hanna SE, Yousefi-Nooraie R, Lin CYA, Mahoney WJ, Law MC, McCauley D. Quality-of-life after brain injury in childhood: time, not severity, is the significant factor. Brain Inj 2014; 28:114-21. [PMID: 24328806 DOI: 10.3109/02699052.2013.848380] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Little is known about the impact of acquired brain injury (ABI) on the long-term quality-of-life (QoL) in children and youth. The objectives of this study were to illustrate the long-term QoL trajectories at 5 years post-ABI. METHODS The QoL of children between 5-18 years (n = 94) admitted to McMaster Children's Hospital with ABI were assessed longitudinally for a minimum of 5 years post-injury using the Child Health Questionnaire. Independent t-tests were used to examine differences in QoL between the study cohort and a normative sample at different time points. Mixed-effects models were used to identify predictors for QoL. RESULTS The QoL of children with ABI was significantly poorer (p < 0.05) than the normative data on all domains and at all-time points except at baseline. The CHQ physical summary score (PHSS) showed a significant decline immediately after injury and a significant recovery at 8 months post-injury; while the CHQ psychosocial summary score (PSSS) showed a significant immediate decline, which remained over the course of the study. Pre-morbid school record, time post-injury and mechanism of injury significantly predicted the CHQ PSSS. CONCLUSIONS QoL is impacted by ABI regardless of severity. This impact is further affected by time post-injury.
Collapse
|
42
|
Pollack MM, Holubkov R, Funai T, Clark A, Moler F, Shanley T, Meert K, Newth CJL, Carcillo J, Berger JT, Doctor A, Berg RA, Dalton H, Wessel DL, Harrison RE, Dean JM, Jenkins TL. Relationship between the functional status scale and the pediatric overall performance category and pediatric cerebral performance category scales. JAMA Pediatr 2014; 168:671-6. [PMID: 24862461 PMCID: PMC4589215 DOI: 10.1001/jamapediatrics.2013.5316] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Functional status assessment methods are important as outcome measures for pediatric critical care studies. OBJECTIVE To investigate the relationships between the 2 functional status assessment methods appropriate for large-sample studies, the Functional Status Scale (FSS) and the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category (POPC/PCPC) scales. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study with random patient selection at 7 sites and 8 children's hospitals with general/medical and cardiac/cardiovascular pediatric intensive care units (PICUs) in the Collaborative Pediatric Critical Care Research Network. Participants included all PICU patients younger than 18 years. MAIN OUTCOMES AND MEASURES Functional Status Scale and POPC/PCPC scores determined at PICU admission (baseline) and PICU discharge. We investigated the association between the baseline and PICU discharge POPC/PCPC scores and the baseline and PICU discharge FSS scores, the dispersion of FSS scores within each of the POPC/PCPC ratings, and the relationship between the FSS neurologic components (FSS-CNS) and the PCPC. RESULTS We included 5017 patients. We found a significant (P < .001) difference between FSS scores in each POPC or PCPC interval, with an FSS score increase with each worsening POPC/PCPC rating. The FSS scores for the good and mild disability POPC/PCPC ratings were similar and increased by 2 to 3 points for the POPC/PCPC change from mild to moderate disability, 5 to 6 points for moderate to severe disability, and 8 to 9 points for severe disability to vegetative state or coma. The dispersion of FSS scores within each POPC and PCPC rating was substantial and increased with worsening POPC and PCPC scores. We also found a significant (P < .001) difference between the FSS-CNS scores between each of the PCPC ratings with increases in the FSS-CNS score for each higher PCPC rating. CONCLUSIONS AND RELEVANCE The FSS and POPC/PCPC system are closely associated. Increases in FSS scores occur with each higher POPC and PCPC rating and with greater magnitudes of change as the dysfunction severity increases. However, the dispersion of the FSS scores indicated a lack of precision in the POPC/PCPC system when compared with the more objective and granular FSS. The relationship between the PCPC and the FSS-CNS paralleled the relationship between the FSS and POPC/PCPC system.
Collapse
Affiliation(s)
- Murray M. Pollack
- Department of Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, Arizona,Department of Child Health, University of Arizona College of Medicine–Phoenix
| | - Richard Holubkov
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Tomohiko Funai
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Amy Clark
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Frank Moler
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Thomas Shanley
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Kathy Meert
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit
| | - Christopher J. L. Newth
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, California
| | - Joseph Carcillo
- Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - John T. Berger
- Department of Pediatrics, Children’s National Medical Center, Washington, DC
| | - Allan Doctor
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri,Department of Biochemistry, Washington University School of Medicine, St Louis, Missouri
| | - Robert A. Berg
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Heidi Dalton
- Department of Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, Arizona,Department of Child Health, University of Arizona College of Medicine–Phoenix
| | - David L. Wessel
- Department of Pediatrics, Children’s National Medical Center, Washington, DC
| | | | - J. Michael Dean
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Tammara L. Jenkins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
43
|
Brown EA, Kenardy JA, Dow BL. PTSD Perpetuates Pain in Children With Traumatic Brain Injury. J Pediatr Psychol 2014; 39:512-20. [DOI: 10.1093/jpepsy/jsu014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
44
|
Soo C, Tate R, Brookes N. Psychosocial adjustment following acquired brain injury in childhood and adolescence: Executive, behavioural and emotional contributions. Brain Inj 2014; 28:906-14. [DOI: 10.3109/02699052.2014.888762] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
45
|
Roth RM, Erdodi LA, McCulloch LJ, Isquith PK. Much ado about norming: the Behavior Rating Inventory of Executive Function. Child Neuropsychol 2014; 21:225-33. [PMID: 24650292 DOI: 10.1080/09297049.2014.897318] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Behavior Rating Inventory of Executive Function (BRIEF) is a rating scale designed to assess executive functions in everyday life that is widely used in school and clinical settings and in research studies. It has been recently suggested, however, that the limited geographic stratification of the standardization sample renders the measure overly sensitive. We evaluated this hypothesis by examining BRIEF scores across studies of typically developing children and adolescents. Thirty-nine studies were identified that included at least one of three possible index scores. Mean scores across studies were (a) within one to two T-score units from the standardization sample mean of 50, (b) tended to be slightly lower than 50, and (c) were unrelated to geographic location (US Census regions or internationally). These findings refute recent claims that the BRIEF is overly sensitive and further add to the large body of literature supporting the validity of the measure.
Collapse
Affiliation(s)
- Robert M Roth
- a Neuropsychology Program, Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
| | | | | | | |
Collapse
|
46
|
Hung R, Carroll LJ, Cancelliere C, Côté P, Rumney P, Keightley M, Donovan J, Stålnacke BM, Cassidy JD. Systematic Review of the Clinical Course, Natural History, and Prognosis for Pediatric Mild Traumatic Brain Injury: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Arch Phys Med Rehabil 2014; 95:S174-91. [DOI: 10.1016/j.apmr.2013.08.301] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 07/30/2013] [Accepted: 08/07/2013] [Indexed: 10/25/2022]
|
47
|
Schmidt AT, Li X, Zhang-Rutledge K, Hanten GR, Levin HS. A history of low birth weight alters recovery following a future head injury: a case series. Child Neuropsychol 2013; 20:495-508. [PMID: 23961997 PMCID: PMC5385139 DOI: 10.1080/09297049.2013.822059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Low birth weight (LBW; below 2500 grams) is a general risk factor for a variety of neurodevelopmental difficulties. However, these children may remain more vulnerable to neurologic and environmental insults occurring years later. This prospective case series reports on children who sustained a mild, moderate, or severe traumatic brain injury (TBI) in middle childhood but who had also been born with birth weights below 2500 grams. PARTICIPANTS PARTICIPANTS were 14 children with mild, moderate, or severe traumatic brain injury (TBI), 5 of whom had birth weights under 2500 grams (LBW) and 9 children with normal birth weight (NBW). All participants were drawn from a larger study on the long-term cognitive and behavioral impact of pediatric TBI and were matched on age, estimated socioeconomic status (SES), and severity of TBI (with NBW children actually having a slightly worse overall injury severity). RESULTS At baseline, both groups exhibited similar scores on WJ-R Letter Word Identification and Calculations, Tower of London number solved, and CVLT-C total correct. Baseline group differences were observed on the CELF-III Formulated Sentences (NBW > LBW) and on the VABS Adaptive Behavior Composite and Socialization subdomain (LBW > NBW). Over 2 years, relative to the NBW group, the LBW group evidenced declines on both WJ-R subtests, CVLT-C total correct, CELF-III Formulated Sentences, and VABS Adaptive Behavior Composite and Socialization. CONCLUSIONS Although preliminary in nature due to small sample size, findings suggest a history of LBW influences the recovery trajectory following childhood TBI. Academic and adaptive functioning and verbal memory appeared particularly affected.
Collapse
Affiliation(s)
- Adam T Schmidt
- a Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and University of Texas-Houston Medical School , Houston , Texas , USA
| | | | | | | | | |
Collapse
|