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Serpa RO, Ferguson L, Larson C, Bailard J, Cooke S, Greco T, Prins ML. Pathophysiology of Pediatric Traumatic Brain Injury. Front Neurol 2021; 12:696510. [PMID: 34335452 PMCID: PMC8319243 DOI: 10.3389/fneur.2021.696510] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022] Open
Abstract
The national incidence of traumatic brain injury (TBI) exceeds that of any other disease in the pediatric population. In the United States the Centers for Disease Control and Prevention (CDC) reports 697,347 annual TBIs in children ages 0–19 that result in emergency room visits, hospitalization or deaths. There is a bimodal distribution within the pediatric TBI population, with peaks in both toddlers and adolescents. Preclinical TBI research provides evidence for age differences in acute pathophysiology that likely contribute to long-term outcome differences between age groups. This review will examine the timecourse of acute pathophysiological processes during cerebral maturation, including calcium accumulation, glucose metabolism and cerebral blood flow. Consequences of pediatric TBI are complicated by the ongoing maturational changes allowing for substantial plasticity and windows of vulnerabilities. This review will also examine the timecourse of later outcomes after mild, repeat mild and more severe TBI to establish developmental windows of susceptibility and altered maturational trajectories. Research progress for pediatric TBI is critically important to reveal age-associated mechanisms and to determine knowledge gaps for future studies.
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Affiliation(s)
- Rebecka O Serpa
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lindsay Ferguson
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Cooper Larson
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Julie Bailard
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Samantha Cooke
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Tiffany Greco
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Mayumi L Prins
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
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Wiseman-Hakes C, Saleem M, Poulin V, Nalder E, Balachandran P, Gan C, Colantonio A. The development of intimate relationships in adolescent girls and women with traumatic brain injury: a framework to guide gender specific rehabilitation and enhance positive social outcomes. Disabil Rehabil 2019; 42:3559-3565. [PMID: 30994020 DOI: 10.1080/09638288.2019.1597180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Traumatic brain injury is a neurological disorder of biopsychosocial nature influenced by sex and gender interactions across the lifespan. Traumatic brain injury sustained during adolescence can result in cognitive and social communication impairments that compromise the development and maintenance of intimate social relationships. This can increase both short and long-term vulnerability to poor mental health, social isolation, lack of meaningful friendships, exploitation, and abuse. Females with traumatic brain injury experience greater loss of confidence and have increased risk of victimization, sexual abuse, and violence. This paper aims to provide a framework to inform gender specific rehabilitation of social communication and intimacy, to enhance positive social outcomes for girls and women with Traumatic Brain Injury.Methods: The framework is developed through presentation of a conceptual, multi-dimensional model of intimacy and discussion of current evidence regarding trauma-related cognitive/social-communication impairments and considerations regarding social media.Results: Intimacy is strongly influenced by today's technology-informed "youth culture" and for those with Traumatic Brain Injury, is impacted by cognitive and social communication impairments. Females experience different challenges in recovery and experience of intimacy. There is a need to support girls and women with Traumatic Brain Injury as they develop intimate relationships.Conclusions: This framework can guide the development of female gender-specific rehabilitation and inform future research to promote positive social outcomes.Implications for rehabilitationIntimate relationships are a critical component of mental health and an important part of human development; however, the challenges faced by adolescent girls and woman with TBI in developing and maintaining intimate relationships are often overlooked in traditional rehabilitation programs.A multi-dimensional model of intimacy will help rehabilitation professionals understand the complexities of interventions needed to support healthy intimacy, as well as for harm prevention.Rehabilitation professionals play an important role in advocating for gender-specific supports and interventions.There is a need for early interventions, grounded in today's technological and social media culture, that will support healthy intimacy for adolescent girls and women with TBI.
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Affiliation(s)
- Catherine Wiseman-Hakes
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Speech Language Pathology, University of Toronto, Toronto, Canada.,Department of Speech Language Pathology, McMaster University, Hamilton, Canada
| | - Madiha Saleem
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Valérie Poulin
- Départment d'Ergothérapie, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Emily Nalder
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Peraveena Balachandran
- Department of Occupational Therapy, Saskatoon Health Region - Royal University Hospital, Saskatoon, Canada
| | - Caron Gan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital Toronto, Toronto, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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