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Luszawski CA, Plourde V, Sick SR, Galarneau JM, Eliason PH, Brooks BL, Mrazik M, Debert CT, Lebrun C, Babul S, Hagel BE, Dukelow SP, Schneider KJ, Emery CA, Yeates KO. Psychosocial Factors Associated With Time to Recovery After Concussion in Adolescent Ice Hockey Players. Clin J Sport Med 2024; 34:256-265. [PMID: 37707392 DOI: 10.1097/jsm.0000000000001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/06/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To investigate the association between psychosocial factors and physician clearance to return to play (RTP) in youth ice hockey players after sport-related concussion. DESIGN Prospective cohort study, Safe to Play (2013-2018). SETTING Youth hockey leagues in Alberta and British Columbia, Canada. PARTICIPANTS Three hundred fifty-three ice hockey players (aged 11-18 years) who sustained a total of 397 physician-diagnosed concussions. INDEPENDENT VARIABLES Psychosocial variables. MAIN OUTCOME MEASURES Players and parents completed psychosocial questionnaires preinjury. Players with a suspected concussion were referred for a study physician visit, during which they completed the Sport Concussion Assessment Tool (SCAT3/SCAT5) and single question ratings of distress and expectations of recovery. Time to recovery (TTR) was measured as days between concussion and physician clearance to RTP. Accelerated failure time models estimated the association of psychosocial factors with TTR, summarized with time ratios (TRs). Covariates included age, sex, body checking policy, days from concussion to the initial physician visit, and symptom severity at the initial physician visit. RESULTS Self-report of increased peer-related problems on the Strengths and Difficulties Questionnaire (TR, 1.10 [95% CI, 1.02-1.19]), higher ratings of distress about concussion outcomes by participants (TR, 1.06 [95% CI, 1.01-1.11]) and parents (TR, 1.05 [95% CI, 1.01-1.09]), and higher parent ratings of distress about their child's well-being at the time of injury (TR, 1.06 [95% CI, 1.02-1.09]) were associated with longer recovery. CONCLUSIONS Greater pre-existing peer-related problems and acute distress about concussion outcomes and youth well-being predicted longer TTR. Treatment targeting these psychosocial factors after concussion may promote recovery.
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Affiliation(s)
- Caroline A Luszawski
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Vickie Plourde
- School of Psychology, Université de Moncton, Moncton, New Brunswick, Canada
- Centre de Formation médicale du Nouveau-Brunswick, Université de Sherbrooke, Sherbrooke, New Brunswick, Canada
- Faculté Saint-Jean, University of Alberta, Edmonton, Alberta, Canada
| | - Stacy R Sick
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Michel Galarneau
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Paul H Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Alberta Children's Hospital, Neurosciences Program, Calgary, Alberta, Canada
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Martin Mrazik
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Chantel T Debert
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Constance Lebrun
- Glen Sather Sports Medicine Clinic, Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shelina Babul
- Department of Pediatrics, Faculty of Medicine, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brent E Hagel
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; and
| | - Kathryn J Schneider
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Zwicker HM, Fay-McClymont TB, Hou SHJ, Cho S, McDonald K, Guilcher GMT, Yeates KO, Brooks BL, Schulte FSM. Social adjustment in children diagnosed with sickle cell disease: A retrospective study. Pediatr Blood Cancer 2024; 71:e30807. [PMID: 38110802 DOI: 10.1002/pbc.30807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/29/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at risk for physical, psychological, and social adjustment challenges. This study sought to investigate social adjustment and related factors in children living with SCD. METHODS Data from 32 children (50% male, mean age = 10.32 years, SD = 3.27) were retrospectively collected from a neuropsychology clinic at a tertiary care pediatric hospital. Social adjustment was measured using the Behavior Assessment System for Children (BASC-3) parent-proxy, withdrawal subscale, and the Pediatric Quality of Life Inventory (PedsQL) Generic Module Social Functioning self- and parent-proxy subscales. Other measures captured executive functioning (i.e., Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) Parent Form) and non-disease-related associations with social adjustment, including number of years in Canada and family functioning (i.e., PedsQL Family Impact Module). RESULTS Sixteen percent of patients reported elevated social adjustment difficulties. Multiple linear regression found better family functioning [B = .48, t = 2.65, p = .016], and higher executive functioning [B = -.43, t = -2.39, p = .028] were related to higher scores on the PedsQL parent-proxy ratings of social adjustment [F(4,18) = 5.88, p = .003]. Male sex [B = .54, t = 3.08, p = .005], and having lived more years in Canada [B = .55, t = 2.81, p = .009], were related to higher PedsQL self-reported social adjustment [F(4,23) = 3.75, p = .017]. The model examining the BASC-3 withdrawal subscale was not statistically significant [F(4,16) = 1.63, p = .22]. IMPLICATIONS Social adjustment in children diagnosed with SCD warrants future research to understand the influence of executive function, and non-disease-related factors, particularly focusing on sociocultural factors.
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Affiliation(s)
- Hailey M Zwicker
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Taryn B Fay-McClymont
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Neuropsychology Services, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Psychology, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Sharon H J Hou
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Sara Cho
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kaelyn McDonald
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gregory M T Guilcher
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Keith O Yeates
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Neuropsychology Services, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Neuropsychology Services, Alberta Children's Hospital, Calgary, Alberta, Canada
- Child Brain and Mental Health, Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Fiona S M Schulte
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Vasserman M, Myers K, Brooks BL, Fay-McClymont TB, McColm L, Mish S, Becker N, MacAllister WS. Patterns of WISC-V Performance in Children with Congenital Heart Disease. Pediatr Cardiol 2024; 45:483-490. [PMID: 38214737 DOI: 10.1007/s00246-023-03367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024]
Abstract
Congenital heart disease (CHD) is one of the most common congenital birth defects. As surgical and interventional techniques have improved, the mortality has been greatly reduced and the focus has shifted to quality of life and long-term outcomes. The impact of CHD on development and cognition is becoming increasingly recognized. However, more research is needed to understand how children with CHD perform across various cognitive and intellectual domains. This study explored the performance of children with CHD on the newest version of the Wechsler Intelligence Scale for Children compared to normative controls. Children with CHD performed more poorly than normal controls across all indices and most subtests with large effect sizes. Additionally, we explored the patterns of impairment across indices and subtests, as well as the relationships between heard disease variables and WISC-V performance. Block design, Digit Span, and Similarities were the most commonly impaired scores in children with CHD, while Symbol Search, Picture Span, Figure Weights, and Vocabulary were least likely to be impaired.
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Affiliation(s)
- Marsha Vasserman
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada.
- Department of Pediatrics, University of Calgary, Calgary, Canada.
- Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Canada.
| | - Kimberly Myers
- Cardiology, Alberta Children's Hospital, Calgary, Canada
- Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
- Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Canada
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Canada
| | - Taryn B Fay-McClymont
- Department of Psychology, University of British Columbia Okanagan, Kelowna, Canada
- Private Practice, Kelowna, Canada
| | - Lisa McColm
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Sandra Mish
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Norma Becker
- Cardiology, Alberta Children's Hospital, Calgary, Canada
| | - William S MacAllister
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Canada
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Sicard V, Ledoux AA, Tang K, Yeates KO, Brooks BL, Anderson P, Keightley M, Desire N, Beauchamp MH, Zemek R. The association between symptom burden and processing speed and executive functioning at 4 and 12 weeks following pediatric concussion. J Int Neuropsychol Soc 2024:1-13. [PMID: 38273645 DOI: 10.1017/s1355617724000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Symptoms and cognition are both utilized as indicators of recovery following pediatric concussion, yet their interrelationship is not well understood. This study aimed to investigate: 1) the association of post-concussion symptom burden and cognitive outcomes (processing speed and executive functioning [EF]) at 4 and 12 weeks after pediatric concussion, and 2) the moderating effect of sex on this association. METHODS This prospective, multicenter cohort study included participants aged 5.00-17.99 years with acute concussion presenting to four Emergency Departments of the Pediatric Emergency Research Canada network. Five processing speed and EF tasks and the Post-Concussion Symptom Inventory (PCSI; symptom burden, defined as the difference between post-injury and retrospective [pre-injury] scores) were administered at 4 and 12 weeks post-concussion. Generalized least squares models were conducted with task performances as dependent variables and PCSI and PCSI*sex interaction as the main predictors, with important pre-injury demographic and injury characteristics as covariates. RESULTS 311 children (65.0% males; median age = 11.92 [IQR = 9.14-14.21 years]) were included in the analysis. After adjusting for covariates, higher symptom burden was associated with lower Backward Digit Span (χ2 = 9.85, p = .043) and Verbal Fluency scores (χ2 = 10.48, p = .033) across time points; these associations were not moderated by sex, ps ≥ .20. Symptom burden was not associated with performance on the Coding, Continuous Performance Test, and Color-Word Interference scores, ps ≥ .17. CONCLUSIONS Higher symptom burden is associated with lower working memory and cognitive flexibility following pediatric concussion, yet these associations were not moderated by sex. Findings may inform concussion management by emphasizing the importance of multifaceted assessments of EF.
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Affiliation(s)
- Veronik Sicard
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Andrée-Anne Ledoux
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ken Tang
- Independent Statistical Consultant, Richmond, BC, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Brian L Brooks
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Peter Anderson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Mental Health Neuropsychology Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, TorontoON, Canada
- Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Naddley Desire
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Ste-Justine Hospital Research Center, Montreal, QC, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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5
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Hassan A, Brooks BL, McArthur BA, Beauchamp MH, Craig W, Doan Q, Zemek R, Yeates KO. Dynamic Relations Between Psychological Resilience and Post-Concussion Symptoms in Children With Mild Traumatic Brain Injury Versus Orthopedic Injury: An A-CAP Study. J Neurotrauma 2024; 41:135-146. [PMID: 37485612 DOI: 10.1089/neu.2023.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Higher psychological resilience is correlated with less severe post-concussion symptoms (PCS) after mild traumatic brain injury (mTBI) in children, but the directional nature of this relationship remains uncertain. Although traditionally regarded as a stable, trait-like construct, resilience may be malleable and potentially influenced by mTBI and post-concussive symptoms. The current study sought to examine the stability of resilience, elucidate the dynamic nature of the resilience-PCS relation, and determine whether resilience-symptom associations are specific to mTBI or applicable to traumatic injury in general. Participants were children aged 8-16.99 years with either mTBI (n = 633) or orthopedic injury (OI; n = 334) recruited to participate in a prospective cohort study after presenting acutely to five Canadian pediatric emergency departments (EDs). Symptoms and psychological resilience were assessed at 1 week, 3 months, and 6 months post-injury. Group differences in resilience over time were examined using a mixed linear model, and associations between resilience and symptoms over time were examined using random intercepts cross-lagged panel modeling (RI-CLPM). The mTBI group reported significantly lower resilience than the OI group, but the difference was significantly larger 1 week post-injury (d = 0.50) than at 3 months (d = 0.08) and 6 months (d = 0.10). Cross-lagged panel models indicated that resilience had both stable and dynamic aspects, and both affected and was affected by PCS, although their association varied by time post-injury, symptom measure, and reporter (parent vs. child). Higher parent-reported cognitive symptom severity at 1 week was significantly associated with higher resilience at 3 months (β = 0.23, p = 0.001). Higher resilience at 3 months was associated with lower levels of parent-reported somatic symptom severity (β = -0.14, p = 0.004) and fewer total symptoms (β = -0.135, p = 0.029) at 6 months. Higher resilience at 3 months was associated with fewer child-reported symptoms at 6 months (β = -0.11, p = 0.030) and, reciprocally, fewer child-reported symptoms at 3 months were associated with higher resilience at 6 months (β = -0.22, p = 0.001). Notably, injury group was not a significant moderator in cross-lagged models, suggesting that resilience-symptom associations are not specific to mTBI. Psychological resilience and symptoms have bidirectional relationships after injury. Interventions designed to foster resilience have the potential to promote recovery after mTBI specifically and injury more generally.
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Affiliation(s)
- Ali Hassan
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Brian L Brooks
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, and Alberta Children's Hospital Research Institute, University of Calgary, Alberta Children's Hospital, Neurosciences Program, Calgary, Alberta, Canada
| | - Brae Anne McArthur
- Departments of Psychology and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal and Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - William Craig
- Department of Pediatrics, University of Alberta, and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Meghji S, Hilderley AJ, Murias K, Brooks BL, Andersen J, Fehlings D, Dlamini N, Kirton A, Carlson HL. Executive functioning, ADHD symptoms and resting state functional connectivity in children with perinatal stroke. Brain Imaging Behav 2023:10.1007/s11682-023-00827-w. [PMID: 38038867 DOI: 10.1007/s11682-023-00827-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
Perinatal stroke describes a group of focal, vascular brain injuries that occur early in development, often resulting in lifelong disability. Two types of perinatal stroke predominate, arterial ischemic stroke (AIS) and periventricular venous infarction (PVI). Though perinatal stroke is typically considered a motor disorder, other comorbidities commonly exist including attention-deficit hyperactivity disorder (ADHD) and deficits in executive function. Rates of ADHD symptoms are higher in children with perinatal stroke and deficits in executive function may also occur but underlying mechanisms are not known. We measured resting state functional connectivity in children with perinatal stroke using previously established dorsal attention, frontoparietal, and default mode network seeds. Associations with parental ratings of executive function and ADHD symptoms were examined. A total of 120 participants aged 6-19 years [AIS N = 31; PVI N = 30; Controls N = 59] were recruited. In comparison to typically developing peers, both the AIS and PVI groups showed lower intra- and inter-hemispheric functional connectivity values in the networks investigated. Group differences in between-network connectivity were also demonstrated, showing weaker anticorrelations between task-positive (frontoparietal and dorsal attention) and task-negative (default mode) networks in stroke groups compared to controls. Both within-network and between-network functional connectivity values were highly associated with parental reports of executive function and ADHD symptoms. These results suggest that differences in functional connectivity exist both within and between networks after perinatal stroke, the degree of which is associated with ADHD symptoms and executive function.
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Affiliation(s)
- Suraya Meghji
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
| | - Alicia J Hilderley
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Kara Murias
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Brian L Brooks
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Darcy Fehlings
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Nomazulu Dlamini
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Children's Stroke Program, Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada.
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Brooks BL, MacAllister WS, Fay-McClymont TB, Mish S, Vasserman M, Sherman EMS. Brief memory assessment in children: can the ChAMP Screening Index detect memory impairment? Child Neuropsychol 2023:1-11. [PMID: 37782220 DOI: 10.1080/09297049.2023.2259540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023]
Abstract
Abbreviated memory batteries play a role in some clinical and research assessments, but their validity and accuracy need to be well supported. The purpose of this study was to examine the accuracy of the ChAMP Screening Index for detecting memory impairment. The sample included N = 804 youths (ages 5-21 years) with medical and neurological diagnoses who were presented for a clinical neuropsychological assessment. All completed the full Child and Adolescent Memory Profile and had valid data. The ChAMP Screening Index contains the first two subtests of the battery (Lists and Objects) and takes about 10 min to administer (full ChAMP is about 35 min). Analyses to examine the accuracy of the ChAMP Screening Index with both the Total Memory Index and Delayed Memory Index included Intraclass correlations, Cohen's Kappa coefficients, receiver operating characteristics, and classification metrics (e.g., sensitivity, specificity, positive predictive values [PPV], and negative predictive values [NPV]). Very strong correlations, minimal mean difference scores, substantial agreement on kappa coefficients, and outstanding receiver operating characteristics all support the Screening Index accuracy. A cutoff score on the Screening Index of 70 provides a good balance between a high PPV (.91) and a high NPV (.96) for the Total Memory Index. When detecting impairment on the Delayed Memory Index, a Screening Index cutoff score of 65 provides a balance between a high PPV (.92) and a high NPV (.94). This study supports the accuracy, validity, and utility of the 10-min ChAMP Screening Index in those clinical and research situations where a brief evaluation of memory is desired.
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Affiliation(s)
- Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, AB, Canada
- Child Brain and Mental Health program, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - William S MacAllister
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Child Brain and Mental Health program, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Taryn B Fay-McClymont
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Child Brain and Mental Health program, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Department of Psychology, University of British Columbia Okanagan, Kelowna, BC, Canada
- Private Practice, Kelowna, BC, Canada
| | - Sandra Mish
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Marsha Vasserman
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Child Brain and Mental Health program, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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Ware AL, McLarnon MJW, Lapointe AP, Brooks BL, Bacevice A, Bangert BA, Beauchamp MH, Bigler ED, Bjornson B, Cohen DM, Craig W, Doan Q, Freedman SB, Goodyear BG, Gravel J, Mihalov HLK, Minich NM, Taylor HG, Zemek R, Yeates KO. IQ After Pediatric Concussion. Pediatrics 2023:e2022060515. [PMID: 37455662 PMCID: PMC10389777 DOI: 10.1542/peds.2022-060515] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES This study investigated IQ scores in pediatric concussion (ie, mild traumatic brain injury) versus orthopedic injury. METHODS Children (N = 866; aged 8-16.99 years) were recruited for 2 prospective cohort studies from emergency departments at children's hospitals (2 sites in the United States and 5 in Canada) ≤48 hours after sustaining a concussion or orthopedic injury. They completed IQ and performance validity testing postacutely (3-18 days postinjury; United States) or 3 months postinjury (Canada). Group differences in IQ scores were examined using 3 complementary statistical approaches (linear modeling, Bayesian, and multigroup factor analysis) in children performing above cutoffs on validity testing. RESULTS Linear models showed small group differences in full-scale IQ (d [95% confidence interval] = 0.13 [0.00-0.26]) and matrix reasoning (0.16 [0.03-0.30]), but not in vocabulary scores. IQ scores were not related to previous concussion, acute clinical features, injury mechanism, a validated clinical risk score, pre- or postinjury symptom ratings, litigation, or symptomatic status at 1 month postinjury. Bayesian models provided moderate to very strong evidence against group differences in IQ scores (Bayes factor 0.02-0.23). Multigroup factor analysis further demonstrated strict measurement invariance, indicating group equivalence in factor structure of the IQ test and latent variable means. CONCLUSIONS Across multisite, prospective study cohorts, 3 complementary statistical models provided no evidence of clinically meaningful differences in IQ scores after pediatric concussion. Instead, overall results provided strong evidence against reduced intelligence in the first few weeks to months after pediatric concussion.
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Affiliation(s)
- Ashley L Ware
- Department of Psychology, Georgia State University, Atlanta, Georgia
- Department of Neurology, University of Utah, Salt Lake City, Utah
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Matthew J W McLarnon
- Department of General Management and Human Resources, Bissett School of Business, Mount Royal University, Calgary, Alberta, Canada
| | - Andrew P Lapointe
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Neurosciences Program, Alberta Children's Hospital, Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ann Bacevice
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | - Barbara A Bangert
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal and CHU Sainte-Justine Hospital Research Center, Montréal, Québec, Canada
| | - Erin D Bigler
- Department of Neurology, University of Utah, Salt Lake City, Utah
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Bruce Bjornson
- Division of Neurology
- Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Daniel M Cohen
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - William Craig
- University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Stephen B Freedman
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine; CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Montréal, Québec, Canada
| | - H Leslie K Mihalov
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Nori Mercuri Minich
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
- Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio; and
| | - H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Roger Zemek
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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9
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Shinde K, Craig BT, Hassett J, Dlamini N, Brooks BL, Kirton A, Carlson HL. Alterations in cortical morphometry of the contralesional hemisphere in children, adolescents, and young adults with perinatal stroke. Sci Rep 2023; 13:11391. [PMID: 37452141 PMCID: PMC10349116 DOI: 10.1038/s41598-023-38185-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
Perinatal stroke causes most hemiparetic cerebral palsy and cognitive dysfunction may co-occur. Compensatory developmental changes in the intact contralesional hemisphere may mediate residual function and represent targets for neuromodulation. We used morphometry to explore cortical thickness, grey matter volume, gyrification, and sulcal depth of the contralesional hemisphere in children, adolescents, and young adults after perinatal stroke and explored associations with motor, attention, and executive function. Participants aged 6-20 years (N = 109, 63% male) with unilateral perinatal stroke underwent T1-weighted imaging. Participants had arterial ischemic stroke (AIS; n = 36), periventricular venous infarction (PVI; n = 37) or were controls (n = 36). Morphometry was performed using the Computational Anatomy Toolbox (CAT12). Group differences and associations with motor and executive function (in a smaller subsample) were assessed. Group comparisons revealed areas of lower cortical thickness in contralesional hemispheres in both AIS and PVI and greater gyrification in AIS compared to controls. Areas of greater grey matter volume and sulcal depth were also seen for AIS. The PVI group showed lower grey matter volume in cingulate cortex and less volume in precuneus relative to controls. No associations were found between morphometry metrics, motor, attention, and executive function. Cortical structure of the intact contralesional hemisphere is altered after perinatal stroke. Alterations in contralesional cortical morphometry shown in perinatal stroke may be associated with different mechanisms of damage or timing of early injury. Further investigations with larger samples are required to more thoroughly explore associations with motor and cognitive function.
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Affiliation(s)
- Karan Shinde
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
| | - Brandon T Craig
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jordan Hassett
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
| | - Nomazulu Dlamini
- Children's Stroke Program, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Brian L Brooks
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Helen L Carlson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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10
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Doan Q, Chadwick L, Tang K, Brooks BL, Beauchamp M, Zemek R, Craig W, Gravel J, Yeates KO. A Prospective Cohort Study of the Association Between Preinjury Psychosocial Function and Postconcussive Symptoms in Pediatric Mild Traumatic Brain Injury: An A-CAP Study. J Head Trauma Rehabil 2023; 38:294-307. [PMID: 36602261 DOI: 10.1097/htr.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE We evaluated the moderating effect of preinjury psychosocial function on postconcussion symptoms for children with mild traumatic brain injury (mTBI). DESIGN, SETTING, AND POPULATION We conducted a prospective cohort study of children ages 8.0 to 16.9 years with mTBI ( n = 633) or orthopedic injury (OI; n = 334), recruited from 5 pediatric emergency departments from September 2016 to December 2018. MAIN MEASURES Participants completed baseline assessments within 48 hours of injury, and postconcussion symptoms assessments at 7 to 10 days, weekly to 3 months, and biweekly to 6 months post-injury. Preinjury psychosocial function was measured using parent ratings on the Pediatric Quality of Life Inventory (PedsQL) and the Strengths and Difficulties Questionnaire (SDQ), retrospectively evaluating their child's status prior to the injury. Parent and child ratings on the Health and Behavior Inventory (HBI) (cognitive and somatic subscales) and the Post-Concussion Symptom Interview (PCS-I) were used as measures of postconcussion symptoms. We fitted 6 longitudinal regression models, which included 747 to 764 participants, to evaluate potential interactions between preinjury psychosocial function and injury group as predictors of child- and parent-reported postconcussion symptoms. RESULTS Preinjury psychosocial function moderated group differences in postconcussion symptoms across the first 6 months post-injury. Higher emotional and conduct problems were significantly associated with more severe postconcussion symptoms among children with mTBI compared with OI. Wald's χ 2 for interaction terms (injury group × SDQ subscales) ranged from 6.3 to 10.6 ( P values <.001 to .043) across parent- and child-reported models. In contrast, larger group differences (mTBI > OI) in postconcussion symptoms were associated with milder hyperactivity (Wald's χ 2 : 15.3-43.0, all P < .001), milder peer problems (Wald's χ 2 : 11.51, P = .003), and higher social functioning (Wald's χ 2 : 12.435, P = .002). CONCLUSIONS Preinjury psychosocial function moderates postconcussion symptoms in pediatric mTBI, highlighting the importance of assessing preinjury psychosocial function in children with mTBI.
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Affiliation(s)
- Quynh Doan
- Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada (Dr Doan); Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada (Ms Chadwick and Dr Yeates); Independent Statistical Consultant, Vancouver, Canada (Dr Tang); Departments of Pediatrics, Clinical Neurosciences, and Psychology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada (Dr Brooks); Department of Psychology, University of Montreal & Ste-Justine Hospital Research Center, Montreal, Canada (Dr Beauchamp); Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada (Dr Zemek); Department of Pediatrics, University of Alberta, and Stollery Children's Hospital, Edmonton, Alberta, Canada (Dr Craig); and Department of Pediatric Emergency Medicine, CHU Sainte-Justine, Université de Montréal, Montreal, Canada (Dr Gravel)
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11
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Gerschman T, Brooks BL, Mrazik M, Eliason PH, Bonfield S, Yeates KO, Emery CA, Schneider KJ. Are Self-Reported and Parent-Reported Attention Problems and Hyperactivity Associated With Higher Rates of Concussion in Youth Ice Hockey Players? Clin J Sport Med 2023; 33:130-138. [PMID: 36731042 DOI: 10.1097/jsm.0000000000001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/24/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the association between self-reported and parent-reported attention problems and hyperactivity and rates of injury and concussion in Canadian youth ice hockey players. DESIGN Secondary analyses of 2 prospective cohort studies. SETTING Canadian youth ice hockey teams. PARTICIPANTS Ice hockey players (ages 11-17 years) were recruited by team, over 4 seasons (2011-2016). A combined 1709 players contributing 1996 player-seasons were analyzed (257 players participated in more than one season). ASSESSMENT OF RISK FACTORS Data were collected from preseason baseline questionnaires, including child and parent proxy forms of the Behavior Assessment System for Children, second edition. MAIN OUTCOME MEASURES Injury and concussion rates and incidence rate ratios (IRR) comparing players with and without self-identified or parent-identified attention problems and hyperactivity, adjusted for covariates (ie, body checking policy, previous injury/concussion, and age) and a random effect for team, were estimated using multiple multilevel negative binomial regression. RESULTS When analyzed continuously, rates of concussion increased with higher self-reported and parent-reported measures of attention problems [IRR SELF = 1.025; 95% confidence interval (CI): 1.011-1.040; IRR PARENT = 1.032; 95% CI: 1.008-1.057]. Self-reported hyperactivity was significantly associated with concussion (IRR = 1.021; 95% CI: 1.007-1.035), but parent-reported hyperactivity was not (IRR = 1.005; 95% CI: 0.983-1.028). A T score ≥ 60 cutoff combining attention problems and hyperactivity scores (an estimate of probable attention-deficit hyperactivity disorder) was not significantly associated with rates of injury or concussion. CONCLUSIONS Attention problems and hyperactivity may place youth ice hockey players at increased risk of concussion and injury. Preseason assessments could identify players for targeted concussion education and risk reduction strategies.
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Affiliation(s)
- Tommy Gerschman
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brian L Brooks
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital, Neurosciences Program, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Martin Mrazik
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Paul H Eliason
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Stephan Bonfield
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Keith O Yeates
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Carolyn A Emery
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathryn J Schneider
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Sport Medicine Center, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; and.,Evidence Sport and Spinal Therapy, Calgary, AB, Canada
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12
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Craig BT, Geeraert B, Kinney-Lang E, Hilderley AJ, Yeates KO, Kirton A, Noel M, MacMaster FP, Bray S, Barlow KM, Brooks BL, Lebel C, Carlson HL. Structural brain network lateralization across childhood and adolescence. Hum Brain Mapp 2023; 44:1711-1724. [PMID: 36478489 PMCID: PMC9921220 DOI: 10.1002/hbm.26169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Developmental lateralization of brain function is imperative for behavioral specialization, yet few studies have investigated differences between hemispheres in structural connectivity patterns, especially over the course of development. The present study compares the lateralization of structural connectivity patterns, or topology, across children, adolescents, and young adults. We applied a graph theory approach to quantify key topological metrics in each hemisphere including efficiency of information transfer between regions (global efficiency), clustering of connections between regions (clustering coefficient [CC]), presence of hub-nodes (betweenness centrality [BC]), and connectivity between nodes of high and low complexity (hierarchical complexity [HC]) and investigated changes in these metrics during development. Further, we investigated BC and CC in seven functionally defined networks. Our cross-sectional study consisted of 211 participants between the ages of 6 and 21 years with 93% being right-handed and 51% female. Global efficiency, HC, and CC demonstrated a leftward lateralization, compared to a rightward lateralization of BC. The sensorimotor, default mode, salience, and language networks showed a leftward asymmetry of CC. BC was only lateralized in the salience (right lateralized) and dorsal attention (left lateralized) networks. Only a small number of metrics were associated with age, suggesting that topological organization may stay relatively constant throughout school-age development, despite known underlying changes in white matter properties. Unlike many other imaging biomarkers of brain development, our study suggests topological lateralization is consistent across age, highlighting potential nonlinear mechanisms underlying developmental specialization.
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Affiliation(s)
- Brandon T Craig
- University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Bryce Geeraert
- University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Eli Kinney-Lang
- University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Alicia J Hilderley
- University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Keith O Yeates
- University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Adam Kirton
- University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Noel
- University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Frank P MacMaster
- University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Child and Adolescent Imaging Research (CAIR) Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Signe Bray
- University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Child and Adolescent Imaging Research (CAIR) Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen M Barlow
- University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Child and Adolescent Imaging Research (CAIR) Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Brian L Brooks
- University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Catherine Lebel
- University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Child and Adolescent Imaging Research (CAIR) Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Helen L Carlson
- University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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13
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Brooks BL, Fay-McClymont TB, MacAllister WS, Vasserman M, Mish S, Sherman EMS. New Child and Adolescent Memory Profile Embedded Performance Validity Test. Arch Clin Neuropsychol 2023:6972889. [PMID: 36617240 DOI: 10.1093/arclin/acac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE It is essential to interpret performance validity tests (PVTs) that are well-established and have strong psychometrics. This study evaluated the Child and Adolescent Memory Profile (ChAMP) Validity Indicator (VI) using a pediatric sample with traumatic brain injury (TBI). METHOD A cross-sectional sample of N = 110 youth (mean age = 15.1 years, standard deviation [SD] = 2.4 range = 8-18) on average 32.7 weeks (SD = 40.9) post TBI (71.8% mild/concussion; 3.6% complicated mild; 24.6% moderate-to-severe) were administered the ChAMP and two stand-alone PVTs. Criterion for valid performance was scores above cutoffs on both PVTs; criterion for invalid performance was scores below cutoffs on both PVTs. Classification statistics were used to evaluate the existing ChAMP VI and establish a new VI cutoff score if needed. RESULTS There were no significant differences in demographics or time since injury between those deemed valid (n = 96) or invalid (n = 14), but all ChAMP scores were significantly lower in those deemed invalid. The original ChAMP VI cutoff score was highly specific (no false positives) but also highly insensitive (sensitivity [SN] = .07, specificity [SP] = 1.0). Based on area under the curve (AUC) analysis (0.94), a new cutoff score was established using the sum of scaled scores (VI-SS). A ChAMP VI-SS score of 32 or lower achieved strong SN (86%) and SP (92%). Using a 15% base rate, positive predictive value was 64% and negative predictive value was 97%. CONCLUSIONS The originally proposed ChAMP VI has insufficient SN in pediatric TBI. However, this study yields a promising new ChAMP VI-SS, with classification metrics that exceed any other current embedded PVT in pediatrics.
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Affiliation(s)
- Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta T3B 6A8, Canada.,Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Child Brain and Mental Health Section, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Taryn B Fay-McClymont
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta T3B 6A8, Canada.,Child Brain and Mental Health Section, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Department of Psychology, University of British Columbia Okanagan, Kelowna, British Columbia V1V 1V7, Canada
| | - William S MacAllister
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta T3B 6A8, Canada.,Child Brain and Mental Health Section, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Marsha Vasserman
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta T3B 6A8, Canada.,Child Brain and Mental Health Section, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Sandra Mish
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta T3B 6A8, Canada
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14
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Vasserman M, Virani S, MacAllister WS, Désiré N, Mish S, Fay-McClymont T, Medlin LC, Brooks BL. Parent ratings on the MEMRY questionnaire predict children's academic performance. Child Neuropsychol 2023; 29:96-114. [PMID: 35534941 DOI: 10.1080/09297049.2022.2071420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Given the high rates of learning challenges in children with medical conditions, efficient and reliable screening methods are crucial. This study examined whether parent report of daily learning and memory predicts academic achievement in youth. Parents of 213 youth (aged 6-18) with varied medical diagnoses completed the Multidimensional Everyday Memory Ratings for Youth (MEMRY), and youth completed subtests from the Wechsler Individual Achievement Test-Third Edition (WIAT-III) as part of a comprehensive assessment. All scales of the MEMRY (Learning, Daily Memory, Executive/Working Memory) correlated significantly with WIAT-III Spelling, Word Reading, and Numerical Operations, while only the MEMRY Learning subscale correlated significantly with WIAT-III Pseudoword Decoding. Regression analyses indicated that MEMRY Learning significantly predicted WIAT-III Word Reading and Spelling, while both the MEMRY Learning and MEMRY Daily Memory scales significantly predicted WIAT-III Numerical Operations. When Full Scale IQ was entered into the models first, the MEMRY Learning subscale accounted for an additional 4% of variance in WIAT-III Word Reading and 7% of variance in WIAT-III Spelling, but did not account for additional variance in WIAT-III Numerical Operations or Pseudoword Decoding. Analyses in a subset of children with broadly normal intellectual functioning demonstrated very similar results, with even higher variance in academic testing accounted for by the MEMRY. In sum, the MEMRY questionnaire may serve as an efficient screen to identify children at risk for reading, spelling, and math deficits.
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Affiliation(s)
- Marsha Vasserman
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, AB, Canada.,Child Brain & Mental Health Program Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Shane Virani
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Kinesiology, University of Calgary
| | - William S MacAllister
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, AB, Canada.,Child Brain & Mental Health Program Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Naddley Désiré
- Department of Psychology and Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Sandra Mish
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Taryn Fay-McClymont
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, AB, Canada.,Child Brain & Mental Health Program Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - L Collins Medlin
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, AB, Canada.,Child Brain & Mental Health Program Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Psychology, University of Calgary
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15
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Fay-McClymont TB, Monagel DA, Singh G, Schulte F, Brooks BL, MacAllister WS, Désiré N, Mineyko A, Vasserman M, Leaker MT, Truong TH, Shah R, Lewis VA, Yeates KO, Guilcher GMT. Neuropsychological, behavioral, and quality-of-life outcomes in children and adolescents with sickle cell disease treated with nonmyeloablative matched sibling donor hematopoietic cell transplantation: A case series. Pediatr Blood Cancer 2022; 69:e29893. [PMID: 35891584 DOI: 10.1002/pbc.29893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/06/2022] [Accepted: 07/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND/OBJECTIVES Despite advances in the treatment of sickle cell disease (SCD), cerebrovascular and cognitive insults can have lifelong consequences. Hematopoietic cell transplantation (HCT) is an established curative therapy, and recent studies have demonstrated efficacy with reduced toxicity nonmyeloablative (NMA) regimens, but little is known about neuropsychological outcomes. The objective of this study was to describe neuropsychological, behavioral, and quality-of-life outcomes with medical correlates in children with SCD who received an NMA matched sibling donor (MSD) HCT. DESIGN/METHODS Retrospective cohort analysis of nine recipients with hemoglobin SS SCD who underwent MSD HCT using the National Institutes of Health (NIH) NMA protocol. RESULTS Mean full-scale intellectual functioning (FSIQ) was average pre-HCT (FSIQ = 92.1, SD 9.0; n = 8) and 2 years post-HCT (mean FSIQ = 96.6; SD 11.1; N = 9). Neuropsychological functioning was largely average across all cognitive domains, and no pre/post-HCT differences were found to be statistically significant given the small sample size. However, effect sizes revealed moderate improvements in processing speed (Cohen's d = .72) and verbal memory (Cohen's d = .60) post-HCT, and declines in measures of attention (Cohen's d = -.54) and fine motor speed and dexterity (Cohen's d = -.94). Parents endorsed better quality of life (Cohen's d = .91), less impact of SCD on their family, and less worry about their child's future (Cohen's d = 1.44). CONCLUSION Neuropsychological functioning in a sample of children and adolescents treated uniformly with NMA MSD HCT remained stable or improved in most cognitive domains, and improvements in quality of life and family functioning were observed.
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Affiliation(s)
- Taryn B Fay-McClymont
- Neuropsychology/Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, Irving K. Barber Faculty of Arts and Social Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Dania A Monagel
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Gurpreet Singh
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Schulte
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- Neuropsychology/Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - William S MacAllister
- Neuropsychology/Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Naddley Désiré
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aleksandra Mineyko
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Marsha Vasserman
- Neuropsychology/Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael T Leaker
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tony H Truong
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ravi Shah
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Victor A Lewis
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Gregory M T Guilcher
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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16
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Abstract
OBJECTIVE A significant minority of adolescents will have persistent postconcussion symptoms after an injury, potentially having a negative impact on family functioning. However, the reasons for a family's negative impact are not clearly understood. The objective of this study was to determine whether preinjury/demographic factors, injury characteristics, and/or worse postinjury symptoms are associated with higher levels of family stress in youth with refractory postconcussion symptoms. SETTING Pediatric refractory concussion clinic in a tertiary care center. PARTICIPANTS A total of 121 adolescents (13-18 years old) who were 1 to 12 months postconcussion. MEASURES Primary outcome was the mean stress rating on the Family Burden of Injury Interview (FBII), a 27-item questionnaire rating the impact on a family as a result of an injury. Preinjury/demographic and injury details were collected. Youth and their parents also completed measures of postconcussion symptoms, depression, anxiety, and behavioral problems. RESULTS Participants had a mean age of 16.0 years (SD = 1.3), of which, 65% identified as female, and were on an average 5.2 months (SD = 2.4) postconcussion. FBII ratings were not significantly correlated with demographics, preinjury functioning, injury severity, duration of persistent postconcussion problems (ie, time since injury), or self-reported postconcussion symptoms. Greater family burden (higher FBII ratings) significantly correlated with worse parent-reported postconcussion symptoms, worse psychological functioning (self-reported depression, parent-reported anxiety, and depression), and worse behavioral functioning (parent-reported conduct problems and peer problems). A multiple linear regression model revealed that parent-perceived postconcussion cognitive symptoms (β = .292, t = 2.56, P = .012) and parent-perceived peer problems (β = .263, t = 2.59, P = .011) were significantly associated with family burden ( F8,105 = 6.53; P < .001; R2 = 0.35). CONCLUSION Families of youth with refractory postconcussion symptoms can experience a negative impact. The severity of reported family burden in those with slow recovery from concussion was significantly associated with parents' perception of their child's cognitive symptoms and peer problems. These results could provide support for family-based interventions in this population.
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Affiliation(s)
- Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada (Dr Brooks); Departments of Paediatrics (Dr Brooks), Clinical Neurosciences (Dr Brooks), and Psychology (Dr Brooks), Alberta Children's Hospital Research Institute (Dr Brooks and Mr Virani), Hotchkiss Brain Institute (Dr Brooks), Faculty of Nursing (Ms Kumari), and Faculty of Kinesiology (Mr Virani), University of Calgary, Calgary, Alberta, Canada
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17
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Plourde V, Silverberg ND, Cairncross M, Virani S, Brooks BL. Perceptions of Symptom Duration are Associated With Emotional Distress and Functioning in Adolescents With Protracted Concussion Recovery. J Pediatr Psychol 2022; 47:905-915. [DOI: 10.1093/jpepsy/jsac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/27/2022] [Accepted: 02/27/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Adolescents with persisting post-concussive symptoms often report high levels of emotional distress, which can impact their daily functioning. The associations between modifiable factors, such as perceptions of recovery, and emotional distress have not been investigated in this age group.
Objective
To evaluate perceptions about recovery duration (e.g., “my symptoms will last a long time”, “my symptoms will be permanent rather than temporary”) and its associations with emotional distress and functioning in children and adolescents with a slower post-concussive recovery.
Methods
Participants (N = 49, 69% girls, 11–17 years old, M = 15.8 years old, SD = 1.8) were recruited from a concussion clinic on average 7.7 months after injury (SD = 2.5). Measures included the Illness Perception Questionnaire Revised (perceived duration of symptoms only) to evaluate recovery expectations, the Health and Behavior Inventory (self and parent reports) to evaluate current post-concussive symptoms (cognitive and somatic symptoms), the emotional distress subscale of the Strengths and Difficulties Questionnaire (SDQ—self-report), and the emotional functioning subscale of the Pediatric Quality of Life Questionnaire (PedsQL—self-report).
Results
Regression analyses (linear models with all covariates entered at once) suggested that greater expectations for symptom persistence were significantly associated with higher emotional distress on both SDQ and PedsQL subscales, after controlling for post-concussive symptom severity and other confounds. Emotional distress/functioning was not associated with perceptions of symptom duration reported by parents, severity of post-concussive symptoms (self- and parent reports), age, number of concussions, time since injury, or a history of mental health concern or diagnosis (parent-reported).
Conclusions
This study suggests that pessimistic attitudes for recovery duration may be more strongly associated with emotional distress than current post-concussive symptom severity or a history of mental health concern or diagnosis.
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Affiliation(s)
- Vickie Plourde
- School of Psychology, Université de Moncton, New Brunswick, Canada; Centre de formation médicale du Nouveau-Brunswick, Université de Sherbrooke, New Brunswick, Canada
- Faculté Saint-Jean, University of Alberta, Alberta, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, British Columbia, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - Molly Cairncross
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, British Columbia, Canada
- Department of Psychology, Simon Fraser University, British Columbia, Canada
| | - Shane Virani
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- Neurosciences program, Alberta Children’s Hospital, Alberta, Canada
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
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18
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Li E, Smithson L, Khan M, Kirton A, Pei J, Andersen J, Yager JY, Brooks BL, Rasmussen C. Effects of Perinatal Stroke on Executive Functioning and Mathematics Performance in Children. J Child Neurol 2022; 37:133-140. [PMID: 34985353 PMCID: PMC8801623 DOI: 10.1177/08830738211063683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of this study was to examine executive functioning, math performance, and visuospatial processing skills of children with perinatal stroke, which have not been well explored in this population. Participants included 18 children with perinatal stroke (aged 6-16 years old) and their primary caregiver. Each child completed standardized tests of executive function and visuospatial processing skills, Intelligence Quotient (IQ), and math achievement. Performance on executive function, IQ, math, and visuospatial processing tests was significantly lower in children with perinatal stroke when compared to normative means. Poorer inhibitory control was associated with worse math performance. Increased age at testing was associated with better performance on visuospatial ability (using standardized scores), and females performed better than males on a test of inhibitory control. Children with perinatal stroke displayed a range of neuropsychological impairments, and difficulties with executive function (inhibition) may contribute to math difficulties in this population.
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Affiliation(s)
- Eliza Li
- University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Smithson
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Adam Kirton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - John Andersen
- University of Alberta, Edmonton, Alberta, Canada,Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | | | - Brian L. Brooks
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada,Faculty of Arts, University of Calgary, Calgary, Alberta, Canada,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Carmen Rasmussen
- University of Alberta, Edmonton, Alberta, Canada,Carmen Rasmussen, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 4-478, Edmonton Clinic Health Academy (ECHA), 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
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19
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Larsen N, Craig BT, Hilderley AJ, Virani S, Murias K, Brooks BL, Kirton A, Carlson HL. Frontal interhemispheric structural connectivity, attention, and executive function in children with perinatal stroke. Brain Behav 2022; 12:e2433. [PMID: 34825521 PMCID: PMC8785614 DOI: 10.1002/brb3.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022] Open
Abstract
Perinatal stroke affects ∼1 in 1000 births and concomitant cognitive impairments are common but poorly understood. Rates of Attention Deficit/Hyperactivity Disorder (ADHD) are increased 5-10× and executive dysfunction can be disabling. We used diffusion imaging to investigate whether stroke-related differences in frontal white matter (WM) relate to cognitive impairments. Anterior forceps were isolated using tractography and sampled along the tract. Resulting metrics quantified frontal WM microstructure. Associations between WM metrics and parent ratings of ADHD symptoms (ADHD-5 rating scale) and executive functioning (Behavior Rating Inventory of Executive Function (BRIEF)) were explored. Eighty-three children were recruited (arterial ischemic stroke [AIS] n = 26; periventricular venous infarction [PVI] n = 26; controls n = 31). WM metrics were altered for stroke groups compared to controls. Along-tract analyses showed differences in WM metrics in areas approximating the lesion as well as more remote differences at midline and in the nonlesioned hemisphere. WM metrics correlated with parental ratings of ADHD and executive function such that higher diffusivity values were associated with poorer function. These findings suggest that underlying microstructure of frontal white matter quantified via tractography may provide a relevant biomarker associated with cognition and behavior in children with perinatal stroke.
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Affiliation(s)
- Nicole Larsen
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada
| | - Brandon T Craig
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Alicia J Hilderley
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Shane Virani
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Kara Murias
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Brian L Brooks
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Department of Psychology, University of Calgary, Calgary, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
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20
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De Somma E, O'Mahony J, Brown RA, Brooks BL, Yeh EA, Cardenas de La Parra A, Arnold D, Collins DL, Maranzano J, Narayanan S, Marrie RA, Bar-Or A, Banwell B, Till C. Disrupted cognitive development following pediatric acquired demyelinating syndromes: a longitudinal study. Child Neuropsychol 2021; 28:649-670. [PMID: 34872458 DOI: 10.1080/09297049.2021.2002289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Long-term cognitive deficits have been observed in some children who experience an acquired demyelinating syndrome (ADS). We examined changes in cognitive functioning over the first two years following incident ADS andtested whether normalized brain and thalamic volume accounted for decline over time. Twenty-five youth (mean age 12.8 years) with ADS, 9 of whom were diagnosed with multiple sclerosis (MS) and 16 of whom experienced monophasic ADS (monoADS), underwent two neuropsychological evaluationsand MRI scans at approximately6- and 24-months post ADS-onset. We examined changes in cognitive outcomes over time and between patient groups. Generalized linear mixed-effect regression models were used to examine the association of normalized brain and thalamic volumesbetween the two timepointswith cognitive z-scores. Cognitive performance was within the age-expected range for both groups and remained stable over time on 15 measures. In the combined sample of monoADS and MS patients, declines (p < .05) were noted on the Symbol Digit Modalities Test (SDMT), the Auditory Working Memory (AWM), and the WJ-III Visual Matching (VisMat)tests, but did not survive FDR correction. Clinically significant declines, as measured by the Reliable Change Index, were observed on the SDMT,AWM, and VisMattests by 19, 42, and 32%, respectively. Lower normalized brain volume at 6-months predicted a negative change in SDMT (B = 0.45, 95%CI: 0.07,0.83) and AWM (B = 0.30, 95%CI: 0.13, 0.47). Chronicity of demyelination is not required for cognitive decline nor for reduced brain volume, suggesting that even a single demyelinating event may negatively impact cognitive potential in children.
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Affiliation(s)
| | - Julia O'Mahony
- Neurosciences and Mental Health, Hospital for Sick Children, Canada Hospital for Sick Children, Toronto, Canada
| | | | - Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Canada
| | - E Ann Yeh
- Neurosciences and Mental Health, Hospital for Sick Children, Canada Hospital for Sick Children, Toronto, Canada.,Department of Neurology, Hospital for Sick Children, Toronto, Canada
| | | | - Douglas Arnold
- McConnell Brain Imaging Centre, McGill University, Montreal, Canada
| | - D Louis Collins
- McConnell Brain Imaging Centre, McGill University, Montreal, Canada
| | | | - Sridar Narayanan
- McConnell Brain Imaging Centre, McGill University, Montreal, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Amit Bar-Or
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brenda Banwell
- Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christine Till
- Department of Psychology, York University, Toronto, Canada.,Neurosciences and Mental Health, Hospital for Sick Children, Canada Hospital for Sick Children, Toronto, Canada
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21
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Iverson GL, Cook NE, Gilman IG, Maxwell B, Mannix R, Zafonte R, Berkner PD, Brooks BL. Multiple Past Concussions in High School Hockey Players: Examining Cognitive Functioning and Symptom Reporting. Clin J Sport Med 2021; 31:e313-e320. [PMID: 32941379 DOI: 10.1097/jsm.0000000000000806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 10/21/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate (1) if there are meaningful differences in baseline preseason cognitive functioning or symptom reporting between high school ice hockey players with and without prior concussions and (2) determine which health history variables predict symptom reporting. DESIGN Cross-sectional study. SETTING High schools across the state of Maine. PARTICIPANTS Participants were 1616 male high school ice hockey players (mean age = 15.6 years; SD = 1.5 years) who completed baseline testing between 2009 and 2015. INDEPENDENT VARIABLES Athletes were grouped according to their self-reported concussion history [0 (n = 1136), 1 (n = 321), 2 (n = 112), or 3+ (n = 47) previous concussions]. MAIN OUTCOME MEASURES Cognitive functioning was measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery, and symptom ratings were obtained from the Post-Concussion Symptom Scale. RESULTS There were no statistically significant differences between groups in cognitive functioning as measured by ImPACT. The group with ≥3 prior concussions endorsed higher total symptom scores, but the effect sizes were small and not statistically significant. In a multivariate model, prior treatment for headaches (not necessarily migraines), prior treatment for a psychiatric condition, and prior treatment for substance/alcohol use all significantly predicted total symptom scores, with concussion history being the weakest independent predictor. CONCLUSIONS Players with a history of prior concussions performed similarly to players with no prior concussions on cognitive testing. Health history factors were more strongly associated with symptom reporting than concussion history.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, Massachusetts
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts
- MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts
| | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Isabelle G Gilman
- Department of Psychological and Brain Sciences, Villanova University, Villanova, Pennsylvania
| | - Bruce Maxwell
- Department of Computer Science, Colby College, Waterville, Maine
| | - Rebekah Mannix
- Division of Emergency Medicine, Brain Injury Center, Boston Children's Hospital, Boston, Massachusetts
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul D Berkner
- Health Services and the Department of Biology, Colby College, Waterville, Maine
| | - Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, AB, Canada ; and
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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22
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Virani S, Barton A, Goodyear BG, Yeates KO, Brooks BL. Susceptibility-Weighted Magnetic Resonance Imaging (MRI) of Microbleeds in Pediatric Concussion. J Child Neurol 2021; 36:867-874. [PMID: 33966537 PMCID: PMC8438780 DOI: 10.1177/08830738211002946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The long-term consequences of pediatric concussion on brain structure are poorly understood. This study aimed to evaluate the presence and clinical significance of cerebral microbleeds several years after pediatric concussion. METHODS Children and adolescents 8-19 years of age with either a history of concussion (n = 35), or orthopedic injury (n = 20) participated. Mean time since injury for the sample was 30.4 months (SD = 19.6). Participants underwent susceptibility-weighted imaging, rated their depression and postconcussion symptoms, and completed cognitive testing. Parents of participants also completed symptom ratings for their child. Hypointensities in susceptibility-weighted images indicative of cerebral microbleeds were calculated as a measure of hypointensity burden. RESULTS Hypointensity burden did not differ significantly between participants with a history of concussion and those with a history of orthopedic injury. Depression ratings (self and parent report), postconcussion symptom ratings (self and parent report), and cognitive performance did not significantly correlate with hypointensity burden in the concussion group. CONCLUSIONS These findings suggest that at approximately 2.5 years postinjury, children and adolescents with prior concussion do not have a greater amount of cerebral microbleeds compared to those with orthopedic injury. Future research should use longitudinal study designs and investigate children with persistent postconcussive symptoms to gain better insight into the long-term effects of concussion on cerebral microbleeds.
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Affiliation(s)
- Shane Virani
- Department of Pediatrics, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada,Department of Pediatrics, Neurosciences Program, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Alexander Barton
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G. Goodyear
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Calgary, Alberta, Canada,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Calgary, Alberta, Canada,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada,Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Brian L. Brooks
- Department of Pediatrics, Neurosciences Program, Alberta Children’s Hospital, Calgary, Alberta, Canada,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Calgary, Alberta, Canada,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada,Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada,Brian L. Brooks, PhD, Alberta Children’s Hospital, 28 Oki Drive NW, Calgary, Alberta, Canada T3B 6A8.
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23
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Virani S, Rasmussen C, Zivanovic N, Smithson L, Pei J, Andersen J, Yager JY, Kirton A, Brooks BL. Learning and memory profiles in youth with perinatal stroke: a study of the Child and Adolescent Memory Profile (ChAMP). Child Neuropsychol 2021; 28:99-106. [PMID: 34375160 DOI: 10.1080/09297049.2021.1957089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There is limited understanding of the effect of perinatal stroke on child and adolescent learning and memory abilities. This study sought to evaluate the clinical utility of the Child and Adolescent Memory Profile (ChAMP) in quantifying memory performance in youth with perinatal stroke. Children and adolescents aged 6-16 years old with a history of perinatal stroke (PS; n = 41) completed two subtests from the ChAMP (Lists and Objects). Age, sex, and ethnicity-matched healthy control (HC) data were obtained from the test publisher's standardization data set. Participants with a history of PS performed significantly worse (p < .05) with medium effect size (ƞp2 ≥ .06) than HC on the ChAMP Screening Index and on all ChAMP Lists and Objects scaled scores. Classification accuracy for the ChAMP scores ranged from 57% to 68% with the area under the curve ranging from .62-.75. No significant group differences on ChAMP performance (p > .05) were found for stroke side (left versus right-sided) or for seizure history (present versus absent). This study supports the utility of the ChAMP in perinatal stroke patients by demonstrating significantly worse performance in verbal and visual memory than HC. Classification accuracy is limited, but supportive for the Screening Index and Objects Delayed scores. The ChAMP may be a useful tool for evaluating cognition in this population when taken alongside the context of other tests, background history, and clinical observations.
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Affiliation(s)
- Shane Virani
- Departments of Pediatrics, University of Calgary, Calgary, AB, Canada.,Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Nikola Zivanovic
- Departments of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Lisa Smithson
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Adam Kirton
- Departments of Pediatrics, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Brian L Brooks
- Departments of Pediatrics, University of Calgary, Calgary, AB, Canada.,Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Psychology, University of Calgary, Calgary, AB, Canada
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24
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Yu S, Lam C, Shinde S, Kuczynski AM, Carlson HL, Dukelow SP, Brooks BL, Kirton A. Perilesional Gliosis Is Associated with Outcome after Perinatal Stroke. Journal of Pediatric Neurology 2021. [DOI: 10.1055/s-0041-1728687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractPerinatal ischemic stroke results in focal brain injury and life-long disability. Hemiplegic cerebral palsy and additional sequelae are common. With no prevention strategies, improving outcomes depends on understanding brain development. Reactive astrogliosis is a hallmark of brain injury that has been associated with outcomes but is unstudied in perinatal stroke. In this article, we hypothesized that gliosis was quantifiable and its extent would inversely correlate with clinical motor function. This was a population-based, retrospective, and cross-sectional study. Children with perinatal arterial ischemic stroke (AIS) or periventricular venous infarction (PVI) with magnetic resonance (MR) imaging were included. An image thresholding technique based on image intensity was utilized to quantify the degree of chronic gliosis on T2-weighted sequences. Gliosis scores were corrected for infarct volume and compared with the Assisting Hand and Melbourne Assessments (AHA and MA), neuropsychological profiles, and robotic measures. In total, 42 children were included: 25 with AIS and 17 with PVI (median = 14.0 years, range: 6.3–19 years, 63% males). Gliosis was quantifiable in all scans and scores were highly reliable. Gliosis scores as percentage of brain volume ranged from 0.3 to 3.2% and were comparable between stroke types. Higher gliosis scores were associated with better motor function for all three outcomes in the AIS group, but no association was observed for PVI. Gliosis can be objectively quantified in children with perinatal stroke. Associations with motor outcome in arterial but not venous strokes suggest differing glial responses may play a role in tissue remodeling and developmental plasticity following early focal brain injury.
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Affiliation(s)
- Sabrina Yu
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Charissa Lam
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Siddharth Shinde
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | | | - Helen L. Carlson
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Sean P. Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, Canada
| | - Brian L. Brooks
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Adam Kirton
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, Canada
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25
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Emery CA, Warriyar Kv V, Black AM, Palacios-Derflingher L, Sick S, Debert C, Brooks BL, Yeates KO, Mrazik M, Lebrun C, Hagel BE, Dukelow S, Schneider KJ. Factors Associated With Clinical Recovery After Concussion in Youth Ice Hockey Players. Orthop J Sports Med 2021; 9:23259671211013370. [PMID: 34017881 PMCID: PMC8114271 DOI: 10.1177/23259671211013370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background: The identification of factors associated with clinical recovery in youth after sports-related concussion could improve prognostication regarding return to play (RTP). Purpose: To assess factors associated with clinical recovery after concussion in youth ice hockey players. Study Design: Cohort study; Level of evidence, 2. Methods: Participants were part of a larger longitudinal cohort study (the Safe to Play study; N = 3353). Included were 376 ice hockey players (age range, 11-17 years) from teams in Calgary and Edmonton, Canada, with 425 physician-diagnosed ice hockey–related concussions over 5 seasons (2013-2018). Any player with a suspected concussion was referred to a sports medicine physician for diagnosis, and a Sport Concussion Assessment Tool (SCAT) form was completed. Time to clinical recovery was based on time between concussion and physician clearance to RTP. Two accelerated failure time models were used to estimate days to RTP clearance: model 1 considered symptom severity according to the SCAT3/SCAT5 symptom evaluation score (range, 0-132 points), and model 2 considered responses to individual symptom evaluation items (eg, headache, neck pain, dizziness) of none/mild (0-2 points) versus moderate/severe (3-6 points). Other covariates were time to physician first visit (≤7 and >7 days), age group (11-12, 13-14, and 15-17 years), sex, league type (body checking and no body checking), tandem stance (modified Balance Error Scoring System result ≥4 errors out of 10), and number of previous concussions (0, 1, 2, and ≥3). Results: The complete case analysis (including players without missing covariates) included 329 players (366 diagnosed concussions). The median time to clinical recovery was 18 days. In model 1, longer time to first physician visit (>7 days) (time ratio [TR], 1.637 [95% confidence interval (CI), 1.331-1.996]) and greater symptom severity (TR, 1.016 [95% CI, 1.012-1.020]) were significant predictors of longer clinical recovery. In model 2, longer time to first physician visit (TR, 1.698 [95% CI, 1.399-2.062]), headache (moderate/severe) (TR, 1.319 [95% CI, 1.110-1.568]), and poorer tandem stance (TR, 1.249 [95% CI, 1.052-1.484]) were significant predictors of longer clinical recovery. Conclusion: Medical clearance to RTP was longer for players with >7 days to physician assessment, poorer tandem stance, greater symptom severity, and moderate/severe headache at first visit.
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Affiliation(s)
- Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vineetha Warriyar Kv
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Amanda M Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Luz Palacios-Derflingher
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stacy Sick
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Chantel Debert
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences and Division of Physical Medicine and Rehabilitation, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada.,Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences and Division of Physical Medicine and Rehabilitation, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Martin Mrazik
- Faculty of Education, University of Alberta, Edmonton, Alberta, Canada
| | - Constance Lebrun
- Family Medicine, Faculty of Medicine and Dentistry and Glen Sather Sport Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada
| | - Brent E Hagel
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences and Division of Physical Medicine and Rehabilitation, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences and Division of Physical Medicine and Rehabilitation, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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26
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Cairncross M, Brooks BL, Virani S, Silverberg ND. Fear avoidance behavior in youth with poor recovery from concussion: measurement properties and correlates of a new scale. Child Neuropsychol 2021; 27:911-921. [PMID: 33876703 DOI: 10.1080/09297049.2021.1908533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of the current study was to develop a measure of fear avoidance behavior after concussion for youth and parent respondents and examine its basic psychometric properties and correlates. Children (N = 51) who were seen in a hospital concussion clinic after sustaining a concussion (M = 7.6 months, SD = 7.01) and their primary caregiver (N = 51)completed self- and informant-report measures of fear avoidance (Pediatric Fear Avoidance Behavior after Traumatic Brain Injury Questionnaire; PFAB-TBI), post-concussion symptoms (Health Behavior Inventory), emotional distress (Strengths and Difficulties Questionnaire), and quality of life (Pediatric Quality of Life Inventory Version 4.0). The self- and informant-report PFAB-TBI scores were moderately correlated (r = 0.51, p < 0.001). Neither measure demonstrated floor or ceiling effects. Both had strong internal consistency (Cronbach's α = 0.87 and 0.89, respectively). The PFAB-TBI self-report was positively correlated with somatic symptoms (r = 0.37), emotional distress (r = 0.39), and negatively associated with quality of life (r = -0.57). The PFAB-TBI informant-report was positively associated with informant reported somatic symptoms (r = 0.52) and emotional distress (r = .50) Overall, the PFAB-TBI has desirable basic measurement properties and expected correlations with clinical outcomes. This measure can potentially help clinicians and researchers better understand the impacts of fear avoidance behavior after pediatric concussion.
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Affiliation(s)
- Molly Cairncross
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Rehabilitation, Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Shane Virani
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Rehabilitation, Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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27
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Buchhalter JR, Scantlebury MH, D'Alfonso S, Pablo Appendino J, Bello Espinosa L, Brooks BL, Claassen C, Corbeil J, Czank D, Dean S, Ho AW, Jacobs J, Mackay M, McMahon J, Mineyko A, Rho JM, Roberts T, Rothenmund S, Ruta G, Sawchuk T, Simms BA, Smyth K, Still T, Thornton N. Creation and implementation of an electronic health record note for quality improvement in pediatric epilepsy: Practical considerations and lessons learned. Epilepsia Open 2021; 6:345-358. [PMID: 34033240 PMCID: PMC8166802 DOI: 10.1002/epi4.12480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/26/2020] [Accepted: 02/19/2021] [Indexed: 11/16/2022] Open
Abstract
Objective To describe the development of the Pediatric Epilepsy Outcome‐Informatics Project (PEOIP) at Alberta Children's Hospital (ACH), which was created to provide standardized, point‐of‐care data entry; near‐time data analysis; and availability of outcome dashboards as a baseline on which to pursue quality improvement. Methods Stakeholders involved in the PEOIP met weekly to determine the most important outcomes for patients diagnosed with epilepsy, create a standardized electronic note with defined fields (patient demographics, seizure and syndrome type and frequency and specific outcomes‐ seizure type and frequency, adverse effects, emergency department visits, hospitalization, and care pathways for clinical decision support. These were embedded in the electronic health record from which the fields were extracted into a data display platform that provided patient‐ and population‐level dashboards updated every 36 hours. Provider satisfaction and family experience surveys were performed to assess the impact of the standardized electronic note. Results In the last 5 years, 3,245 unique patients involving 13, 831 encounters had prospective, longitudinal, standardized epilepsy data accrued via point‐of‐care data entry into an electronic note as part of routine clinical care. A provider satisfaction survey of the small number of users involved indicated that the vast majority believed that the note makes documentation more efficient. A family experience survey indicated that being provided with the note was considered “valuable” or “really valuable” by 86% of respondents and facilitated communication with family members, school, and advocacy organizations. Significance The PEOIP serves as a proof of principle that information obtained as part of routine clinical care can be collected in a prospective, standardized, efficient manner and be used to construct filterable process/outcome dashboards, updated in near time (36 hours). This information will provide the necessary baseline data on which multiple of QI projects to improve meaningful outcomes for children with epilepsy will be based.
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Affiliation(s)
- Jeffrey R Buchhalter
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Morris H Scantlebury
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Sabrina D'Alfonso
- Departments of Pediatrics and Neurosciences University of California San Diego (UCSD), San Diego, CA, USA
| | - Juan Pablo Appendino
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences University of Calgary, Calgary, AB, Canada
| | - Luis Bello Espinosa
- Department of Pediatrics and Neurosciences, Arnold Palmer Hospital for Children, Orland Health, Orlando, FL, USA
| | - Brian L Brooks
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Curtis Claassen
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Jane Corbeil
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - David Czank
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Stafford Dean
- Data & Analytics, Alberta Health Services, Edmonton, AB, Canada
| | - Alice W Ho
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Julia Jacobs
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Maarit Mackay
- Data & Analytics, Alberta Health Services, Edmonton, AB, Canada
| | - Joka McMahon
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | | | - Jong M Rho
- Departments of Pediatrics and Neurosciences University of California San Diego (UCSD), San Diego, CA, USA
| | - Trina Roberts
- Data & Analytics, Alberta Health Services, Edmonton, AB, Canada
| | - Sonia Rothenmund
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Gary Ruta
- Data & Analytics, Alberta Health Services, Edmonton, AB, Canada
| | - Tyson Sawchuk
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Brett A Simms
- Data & Analytics, Alberta Health Services, Edmonton, AB, Canada
| | - Kim Smyth
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Tammy Still
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Nancy Thornton
- Faculty of Nursing, University of Calgar, Calgary, AB, Canada
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Abstract
OBJECTIVE The long-term effects of pediatric concussion on brain morphometry remain poorly delineated. This study used magnetic resonance imaging (MRI) to investigate cortical volume and thickness in youth several years after concussion. METHODS Participants aged 8-19 years old with a history of concussion (n = 37) or orthopedic injury (n = 20) underwent MRI, rated their postconcussion symptoms, and completed cognitive testing on average 2.6 years (SD = 1.6) after injury. FreeSurfer was used to obtain cortical volume and thickness measurements as well as determine any significant correlations between brain morphometry, postconcussion symptoms (parent and self-report), and cognitive functioning. RESULTS No significant group differences were found for either cortical volume or thickness. Youth with a history of concussion had higher postconcussion symptom scores (both parent and self-report Postconcussion Symptom Inventory) than the orthopedic injury group, but symptom ratings did not significantly correlate with cortical volume or thickness. Across both groups, faster reaction time on a computerized neurocognitive test battery (CNS Vital Signs) was associated with a thinner cortex in the left pars triangularis of the inferior frontal gyrus and the left caudal anterior cingulate. Better verbal memory was associated with a thinner cortex in the left rostral middle frontal gyrus. CONCLUSION Findings do not support differences in cortical volume or thickness approximately 2.5 years postconcussion in youth, suggesting either long-term cortical recovery or no cortical differences as a result of injury. Further research using a longitudinal study design and larger samples is needed.
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Affiliation(s)
- Nikola Zivanovic
- 432222Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Shane Virani
- 70402Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Neurosciences Program, 157744Alberta Children's Hospital, Calgary, Alberta, Canada.,157744Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Alysha A Rajaram
- 432222Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Lebel
- 157744Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Department of Radiology, 2129University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- 432222Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,157744Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- 432222Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Neurosciences Program, 157744Alberta Children's Hospital, Calgary, Alberta, Canada.,157744Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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29
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Schneider KJ, Nettel-Aguirre A, Palacios-Derflingher L, Mrazik M, Brooks BL, Woollings K, Blake T, McKay C, Lebrun C, Barlow K, Taylor K, Lemke N, Meeuwisse WH, Emery CA. Concussion Burden, Recovery, and Risk Factors in Elite Youth Ice Hockey Players. Clin J Sport Med 2021; 31:70-77. [PMID: 30300143 DOI: 10.1097/jsm.0000000000000673] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine rates of concussion and more severe concussion (time loss of greater than 10 days) in elite 13- to 17-year-old ice hockey players. METHODS This is a prospective cohort study (Alberta, Canada). Bantam (13-14 years) and Midget (15-17 years) male and female elite (top 20% by division of play) youth ice hockey players participated in this study. Players completed a demographic and medical history questionnaire and clinical test battery at the beginning of the season. A previously validated injury surveillance system was used to document exposure hours and injury during one season of play (8 months). Players with a suspected ice hockey-related concussion were referred to the study sport medicine physicians for assessment. Time loss from hockey participation was documented on an injury report form. RESULTS Overall, 778 elite youth ice hockey players (659 males and 119 females; aged 13-17 years) participated in this study. In total, 143 concussions were reported. The concussion incidence rate (IR) was 17.60 concussions/100 players (95% CI, 15.09-20.44). The concussion IR was 1.31 concussions/1000 player-hours (95% CI, 1.09-1.57). Time loss of greater than 10 days was reported in 74% of cases (106/143), and 20% (n = 28) had time loss of greater than 30 days. CONCLUSIONS Concussion is a common injury in elite youth ice hockey players. In this study population, a large proportion of concussions (74%) resulted in a time loss of greater than 10 days, possibly reflecting more conservative management or longer recovery in youth athletes.
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Affiliation(s)
- Kathryn J Schneider
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Alberto Nettel-Aguirre
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Luz Palacios-Derflingher
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Martin Mrazik
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Brian L Brooks
- Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Kaikanani Woollings
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
| | - Tracy Blake
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Carly McKay
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
- Department for Health, University of Bath, Bath, Somerset, United Kingdom
| | - Constance Lebrun
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, AB, Canada
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada ; and
| | - Karen Barlow
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Medicine, Child Health Research Centre, University of Queensland, Queensland, Australia
| | - Kirsten Taylor
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
| | - Nicole Lemke
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, AB, Canada
| | - Willem H Meeuwisse
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Carolyn A Emery
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
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30
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Rivera D, Mascialino G, Brooks BL, Olabarrieta-Landa L, Longoni M, Galarza-Del-Angel J, Arango-Lasprilla JC. Multivariate Base Rates of Low Scores on Tests of Executive Functions in a Multi-Country Latin American Sample. Dev Neuropsychol 2020; 46:1-15. [PMID: 33356560 DOI: 10.1080/87565641.2020.1863407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The objective of the study was to determine the prevalence of low scores in a diverse Latin American population for two neuropsychological commonly used tests to evaluate executive functions and to compare the number of low scores obtained using normative data from a Spanish-speaking population from Latin America versus an English-speaking population from U.S.A. Healthy adults (N = 5402) were administered the Modified Wisconsin Card Sorting Test and Stroop Color-Word. Low scores on measures of executive functioning are common. Clinicians working with Spanish-speaking adults should take into account the higher probability of low scores on these measures to reduce false-positive diagnoses of cognitive deficits in an individual.
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Affiliation(s)
- Diego Rivera
- Departamento De Ciencias De La Salud, Universidad Pública De Navarra , Pamplona, Spain
| | - Guido Mascialino
- Escuela De Psicología, Universidad De Las Américas , Quito, Ecuador
| | - Brian L Brooks
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary , Calgary, Alberta, Canada.,Neuropsychology Service, Alberta Children's Hospital , Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada
| | | | - Melina Longoni
- Dirección de Discapacidad de Ituzaingo , Buenos Aires, Argentina
| | | | - Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute. Cruces University Hospital . Barakaldo, Spain.,IKERBASQUE. Basque Foundation for Science ., Bilbao, Spain.,Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU) , Bizkaia, Spain
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Khan MH, Smithson L, Li E, Kirton A, Pei J, Andersen J, Yager JY, Brooks BL, Rasmussen C. Executive behavior and functional abilities in children with perinatal stroke and the associated caregiver impact. Child Neuropsychol 2020; 27:83-95. [PMID: 32718269 DOI: 10.1080/09297049.2020.1796953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Perinatal stroke is the most common form of stroke in childhood and is followed by a variety of outcomes, with many children experiencing specific functional and neuropsychological deficits. The association of these outcomes with the psychosocial impact caregivers face is not well documented. The goal of our pilot study was to examine caregivers' perception of executive behavior and functional abilities among children with perinatal stroke, and how these outcomes impact the caregivers. We administered three questionnaires to primary caregivers of children with perinatal stroke to obtain caregiver-reported measures of (1) executive behavior of their child (Behavior Rating Inventory of Executive Function, Second Edition), (2) the functional abilities of their child (Pediatric Evaluation of Disability Inventory Computer Adaptive Test), and (3) the psychosocial impact experienced by the caregiver themselves (Parental Outcome Measure). Participants included 20 children (mean age = 9.3 years, range = 6-16 years) with perinatal stroke and their primary caregivers. Functional abilities in the children were rated as clinically impaired in the domains of daily activities and mobility. Half of the children exhibited clinically impaired ratings on at least one executive behavior domain, but the mean scores for these domains did not reach clinically impaired levels. Greater ratings of problems in daily activities for the child was associated with greater caregiver guilt (r = -0.55, p = 0.02). Caregivers of children with perinatal stroke who experience limitations in performing daily activities should be more closely monitored for adverse impact and be provided the necessary support and education to alleviate the associated guilt.
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Affiliation(s)
- Muhammad H Khan
- Department of Pediatrics, University of Alberta , Edmonton, Canada
| | - Lisa Smithson
- Department of Pediatrics, University of Calgary , Calgary, Canada
| | - Eliza Li
- Department of Educational Psychology, University of Alberta , Edmonton, Canada
| | - Adam Kirton
- Department of Pediatrics, University of Calgary , Calgary, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta , Edmonton, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta , Edmonton, Canada.,Section of Pediatric Neurosciences, Stollery Children's Hospital , Edmonton, Canada.,Child Health, Glenrose Rehabilitation Hospital , Edmonton, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta , Edmonton, Canada.,Section of Pediatric Neurosciences, Stollery Children's Hospital , Edmonton, Canada
| | - Brian L Brooks
- Department of Pediatrics, University of Calgary , Calgary, Canada.,Neuropsychology Service, Alberta Children's Hospital , Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine , Calgary, Canada.,Department of Psychology, University of Calgary , Calgary, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta , Edmonton, Canada
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Brooks BL, Virani S, Khetani A, Carlson H, Jadavji Z, Mauthner M, Low TA, Plourde V, MacMaster FP, Bray S, Harris AD, Lebel C, Lebel RM, Esser MJ, Yeates KO, Barlow KM. Functional magnetic resonance imaging study of working memory several years after pediatric concussion. Brain Inj 2020; 34:895-904. [PMID: 32396403 DOI: 10.1080/02699052.2020.1753240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PRIMARY OBJECTIVE The neurophysiological effects of pediatric concussion several years after injury remain inadequately characterized. The objective of this study was to determine if a history of concussion was associated with BOLD response differences during an n-back working memory task in youth. RESEARCH DESIGN Observational, cross-sectional. METHODS AND PROCEDURES Participants include 52 children and adolescents (M = 15.1 years, 95%CI = 14.4-15.8, range = 9-19) with past concussion (n = 33) or orthopedic injury (OI; n = 19). Mean time since injury was 2.5 years (95%CI = 2.0-3.0). Measures included postconcussion symptom ratings, neuropsychological testing, and blood-oxygen-dependent-level (BOLD) functional magnetic resonance imaging (fMRI) during an n-back working memory task. MAIN OUTCOMES AND RESULTS Groups did not differ on accuracy or speed during the three n-back conditions. They also did not differ in BOLD signal change for the 1- vs. 0-back or 2- vs. 0-back contrasts (controlling for task performance). CONCLUSIONS This study does not support group differences in BOLD response during an n-back working memory task in youth who are on average 2.5 years post-concussion. The findings are encouraging from the perspective of understanding recovery after pediatric concussion.
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Affiliation(s)
- Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital , Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary , Calgary, Alberta, Canada
| | - Shane Virani
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary , Calgary, Alberta, Canada.,Vi Riddell Pain and Rehabilitation Program, Alberta Children's Hospital Research Institute , Calgary, Alberta, Canada
| | - Aneesh Khetani
- Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Helen Carlson
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Zeanna Jadavji
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Micaela Mauthner
- Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Trevor A Low
- Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Vickie Plourde
- École de Psychologie, Faculté des sciences de la santé et des services communautaires, Université de Moncton, Monton, New Brunswick, Canada; Faculty Saint-Jean, University of Alberta , Edmonton, AB, Canada
| | - Frank P MacMaster
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Psychiatry and Paediatrics, University of Calgary , Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute , Calgary, Alberta, Canada.,Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services , Edmonton, Alberta, Canada
| | - Signe Bray
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Ashley D Harris
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Radiology, University of Calgary , Calgary, Alberta, Canada
| | - Catherine Lebel
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Radiology, University of Calgary , Calgary, Alberta, Canada
| | - R Marc Lebel
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Radiology and Biomedical Engineering, University of Calgary , Calgary, Alberta, Canada.,MR Applications and Workflow, GE Healthcare , Calgary, Alberta, Canada
| | - Michael J Esser
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Karen M Barlow
- Departments of Paediatrics and Clinical Neurosciences, University of Calgary , Calgary, Alberta, Canada.,Faculty of Medicine, University of Queensland , Brisbane, Australia
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Iverson GL, Wojtowicz M, Brooks BL, Maxwell BA, Atkins JE, Zafonte R, Berkner PD. High School Athletes With ADHD and Learning Difficulties Have a Greater Lifetime Concussion History. J Atten Disord 2020; 24:1095-1101. [PMID: 27431932 DOI: 10.1177/1087054716657410] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Examine lifetime history of concussions in adolescents who have developmental problems in comparison with those with no developmental problems. Method: Thirty-two thousand four hundred eighty-seven adolescent athletes completed baseline/pre-season evaluations. Based on self-reported histories, athletes were divided into four groups: ADHD only, ADHD and learning difficulties (LD), LD only, and controls. Results: Athletes with ADHD, LD, or ADHD plus LD reported a greater prevalence of prior concussions than athletes without these developmental conditions (ps < .05). When adjusting for sex differences in concussion prevalence rates (boys are greater than girls), there was an increase in prevalence of prior injuries in those with ADHD, and ADHD plus learning difficulties compared with those with LD only. This pattern was found for both girls and boys. There was no additive effect of having both conditions. Conclusion: Developmental conditions in adolescent athletes, such as ADHD and learning difficulties, are associated with a greater prevalence rate of prior concussion.
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Affiliation(s)
- Grant L Iverson
- Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, USA.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, USA
| | - Magdalena Wojtowicz
- Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, USA.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, USA
| | - Brian L Brooks
- Alberta Children's Hospital, Calgary, Canada.,University of Calgary, Alberta, Canada
| | | | | | - Ross Zafonte
- Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, USA.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, USA.,Massachusetts General Hospital, Boston, USA.,Brigham and Women's Hospital, Boston, MA, USA
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MacAllister WS, Désiré N, Vasserman M, Dalrymple J, Salinas L, Brooks BL. The use of the MSVT in children and adolescents with epilepsy. Appl Neuropsychol Child 2020; 9:323-328. [PMID: 32297798 DOI: 10.1080/21622965.2020.1750127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Pediatric neuropsychologists are increasingly recognizing the importance of performance validity testing during evaluations. The use of such measures to detect insufficient effort is of particular importance in pediatric epilepsy evaluations, where test results are often used to guide surgical decisions and failure to detect poor task engagement can result in postsurgical cognitive decline. The present investigation assesses the utility of the Medical Symptom Validity Test (MSVT) in 104 clinically referred children and adolescents with epilepsy. Though the overall failure rate was 15.4% of the total group, children with 2nd grade or higher reading skills (a requirement of the task) passed at a very high rate (96.6%). Of the three failures, two were unequivocally deemed true positives, while the third failed due to extreme somnolence during testing. Notably, for those with ≥2nd grade reading levels, MSVT validity indices were unrelated to patient age, intellectual functioning, or age of epilepsy onset, while modest relations were seen with specific memory measures, number of epilepsy medications, and seizure frequency. Despite these associations, however, this did not result in more failures in this population of children and adolescents with substantial neurologic involvement, as pass rates exceeded 92% for those with intellectual disability, high seizure frequency, high medication burden, and even prior surgical resection of critical memory structures.
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Affiliation(s)
- William S MacAllister
- Neuropsychology Service, Alberta Children's Hospital, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Naddley Désiré
- Neuropsychology Service, Alberta Children's Hospital, Calgary, Canada
| | - Marsha Vasserman
- Neuropsychology Service, Alberta Children's Hospital, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | | | - Lilian Salinas
- New York University Comprehensive Epilepsy Center, New York, New York, USA
| | - Brian L Brooks
- Neuropsychology Service, Alberta Children's Hospital, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Department of Psychology, University of Calgary, Calgary, Canada
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Barlow KM, Brooks BL, Esser MJ, Kirton A, Mikrogianakis A, Zemek RL, MacMaster FP, Nettel-Aguirre A, Yeates KO, Kirk V, Hutchison JS, Crawford S, Turley B, Cameron C, Hill MD, Samuel T, Buchhalter J, Richer L, Platt R, Boyd R, Dewey D. Efficacy of Melatonin in Children With Postconcussive Symptoms: A Randomized Clinical Trial. Pediatrics 2020; 145:peds.2019-2812. [PMID: 32217739 DOI: 10.1542/peds.2019-2812] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Approximately 25% of children with concussion have persistent postconcussive symptoms (PPCS) with resultant significant impacts on quality of life. Melatonin has significant neuroprotective properties, and promising preclinical data suggest its potential to improve outcomes after traumatic brain injury. We hypothesized that treatment with melatonin would result in a greater decrease in PPCS symptoms when compared with a placebo. METHODS We conducted a randomized, double-blind trial of 3 or 10 mg of melatonin compared with a placebo (NCT01874847). We included youth (ages 8-18 years) with PPCS at 4 to 6 weeks after mild traumatic brain injury. Those with significant medical or psychiatric histories or a previous concussion within the last 3 months were excluded. The primary outcome was change in the total youth self-reported Post-Concussion Symptom Inventory score measured after 28 days of treatment. Secondary outcomes included change in health-related quality of life, cognition, and sleep. RESULTS Ninety-nine children (mean age: 13.8 years; SD = 2.6 years; 58% girls) were randomly assigned. Symptoms improved over time with a median Post-Concussion Symptom Inventory change score of -21 (95% confidence interval [CI]: -16 to -27). There was no significant effect of melatonin when compared with a placebo in the intention-to-treat analysis (3 mg melatonin, -2 [95% CI: -13 to 6]; 10 mg melatonin, 4 [95% CI: -7 to 14]). No significant group differences in secondary outcomes were observed. Side effects were mild and similar to the placebo. CONCLUSIONS Children with PPCS had significant impairment in their quality of life. Seventy-eight percent demonstrated significant recovery between 1 and 3 months postinjury. This clinical trial does not support the use of melatonin for the treatment of pediatric PPCS.
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Affiliation(s)
- Karen M Barlow
- Department of Pediatrics, Alberta Children's Hospital Research Institute and .,Clinical Neurosciences, Cumming School of Medicine and.,Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Brian L Brooks
- Department of Pediatrics, Alberta Children's Hospital Research Institute and.,Clinical Neurosciences, Cumming School of Medicine and.,Psychology, University of Calgary, Calgary, Alberta, Canada.,Neuroscience Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Michael J Esser
- Department of Pediatrics, Alberta Children's Hospital Research Institute and.,Clinical Neurosciences, Cumming School of Medicine and
| | - Adam Kirton
- Department of Pediatrics, Alberta Children's Hospital Research Institute and.,Radiology.,Clinical Neurosciences, Cumming School of Medicine and
| | - Angelo Mikrogianakis
- Department of Pediatrics, Alberta Children's Hospital Research Institute and.,Emergency Medicine, and
| | - Roger L Zemek
- Departments of Pediatrics and Emergency Medicine and Research Institute, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Frank P MacMaster
- Department of Pediatrics, Alberta Children's Hospital Research Institute and.,Departments of Psychiatry, Paediatrics, and
| | - Alberto Nettel-Aguirre
- Department of Pediatrics, Alberta Children's Hospital Research Institute and.,Departments of Community Health Sciences
| | - Keith Owen Yeates
- Department of Pediatrics, Alberta Children's Hospital Research Institute and.,Clinical Neurosciences, Cumming School of Medicine and.,Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Valerie Kirk
- Department of Pediatrics, Alberta Children's Hospital Research Institute and
| | - James S Hutchison
- Neurosciences and Mental Health Research Program, Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Susan Crawford
- Neuroscience Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Brenda Turley
- Neuroscience Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Candice Cameron
- Research Pharmacy, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | | | - Tina Samuel
- Neuroscience Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Jeffrey Buchhalter
- Department of Pediatrics, Alberta Children's Hospital Research Institute and
| | - Lawrence Richer
- Department of Pediatrics and Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Platt
- McGill University, Montreal, Québec, Canada; and
| | - Roslyn Boyd
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Deborah Dewey
- Department of Pediatrics, Alberta Children's Hospital Research Institute and.,Departments of Community Health Sciences
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Kwan V, Plourde V, Yeates KO, Noel M, Brooks BL. Headache long after pediatric concussion: presence, intensity, interference, and association with cognition. Brain Inj 2020; 34:575-582. [PMID: 32050786 DOI: 10.1080/02699052.2020.1725842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Document headache presence, intensity, and interference after concussion(s), as well as examine its association with cognition.Participants: Participants 8-19 years of age were assessed on average 34 months (SD = 21.5) after an orthopedic injury (OI, n = 29), single concussion (n = 21), or multiple concussions (n = 15).Measures: Headache intensity was rated using the Headache Rating Scale and headache interference was rated using the Post-Concussion Symptom Inventory (PCSI). Cognition was rated using the PCSI and measured using CNS Vital Signs.Results: Type of injury did not differ significantly in headache presence or intensity. However, there was a dose-response relationship found for children's ratings of headache interference, which was rated highest among children with multiple concussions, intermediate among those with single concussion, and lowest among children with OI. Both headache intensity and interference ratings correlated significantly with self and parent ratings of cognition on the PCSI, but not with cognitive test performance.Conclusions: Youth with single or multiple concussions report greater headache interference - but not higher headache intensity - compared to youth without concussion. Although higher headache intensity and interference were associated with more self-reported cognitive symptoms, headaches did not correlate with cognitive test performance.
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Affiliation(s)
- Vivian Kwan
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Vickie Plourde
- School of Psychology, Université de Moncton, Moncton, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Canada
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Plourde V, Kung JY, Gates A, Jun S, Brooks BL, Sebastianski M. How Perceptions Impact Recovery from Concussion in Childhood and Adolescence: a Systematic Review. Neuropsychol Rev 2020; 30:142-163. [PMID: 32124152 DOI: 10.1007/s11065-020-09430-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 02/16/2020] [Indexed: 12/24/2022]
Abstract
Perceptions about the causes and consequences of concussion, and individual representations and interpretations of these factors, can influence the post-concussive recovery process. The goal of this project was to synthesize evidence on perceptions related to concussions as experienced by children, adolescents, and parents, and to evaluate how these perceptions impact post-concussive recovery in physical, behavioural, cognitive, and psychological domains. We undertook a systematic review based on the Cochrane Handbook, conducting a comprehensive search of six databases and Google Scholar. Duplicate, independent screening was employed and the quality of studies was assessed using the Mixed Methods Appraisal Tool (MMAT). A total of 1552 unique records were identified, and six records (5 scientific articles and 1 thesis, published between 1990 and 2018; N = 26 to 412, age range from 2 to 18 years) were included. Perceptions about concussions were assessed differently between studies, with a range in types of measures and respondents. Some evidence suggested that perceptions could negatively impact concussion recovery, mostly post-concussive symptoms. However, results were not consistent between studies and the methodological quality was variable (and often low). There is limited evidence of the impact of perceptions of children, adolescents, and their parents on concussion recovery. Priorities for future research investigating concussion recovery should include recruiting representative samples, accounting for potential confounders, and measuring perceptions in children, adolescents and parents using validated measures. Higher quality studies are needed to better understand the role of perceptions in concussion recovery and to inform clinical care.
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Affiliation(s)
- Vickie Plourde
- School of Psychology, Université de Moncton, 18 Av Antonine-Maillet, Moncton, NB, E1A 3E6, Canada.
| | - Janice Y Kung
- John W. Scott Health Sciences Library, University of Alberta, 2K3.28 Walter C. Mackenzie Health Sciences Centre, Edmonton, Alberta, T6G 2R7, Canada
| | - Allison Gates
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, 4-482C, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada
| | - Shelly Jun
- Department of Surgery, University of Alberta, 3E1.14 Walter Mackenzie Centre, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada
| | - Brian L Brooks
- Neurosciences program, Alberta Children's Hospital, Calgary, Canada
- Departments of Pediatrics, Clinical Neurosciences, and Pediatrics, University of Calgary, Calgary, Canada
- Alberta Children's Research Institute, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, T3B 6A8, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, 4-486D, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada
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Plourde V, Rohr CS, Virani S, Bray S, Yeates KO, Brooks BL. Default mode network functional connectivity after multiple concussions in children and adolescents. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz073] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The default mode network (DMN), a set of brain regions, has been shown to be affected post-concussion.
Objective
This cross-sectional study aims to elucidate if children and adolescents with multiple concussions demonstrate long-term alterations in DMN functional connectivity (FC).
Method
Participants (N = 57, 27 girls and 30 boys; 8-19 years old, M age = 14.7, SD = 2.8) were divided into three groups (orthopedic injury [OI] n = 20; one concussion n = 16; multiple concussions n = 21, M = 3.2 concussions, SD = 1.7) and seen on average 31.6 months post-injury (range 4.3-130.7 months; SD = 19.4). They underwent a resting-state functional magnetic resonance imaging scan. Parents completed the ADHD rating scale-5 for children and adolescents. Children and parents completed the post-concussion symptom inventory (PCSI).
Results
Anterior and posterior DMN components were extracted from the fMRI data for each participant using FSL’s MELODIC and dual regression. We tested for pairwise group differences within each DMN component in FSL’s Randomize (5000 permutations) using threshold-free cluster enhancement to estimate cluster activation, controlling for age, sex, and symptoms of inattention. FC of the anterior DMN was significantly reduced in the group with multiple concussions compared to the two other groups, whereas there were no significant group differences on FC of the posterior DMN. There were no significant associations between DMN FC and PCSI scores.
Conclusions
These results suggest reduced FC in the anterior DMN in youth with multiple concussions, but no linear association with post-concussive symptoms.
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Affiliation(s)
- Vickie Plourde
- School of Psychology, Université de Moncton, Moncton, Canada; Faculty Saint-Jean, University of Alberta, Edmonton, Canada
| | - Christiane S Rohr
- Department of Radiology, University of Calgary; Child and Adolescent Imaging Research Program, University of Calgary; Alberta Children’s Hospital Research Institute, University of Calgary; Hotchkiss Brain Institute, Calgary, Canada
| | - Shane Virani
- Alberta Children’s Hospital Research Institute, University of Calgary; Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Signe Bray
- Department of Radiology, University of Calgary; Child and Adolescent Imaging Research Program, University of Calgary; Alberta Children’s Hospital Research Institute, University of Calgary; Hotchkiss Brain Institute, Calgary, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary; Alberta Children’s Hospital Research Institute, University of Calgary; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Brian L Brooks
- Neurosciences Program, Alberta Children’s Hospital; Alberta Children’s Hospital Research Institute, University of Calgary; Hotchkiss Brain Institute, University of Calgary; Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Canada
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Beauchamp MH, Aglipay M, Yeates KO, Désiré N, Keightley M, Anderson P, Brooks BL, Barrowman N, Gravel J, Boutis K, Gagnon I, Dubrovsky AS, Zemek R. Predictors of neuropsychological outcome after pediatric concussion. Neuropsychology 2019; 32:495-508. [PMID: 29809036 DOI: 10.1037/neu0000419] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Previous research suggests that neuropsychological outcome after pediatric concussion is determined by unmodifiable, preexisting factors. This study aimed to predict neuropsychological outcome after pediatric concussion by using a sufficiently large sample to explore a vast array of predictors. METHOD A total of 311 children and adolescents (6-18 years old) with concussion were assessed in the emergency department to document acute symptomatology and to screen for cognitive functioning. At 4 and 12 weeks postinjury, they completed tests of intellectual functioning, attention/working memory, executive functions, verbal memory, processing speed, and fine motor abilities. Multiple hierarchical logistic and linear regressions were performed to assess the contribution of premorbid factors, acute symptoms, and acute cognitive screening (Standardized Assessment of Concussion-Child) to aspects of neuropsychological outcome: (a) cognitive inefficiency (defined using a modified Neuropsychological Impairment Rule; Beauchamp et al., 2015) and (b) neuropsychological performance (defined using principal component analysis). RESULTS Neuropsychological impairment was present in 10.3% and 4.5% of participants at 4 and 12 weeks postinjury, respectively. At 4 weeks postinjury, cognitive inefficiency was predicted by premorbid factors and acute cognitive screening, whereas at 12 weeks it was predicted by acute symptoms. Neuropsychological performance at 4 weeks was predicted by a combination of premorbid factors, acute symptoms, and acute cognitive screening, whereas as at 12 weeks, only acute cognitive screening predicted performance. CONCLUSIONS Neuropsychological outcome after pediatric concussion is not attributable solely to preexisting problems but is instead associated with a combination of preexisting and injury-related variables. Acute cognitive screening appears to be particularly useful in predicting neuropsychological status after concussion. (PsycINFO Database Record
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Affiliation(s)
| | - Mary Aglipay
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute
| | - Keith Owen Yeates
- Departments of Psychology, Pediatrics, and Clinical Neurosciences, Alberta Children's Hospital Research Institute
| | | | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital
| | - Peter Anderson
- Children's Hospital of Eastern Ontario Research Institute
| | - Brian L Brooks
- Departments of Psychology, Pediatrics, and Clinical Neurosciences, University of Calgary
| | - Nick Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute
| | | | - Kathy Boutis
- Department of Pediatrics, Hospital for Sick Children
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University
| | | | - Roger Zemek
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute
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Brooks BL, Sayers PQ, Virani S, Rajaram AA, Tomfohr-Madsen L. Insomnia in Adolescents with Slow Recovery from Concussion. J Neurotrauma 2019; 36:2391-2399. [DOI: 10.1089/neu.2018.6257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Brian L. Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, and University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, and University of Calgary, Calgary, Alberta, Canada
| | - Payton Q. Sayers
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shane Virani
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Alysha A. Rajaram
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Lianne Tomfohr-Madsen
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, and University of Calgary, Calgary, Alberta, Canada
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Yeates KO, Tang K, Barrowman N, Freedman SB, Gravel J, Gagnon I, Sangha G, Boutis K, Beer D, Craig W, Burns E, Farion KJ, Mikrogianakis A, Barlow K, Dubrovsky AS, Meeuwisse W, Gioia G, Meehan WP, Beauchamp MH, Kamil Y, Grool AM, Hoshizaki B, Anderson P, Brooks BL, Vassilyadi M, Klassen T, Keightley M, Richer L, DeMatteo C, Osmond MH, Zemek R, Xie J, Chatfield J, Dow N, Papadimitropoulos R, Levesque T, Langford C, Tran TT, McGahern C, DiGirolamo V, Mazza J, Lagacé M, Cook R, Fitzpatrick E, MacIntyre J, Moore J. Derivation and Initial Validation of Clinical Phenotypes of Children Presenting with Concussion Acutely in the Emergency Department: Latent Class Analysis of a Multi-Center, Prospective Cohort, Observational Study. J Neurotrauma 2019; 36:1758-1767. [DOI: 10.1089/neu.2018.6009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kenneth Tang
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Stephen B. Freedman
- Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jocelyn Gravel
- Department of Pediatrics, Hospital Sainte Justine, University of Montreal, Montreal, Quebec, Canada
| | - Isabelle Gagnon
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Gurinder Sangha
- Department of Pediatrics, Children's Hospital of Western Ontario, Western University, London, Ontario, Canada
| | - Kathy Boutis
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Darcy Beer
- Department of Pediatrics, Manitoba Children's Hospital, Winnipeg, Manitoba, Canada
| | - William Craig
- Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Emma Burns
- Department of Emergency Medicine, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Ken J. Farion
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Angelo Mikrogianakis
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Alberta
| | - Karen Barlow
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Alberta
| | - Alexander S. Dubrovsky
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Gerard Gioia
- Department of Neuropsychology, Children's National Health System, George Washington University School of Medicine, Rockville, Maryland
| | - William P. Meehan
- Sports Concussion Clinic, Boston Children's Hospital, Boston, Massachusetts
| | - Miriam H. Beauchamp
- Ste. Justine Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Yael Kamil
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Anne M. Grool
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Blaine Hoshizaki
- Department of Kinesiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Anderson
- Department of Psychology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Brian L. Brooks
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Michael Vassilyadi
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Terry Klassen
- Department of Pediatrics, Manitoba Children's Hospital, Winnipeg, Manitoba, Canada
| | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Lawrence Richer
- Department of Neurology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Carol DeMatteo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Martin H. Osmond
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
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Carlson HL, Sugden C, Brooks BL, Kirton A. Functional connectivity of language networks after perinatal stroke. Neuroimage Clin 2019; 23:101861. [PMID: 31141787 PMCID: PMC6536856 DOI: 10.1016/j.nicl.2019.101861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/17/2019] [Accepted: 05/19/2019] [Indexed: 02/06/2023]
Abstract
Successful language acquisition during development is imperative for lifelong function. Complex language networks develop throughout childhood. Perinatal stroke may cause significant language disabilities but function can also be remarkably normal. Studying such very early brain injury populations may inform developmental plasticity models of language networks. We examined functional connectivity (FC) of language networks in children with arterial and venous perinatal stroke and typically developing controls (TDC) in a population-based, controlled, cohort study. Resting state functional MRI was performed at 3 T (TR/TE = 2000/30 ms, 150 volumes, 3.6mm3 voxels). Seed-based analyses used bilateral inferior frontal and superior temporal gyri. A subset of stroke participants completed clinical language testing. Sixty-six children participated (median age: 12.85±3.8y, range 6-19; arterial N = 17; venous N = 15; TDC N = 34]. Children with left hemisphere strokes had comparable FC in their right hemispheres compared to TDC. Inter- and intra-hemispheric connectivity strengths were similar between TDC and PVI but lower for AIS. Reduced FC was associated with poorer language comprehension. Language networks can be estimated using resting-state fMRI in children with perinatal stroke. Altered connectivity may occur in both hemispheres, is more pronounced with arterial lesions, and is associated with clinical function. Our results have implications for therapeutic language interventions after early stroke.
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Affiliation(s)
- Helen L Carlson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
| | - Cole Sugden
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Brian L Brooks
- Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Neuropsychology Service, Alberta Children's Hospital, Calgary, AB, Canada; Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Brooks BL, Plourde V, Beauchamp MH, Tang K, Yeates KO, Keightley M, Anderson P, Désiré N, Barrowman N, Zemek R, Aglipay M, Barlow K, Beer D, Boutis K, Burns E, Craig W, DeMatteo C, Dubrovsky AS, Farion KJ, Freedman SB, Gagnon I, Gioia G, Gravel J, Grool AM, Hoshizaki B, Kamil Y, Klassen T, McGahern C, Meehan III WP, Meeuwisse W, Mikrogianakis A, Osmond MH, Richer L, Sangha G, Vassilyadi M. Predicting Psychological Distress after Pediatric Concussion. J Neurotrauma 2019; 36:679-685. [DOI: 10.1089/neu.2018.5792] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Brian L. Brooks
- Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Vickie Plourde
- Faculty Saint-Jean, University of Alberta, Edmonton, Alberta, Canada
| | - Miriam H. Beauchamp
- Department of Psychology, University of Montreal & Ste-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - Ken Tang
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Keith Owen Yeates
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Peter Anderson
- Children's Hospital of Eastern Ontario Research Institute, Behavioral Neurosciences & Consultation-Liaison Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Naddley Désiré
- Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Nick Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Roger Zemek
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Deschamps K, Yeates KO, Fay-McClymont TB, Twilt M, Westmacott R, Dropol A, Brooks BL, Kirton A, Gowdie P, Sheikh S, Benseler SM. Cognitive outcomes of childhood primary CNS vasculitis. Neuropsychology 2019; 33:462-469. [PMID: 30762375 DOI: 10.1037/neu0000513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To characterize the clinical cognitive phenotypes and severity of cognitive burden according to disease subtype in children with primary central nervous system vasculitis (cPACNS). METHOD This retrospective multicenter inflammatory brain disease database study examined the neuropsychological outcomes of 80 children (44 male; mean age = 7.89 years, SD = 4.17) consecutively diagnosed with primary CNS vasculitis between 1992 and 2016. Twenty-one children had small-vessel disease (AN_cPACNS), and 59 had large-vessel disease (including 49 nonprogressive [APNP_cPACNS] and 10 progressive [APP_cPACNS]). Neuroimaging revealed MRI abnormalities in 100% and 90% of children with large- and small-vessel vasculitis, respectively. The primary outcomes were Full Scale IQ (FSIQ) and the index scores from the Wechsler Intelligence Scale for Children-III (WISC-III, WISC-IV, and WISC-V). Analyses explored the effect of disease subtype. RESULTS Intellectual functioning was assessed on average 2.82 years after symptom onset. Children with small-vessel CNS vasculitis had significantly lower FSIQ scores than did those with large-vessel CNS vasculitis (Ms = 81.90 vs. 94.82; p = .04). Intellectual disability (FSIQ < 70) was more frequent in children with small-vessel disease (24% vs. 5%). All groups displayed lower Working Memory and Processing Speed index scores relative to Verbal Comprehension and Perceptual Reasoning index scores. Group differences in FSIQ remained significant after controlling for the presence of seizures. CONCLUSION Children with small-vessel CNS vasculitis are more likely to demonstrate deficits in intellectual functioning than are those with large-vessel disease, and children with both types of CNS vasculitis demonstrate relatively poor working memory and processing speed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, University of Calgary
| | | | - Marinka Twilt
- Section of Rheumatology, Department of Pediatrics, Alberta Children's Hospital
| | | | - Anastasia Dropol
- Department of Pediatrics, Cumming School of Medicine, University of Calgary
| | - Brian L Brooks
- Alberta Children's Hospital Research Institute, Department of Pediatrics
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Alberta Children's Hospital Research Institute, University of Calgary
| | - Peter Gowdie
- Rheumatology Service, Department of General Medicine, Royal Children's Hospital
| | - Shehla Sheikh
- Information Services, The Hospital for Sick Children
| | - Susanne M Benseler
- Alberta Children's Hospital Research Institute, Department of Pediatrics, Cumming School of Medicine, University of Calgary
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Brooks BL, Plourde V, Fay-McClymont TB, MacAllister WS, Sherman EMS. Factor structure of the CNS Vital Signs computerized cognitive battery in youth with neurological diagnoses. Child Neuropsychol 2019; 25:980-991. [DOI: 10.1080/09297049.2019.1569609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Brian L. Brooks
- Neuropsychology Service, Alberta Children’s Hospital, Calgary, Canada
- Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Vickie Plourde
- Faculty St-Jean, University of Alberta, Edmonton, Canada
| | - Taryn B. Fay-McClymont
- Neuropsychology Service, Alberta Children’s Hospital, Calgary, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Paediatrics, University of Calgary, Calgary, Canada
| | - William S. MacAllister
- Neuropsychology Service, Alberta Children’s Hospital, Calgary, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Paediatrics, University of Calgary, Calgary, Canada
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Abstract
Despite its popularity in the neuropsychological evaluation of children, the utility of the Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V) has not yet been investigated in children with epilepsy. Eighty clinically referred children and adolescents with epilepsy were administered the WISC-V as part of a comprehensive assessment and scores were compared to matched controls from the WISC-V standardization sample. T tests compared WISC-V indices and subtests between patients and controls and Chi-square analyses compared the rates of low scores. Correlational analyses assessed the relationships between epilepsy severity variables (e.g., age of onset, duration of epilepsy, number of antiepileptic drugs, seizure frequency). All WISC-V composites and subtests were significantly lower in patients versus controls and the rate of low scores was higher in patients than controls for all composites and subtests with the exception of Figure Weights. The Working Memory Index and Processing Speed Index were most sensitive to impairment, while the Verbal Comprehension Index and Fluid Reasoning Index were least sensitive. Of the epilepsy severity variables, age of seizure onset and number of antiepileptic drugs were strong predictors of deficits, whereas seizure frequency was the weakest predictor. Importantly, no significant differences were seen in children with right hemisphere epilepsy versus left on the five WISC-V composites, though a trend was seen towards a lower Visual-Spatial Index in those with right-sided focal seizures.
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Affiliation(s)
- William S MacAllister
- a Neuropsychology Service , Alberta Children's Hospital.,b Department of Paediatrics , University of Calgary.,c Alberta Children's Hospital Research Institute.,d Department of Neurology, Epilepsy Center , New York University School of Medicine
| | | | - Marsha Vasserman
- a Neuropsychology Service , Alberta Children's Hospital.,c Alberta Children's Hospital Research Institute.,f Department of Child Adolescent Psychiatry, Child Study Center , New York University School of Medicine
| | - Taryn Fay-Mcclymont
- a Neuropsychology Service , Alberta Children's Hospital.,b Department of Paediatrics , University of Calgary.,c Alberta Children's Hospital Research Institute
| | - Brian L Brooks
- a Neuropsychology Service , Alberta Children's Hospital.,b Department of Paediatrics , University of Calgary.,c Alberta Children's Hospital Research Institute
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Cook NE, Karr JE, Brooks BL, Garcia-Barrera MA, Holdnack JA, Iverson GL. Multivariate base rates for the assessment of executive functioning among children and adolescents. Child Neuropsychol 2018; 25:836-858. [PMID: 30537889 DOI: 10.1080/09297049.2018.1543389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study provides observed base rates of low executive functioning test scores among healthy children and adolescents, stratifies those base rates by narrow intellectual functioning and age groupings, and provides normative classification ranges to aid the interpretation of performances on the Delis-Kaplan Executive Function System (D-KEFS) in clinical practice and research. Participants included 875 children and adolescents between 8 and 19 years old from the D-KEFS normative sample (48% male; 52% female). Among these participants, 838 had complete data and were included in the current study. The racial/ethnic composition of the sample was: White (73.7%), African American (12.4%), Hispanic (11.1%), and other racial/ethnic backgrounds (2.7%). The Overall Test Battery Mean (OTBM) and the prevalence of low scores at various clinical cut-offs were calculated for the 13 primary scores from the D-KEFS Trail Making Test, Verbal Fluency Test, and Color-Word Interference Test. The OTBM and base rates were also calculated separately for those scores reflecting executive functioning (n = 7) and processing speed (n = 6). Healthy children and adolescents commonly obtained low scores on the D-KEFS tests considered here. Younger age, lower estimated full-scale intelligence quotient, and more test scores interpreted were associated with a greater frequency of low scores. Clinicians and researchers are encouraged to consider these multivariate base rates when assessing and attempting to identify executive functioning impairment among children and adolescents with the D-KEFS.
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Affiliation(s)
- Nathan E Cook
- a Department of Physical Medicine and Rehabilitation , Harvard Medical School , Boston , MA , USA.,b MassGeneral Hospital for Children™ Sport Concussion Program , Boston , MA , USA.,c Spaulding Rehabilitation Hospital , Boston , MA , USA
| | - Justin E Karr
- d Department of Psychology , University of Victoria , Victoria , British Columbia , Canada
| | - Brian L Brooks
- e Neurosciences Program , Alberta Children's Hospital , Calgary , Alberta , Canada.,f Departments of Paediatrics, Clinical Neurosciences, and Psychology , University of Calgary , Calgary , Alberta , Canada.,g Alberta Children's Hospital Research Institute , University of Calgary , Calgary , Alberta , Canada
| | | | | | - Grant L Iverson
- a Department of Physical Medicine and Rehabilitation , Harvard Medical School , Boston , MA , USA.,b MassGeneral Hospital for Children™ Sport Concussion Program , Boston , MA , USA.,c Spaulding Rehabilitation Hospital , Boston , MA , USA
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Brooks BL, Low TA, Plourde V, Virani S, Jadavji Z, MacMaster FP, Barlow KM, Lebel RM, Yeates KO. Cerebral blood flow in children and adolescents several years after concussion. Brain Inj 2018; 33:233-241. [DOI: 10.1080/02699052.2018.1540798] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Brian L. Brooks
- Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Neurosciences Program, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Trevor A. Low
- Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Vickie Plourde
- Faculty Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | - Shane Virani
- Vi Riddell Pain and Rehabilitation Program, Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Zeanna Jadavji
- Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Frank P. MacMaster
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada
- Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
- Departments of Psychiatry and Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Karen M. Barlow
- Child Health Research Centre, University of Queensland, Brisbane, Australia
- Departments of Paediatrics and Clinical Neurosciences, University of Calgary, Brisbane, Australia
- Alberta Children’s Hospital Research Institute, University of Calgary, Brisbane, Australia
| | - R. Marc Lebel
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Radiology and Biomedical Engineering, University of Calgary, Calgary, Alberta, Canada
- GE Healthcare, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Psychology, Paediatrics, and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Brooks BL, Holdnack JA, Iverson GL. Reliable Change on Memory Tests is Common in Healthy Children and Adolescents. Arch Clin Neuropsychol 2018; 32:1001-1009. [PMID: 28383636 DOI: 10.1093/arclin/acx028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/21/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Neuropsychologists interpret a large number of scores in their assessments, including numerous retest scores to determine change over time. The rate at which healthy children and adolescents obtain reliably improved or declined memory scores when retested has yet to be explored. The purpose of this study was to illustrate the prevalence of reliable change scores on memory test batteries in healthy children and adolescents. Methods Participants were children and adolescents from test-retest samples from two published memory test batteries (ChAMP and CMS). Reliable change scores (RCI with 90% confidence interval and practice effects) were calculated for the indexes and subtests of each battery. Multivariate base rates involved considering all change scores simultaneously within each battery and calculating the frequencies of healthy children obtaining one or more reliably declined or one or more reliably improved scores. Results Across both memory batteries, one or more reliably changed index or subtest score was common; however, reliable change on three or more scores was uncommon (i.e., found in <5% of the samples). Base rates of change scores did not differ by parent education. Conclusions Having a single reliably changed score on retest is common when interpreting these memory batteries. Multivariate interpretation is necessary when determining cognitive decline and cognitive recovery. Further research is warranted with other measures, other samples, and different retest intervals.
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Affiliation(s)
- Brian L Brooks
- Neurosciences Program (Brain Injury and Rehabilitation), Alberta Children's Hospital, Calgary, Alberta, Canada.,Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital & Mass General Hospital for Children Sport Concussion Program, Boston, MA, USA
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Plourde V, Hrabok M, Sherman EMS, Brooks BL. Validity of a Computerized Cognitive Battery in Children and Adolescents with Neurological Diagnoses. Arch Clin Neuropsychol 2018; 33:247-253. [PMID: 28981565 DOI: 10.1093/arclin/acx067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/12/2017] [Indexed: 12/26/2022] Open
Abstract
Objective Little is known about the validity of computerized cognitive batteries, such as CNS Vital Signs (CNSVS), in pediatric patients. The purpose of this study was to examine convergent and divergent validity of the CNSVS in a clinical pediatric sample with neurological diagnoses. Method Participants included 123 pediatric patients assessed in a tertiary care setting as part of clinical care. CNSVS (Memory, Psychomotor Speed, Reaction Time, Complex Attention, and Cognitive Flexibility domains, and a Neurocognition Index) and paper-and-pencil neuropsychological measures assessing learning, memory, processing speed, reaction time, attention, and executive functioning were administered. Results Most correlations between CNSVS domain scores and neuropsychological measures assessing similar constructs were medium in strength. With the exception of stronger correlations between psychomotor speed tests, correlations between tests of similar constructs were not significantly higher than those between dissimilar constructs. Conclusions These results provide support for validity of the CNSVS battery, but also caution that many abilities are inter-correlated.
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Affiliation(s)
- Vickie Plourde
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marianne Hrabok
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada.,Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Brian L Brooks
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Neurosciences (Brain Injury and Rehabilitation Program), Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
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