Predictors and indicators of academic outcome in children 2 years following traumatic brain injury

Within the context of a longitudinal study investigating outcome for children following traumatic brain injury, this paper reports on the utility of neuropsychological testing in predicting academic outcome in children 2 years following traumatic brain injury (TBI). Twenty-nine school-age children who were admitted to hospital after TBI were assessed with a battery of neuropsychological and academic measures at 3 and 24 months postinjury. The neuropsychological battery included measures of memory, learning, and speed of information processing. Academic outcome was assessed in terms of post-TBI change in school placement. According to logistic regression analysis, change in placement from regular to special education at 2 years post-TBI was predicted by injury severity and by neuropsychological performance at 3 months post-TBI. Findings suggest that neuropsychological testing is useful in identifying children with special educational needs subsequent to TBI.     

Attentional skills following traumatic brain injury in childhood: a componential analysis

Recent research has documented residual deficits in attention following traumatic brain injury in childhood. The present study aimed to investigate whether such deficits are global, or affect specific components of attention differentially. Four attentional domains were examined using a newly developed test of attention, the Test of Everyday Attention for Children: sustained attention, focussed attention, divided attention, and response inhibition. Eighteen children with a history of traumatic brain injury, aged between 8 and 14 years, and 18 non-injured matched controls participated in the study. Results indicated that attentional skills may be differentially impaired after TBI, with children who have sustained moderate-to-severe TBI exhibiting significant deficits for sustained and divided attention, and response inhibition, but relatively intact focussed attention.     

Predicting premorbid neuropsychological functioning following pediatric traumatic brain injury

This study examined the prediction of premorbid neuropsychological functioning using data from an ongoing prospective study of traumatic brain injuries (TBI) in children ages 6 to 12 years. Prediction equations were derived based on 80 children with orthopedic injuries (OI), who served as a comparison group for the children with TBI. Collectively, parent ratings of premorbid school performance, maternal ethnicity, family socioeconomic status, and children's word recognition skill predicted from 13% to 45% of the variance in three measures of neuropsychological functioning. The regression equations were used to compute predicted scores among 109 children with TBI. Actual scores fell significantly below predicted scores among children with TBI, and the magnitude of the deficits was correlated with injury severity. Premorbid neuropsychological functioning can be predicted in children with TBI, but with less precision than would be desirable for clinical purposes.     

Brain imaging and its clinical application in psychiatry

The common structural and functional brain imaging techniques are described from a practical, clinical point of view. The clinical indications for brain imaging in psychiatry are reviewed in relation to the specific limitations and advantages of each technique. The clinical applications of computerized tomography (CT), magnetic resonance imaging (MRI) and single photon emission computerized tomography (SPECT) are discussed in relation to the differential diagnosis between organic and functional psychiatric disorders. In a 55-year-old man with late onset of behavioral changes but without neurological signs the application of structural brain imaging (CT and MRI) in case management was demonstrated. The imaging findings involved the differential diagnosis between depression and focal brain lesions. In a 38-year-old man with personality changes and depression following a traumatic brain injury, time interval repeated functional brain imaging (SPECT) was used. Brain imaging reflected improvement in clinical status following treatment and was able to differentiate between reversible and permanent traumatic brain injuries. The superior yield of time interval repeated functional imaging in diagnosis and management of postconcussion syndrome is discussed.     

Predicting longitudinal patterns of functional deficits in children with traumatic brain injury.

Longitudinal patterns of functional deficits were investigated in 37 children with severe traumatic brain injury (TBI), 40 children with moderate TBI, and 44 children with orthopedic injuries. They were from 6 to 12 years of age when injured. Their neuropsychological, behavioral, adaptive, and academic functioning were assessed at 6 months, 12 months, and 3–5 years postinjury. Functional deficits (     

A prospective study of short- and long-term outcomes after traumatic brain injury in children: Behavior and achievement.

Longitudinal behavior and achievement outcomes of traumatic brain injury (TBI) were investigated in 53 children with severe TBI, 56 children with moderate TBI, and 80 children with orthopedic injuries not involving brain insult. Measures of preinjury child and family status and of postinjury achievement skills were administered shortly after injury. Assessments were repeated 3 times across a mean follow-up interval of 4 years. Results from mixed model analysis revealed persisting sequelae of TBI. Recovery of math skills was observed in the severe TBI group but only for children from less stressed families. Social disadvantage in children with TBI predicted more adverse behavioral sequelae and less favorable changes in some outcome measures. The findings suggest that pediatric TBI has long-term effects on behavior and achievement but that postinjury progress is influenced by the family environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of parental traumatic brain injury on the behaviour of parents and children

Little is known about the effects of a parent's brain injury and subsequent disabilities on the children in the family. This study examines 24 families in which one parent is brain injured. In each family the children were born before the parent's injury and still lived at home at the time of interview. Reports of the uninjured parent indicate that most of the children experienced some degree of negative behavioural change after the parent's injury. In 10 of the families, significant and problematic changes occurred. Types of problems included poor relationship with the injured parent, acting-out behaviour and emotional problems. Correlates of poor outcomes for the children were: (1) injured parent's gender, (2) compromised parenting performance of the injured parent, (3) compromised parenting performance of the uninjured parent and (4) depression in the uninjured parent. This study points to the importance of recognizing traumatic brain injury as a major family stressor.     

Open capsulorrhaphy with suture anchors for recurrent anterior dislocation of the shoulder

OBJECTIVE: The aim of this study was to index the frequency of occurrence of acute stress disorder following mild traumatic brain injury and to determine its utility in predicting posttraumatic stress disorder (PTSD). METHOD: Consecutive adult patients who sustained a mild traumatic brain injury following a motor vehicle accident (N = 79) were assessed for acute stress disorder within 1 month of their trauma with the Acute Stress Disorder Inventory, a structured clinical interview based on DSM-IV criteria. Patients were followed up 6 months after the trauma (N = 63) and were administered the PTSD module of the Composite International Diagnostic Interview. RESULTS: Acute stress disorder was diagnosed in 14% of patients, and at follow-up 24% satisfied criteria for PTSD. Six months after the trauma PTSD was diagnosed in 82% of patients who had been diagnosed with acute stress disorder and in 11% of those who had not been diagnosed with acute stress disorder. CONCLUSIONS: These findings point to the frequency of PTSD following mild traumatic brain injury. While the criteria for acute stress disorder are useful in identifying those individuals who are at risk of developing chronic PTSD, the findings suggest that current criteria require modification in order to optimally predict PTSD following mild traumatic brain injury.     

Misconceptions about traumatic brain injury among educators and rehabilitation staff: A comparative study.

This study compared the responses of 184 educators and 111 rehabilitation specialists on a measure of knowledge about childhood traumatic brain injury (TBI). Educators displayed more misconceptions about TBI overall compared to rehabilitation staff. They underestimated the effect of TBI on cognition, behavior, and continued development. More specifically, educators showed more misconceptions than the rehabilitation staff in the following areas: coma, memory and new learning, anger management, and factors affecting recovery. An important task for rehabilitation staff members is to clarify educator misconceptions about TBI as children transition to school. Information provided should increase the level of teacher preparation and help to maximize children's academic success and adaptation following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Soluble adhesion molecules in CSF are increased in children with severe head injury

Leukocyte-endothelial adhesion molecules, critical to the development of acute inflammation, are expressed in brain as part of the acute inflammatory response to traumatic brain injury (TBI). We measured the concentrations of the adhesion molecules P-selectin, ICAM-1, E-selectin, L-selectin, and VCAM-1 in ventricular cerebrospinal fluid (CSF) from children with severe TBI (Glasgow coma score < 8) and compared these findings with those from children with bacterial meningitis. P-selectin, an adhesion molecule associated with ischemia/reperfusion, was increased in children with TBI versus meningitis and control. Univariate and multivariate regression analyses demonstrated associations between CSF P-selectin and child abuse and age of < 4 years, and a significant, independent association between CSF intercellular adhesion molecule-1 (ICAM-1) and child abuse. These results are consistent with a specific acute inflammatory component to TBI in children. Future studies of secondary injury mechanisms and therapy after TBI should assess on the roles of P-selectin and ICAM-1 in injury and repair processes in brain after TBI.     

Sexually abused children's perceptions: How they may change treatment focus.

The purpose of this study was to assess differences in sexually abused children's self-concept and experiences of traumatic symptoms and to qualitatively examine the manner in which standardized assessment instruments could be used by therapists for treatment planning and case management. The results of this study suggest that not all sexually abused children have the same perceived level of self-concept, social support, or traumatic symptoms. Sexually abused children who had high self concept had higher perceived levels of social support. Use of the formal assessments assisted therapists in developing individualized treatment plans. Implications of this study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pediatric head injuries and deaths from bicycling in the United States

OBJECTIVE: To estimate the potential benefit of increasing bicycle helmet use among children and adolescents in the United States. DESIGN: All bicycle-related deaths (Multiple Cause-of-Death Public Use Data Tapes, 1989 through 1992) and bicycle-related injuries treated in sampled emergency departments (National Electronic Injury Surveillance System, 1989 through 1993) were used to calculate traumatic brain injury-associated death and head injury rates per 1,000,000 US residents. Preventable injuries and deaths were estimated by calculating the population-attributable risk of head injury due to nonuse of bicycle helmets. PATIENTS: US residents aged 0 through 19 years who were injured or who died as a result of a bicycle crash. RESULTS: An average of 247 traumatic brain injury deaths and 140,000 head injuries among children and adolescents younger than 20 years were related to bicycle crashes each year in the United States. As many as 184 deaths and 116,000 head injuries might have been prevented annually if these riders had worn helmets. An additional 19,000 mouth and chin injuries were treated each year. The youngest age groups had the highest proportions of both head and mouth injuries. CONCLUSION: There continues to be a need to advocate for greater use of bicycle helmets, particularly among young children. Helmet design changes should be considered to prevent mouth injuries.     

Implicit and Explicit Memory in Children With Congenital and Acquired Brain Disorder.

Implicit and explicit memory were examined in 8- to 15-year-old children with myelomeningocele and shunted hydrocephalus, severe traumatic brain injuries, or orthopedic injuries. Each group included between 22 and 29 children. Children completed a fragmented picture identification task to assess perceptual priming and a semantic decision-making task to assess conceptual priming. Each task also assessed procedural learning as well as explicit recall and recognition. All 3 groups showed significant perceptual and semantic priming of similar magnitude. In contrast, both brain-disordered groups displayed poorer explicit memory than did the comparison group. No group showed significant procedural learning on either task. Age and IQ were stronger predictors of explicit recall than of implicit memory. The findings indicate that implicit memory is relatively intact in many children with congenital and acquired brain disorders, despite deficits in explicit memory, and support the existence of separate memory systems in children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing participation bias in a sexual behaviour survey: implications for measuring HIV risk

PURPOSE: To determine risk factors for secondary hemorrhage and poor visual outcome in children with traumatic hyphemas. METHODS: We reviewed 99 eyes of 97 children younger than 18 years who had been hospitalized for hyphema within 48 hours of blunt eye trauma. Inpatient records were examined for race, age, sickle cell trait status, size of hyphema and intraocular pressure at admission, secondary hemorrhage (rebleed of hyphema), and medications while hospitalized. Fifty-five eyes of 53 children had at least 1 month of follow-up or attained best-corrected visual acuity of 20/50 or better at their last outpatient visit. RESULTS: Among 99 eyes of 97 children with traumatic hyphema, secondary hemorrhage occurred in nine eyes (9%). Among 72 eyes of 70 African-American children, secondary hemorrhage occurred in nine eyes (14%), whereas in 27 eyes of 27 white children, there were no secondary hemorrhages. However, when the 14 eyes of 13 sickle cell trait-positive children were excluded from the African-American group, the 57 eyes of sickle cell trait-negative African-American and white children did not have any secondary hemorrhages. The sickle cell trait-positive group had secondary hemorrhages in nine of 14 eyes (64%), significantly (P < .005) different from the 0% rate in the 57 eyes of African-American sickle cell trait-negative and white children. The sickle cell trait-positive group also had higher intraocular pressure and permanent visual impairment. CONCLUSION: Sickle cell trait is a significant risk factor for secondary hemorrhage, increased intraocular pressure, and permanent visual impairment in children who have traumatic hyphemas following blunt trauma.     

Factor structure of the WISC-R in children with traumatic brain injury

The factor structure of the WISC-R was examined in a sample of 108 children with traumatic brain injury. Principal factor analysis of 11 WISC-R subtests yielded three factors, which were subjected to varimax rotation. The rotated factor pattern suggested the existence of a Verbal Comprehension factor, a Perceptual Organization factor, and a somewhat weaker third factor. The meaning and implications of this third factor are discussed.     

Teaching medical students about the appropriateness of social and sexual contact between doctors and their patients: evaluation of a programme

Children exposed to traumatic stress are vulnerable to a variety of stress-related disorders other than classical post-traumatic stress disorder. Several case histories are presented to illustrate some of the diversity of how traumatic stress may manifest in children. African-American children are the main focus of this article as political, economic, social, and morbidity and mortality indicators suggest that African-American children are at high risk for exposure to potentially traumatic stressors. Different presentations of traumatic, stress are discussed in an effort to broaden our understanding of the outcome of traumatic stress to fully help traumatized children.     

Cerebral physiology in paediatric cardiopulmonary bypass

PURPOSE: To analyze studies of neurological injury after open-heart surgery in infants and children and to discuss the effects of cardiopulmonary bypass, hypothermia and deep hypothermic circulatory arrest on cerebral blood flow, cerebral metabolism and brain temperature. SOURCE: Articles were obtained from the databases, Current Science and Medline, from 1966 to present. Search terms include cardiopulmonary bypass (CPB), hypothermia, cerebral blood flow (CBF), cerebral metabolism and brain temperature. Information and abstracts obtained from meetings on the topic of brain and cardiac surgery helped complete the collection of information. PRINCIPAL FINDINGS: In adults the incidence of neurological morbidity is between 7 to 87% with stroke in about 2-5%, whereas the incidence of neurological morbidity increases to 30% in infants and children undergoing cardiopulmonary bypass. Besides the medical condition of the patient, postoperative cerebral dysfunction and neuronal ischaemia associated with cardiac surgery in infants and small children are a combination of intraoperative factors. Deep hypothermic circulatory arrest impairs CBF and cerebral metabolism even after termination of CPB. Inadequate and/or non-homogenous cooling of the brain before circulatory arrest, as well as excessive rewarming of the brain during reperfusion are also major contributory factors. CONCLUSION: Newer strategies, including the use of low-flow CPB, pulsatile CPB, pH-stat acid-base management and a cold reperfusion, are being explored to ensure better cerebral protection. Advances in monitoring technology and better understanding of the relationship of cerebral blood flow and metabolism during the different modalities of cardiopulmonary bypass management will help in the medical and anaesthetic development of strategies to improve neurological and developmental outcomes.     

Neuropsychological Status and Social Problem Solving in Children With Congenital or Acquired Brain Dysfunction.

Objective: To describe the associations between neuropsychological variables and social problem-solving skills in children with congenital versus acquired brain dysfunction. Participants: Twenty-two children and adolescents with cerebral palsy or myelomeningocele (developmental condition, or DC) and 22 with history of traumatic brain injury (TBI), ages 7-12 years, IQ>70. Measures: Social Problem-Solving Measure (SPSM), Video Cues and Consequences (VCC), and brief motor-free neuropsychological assessment. Results: The DC group generated significantly fewer solutions to hypothetical problematic social scenarios than the TBI group, but differences in the relative frequencies of solution types were minimal. The pattern of associations between neuropsychological and social problem-solving variables differed between groups. Conclusions: Neuropsychological status may contribute to development and expression of aspects of social skills, but there may be subtle differences in the nature of that contribution in children with congenital versus acquired brain lesions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Linguistic competence in paediatric closed head injury

The purpose of this investigation was to examine the effects of age at onset of traumatic brain injury on the linguistic competence of children and adolescents who sustained closed head injuries (CHI) that cause diffuse brain damage. The Test of Language Competence-Expanded Edition (TLC-E), a standardized test of subtle language abilities, was administered to 20 children who sustained severe CHI. The study determined whether 10 subjects who experienced CHI at a pre-adolescent age (4 to 11 years) and 10 subjects who experienced CHI at an adolescent age (13 to 18 years) showed quantitative differences in linguistic competence as measured by the TLC-E Test. The language abilities of children in both groups were compared to determine whether there were trends in performance relative to age of onset or type of subtest. In addition, experimental subjects' performance was compared to the normative population used to standardize the TLC-E. Hypotheses were constructed according to separate developmental and pathophysiological perspectives.     

Use of intraocular lenses in children with traumatic cataract in south India

AIMS: To assess the long term results of intraocular lens (IOL) implantation for traumatic cataract in young children in a developing country. METHODS: Prospective hospital based study of 52 children (age 2-10 years) undergoing unilateral cataract extraction and IOL insertion for traumatic cataract performed by a single surgeon in south India. Children were reviewed regularly and followed up initially for 3 years. RESULTS: There were no serious operative complications. Clinically significant posterior capsule opacification was almost universal (92%) and YAG capsulotomy or membranectomy was performed on 48 eyes. Some degree of pupil capture affected 35% of eyes and was complete in 6%. Visual acuity was 6/12 or better in 67% of eyes at the last follow up examination. CONCLUSION: The visual acuity results 3 years after implantation of posterior chamber IOLs in older children with traumatic cataracts in south India were encouraging. In developing countries where follow up is unreliable it is essential to plan to clear the axial part of the posterior capsule either at the time of surgery or soon afterwards.