Journal of Pediatric Rehabilitation Medicine - Volume 2, issue 4
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Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach is an international journal designed to parallel the multi-disciplinary team approach of caring for a child with an acute or chronic disease. The issues will primarily be themed and broad in scope including, but not be limited to cerebral palsy, traumatic brain injury, spinal cord injury, spina-bifida, amputation, muscular dystrophies of all types, stroke, cancer, mental retardation, developmental delays, and others.
The aim is to include a wide range of experts who care for children with the above diagnosis. Authorship by two different disciplines is requested though not required to encourage an interdisciplinary and collaborative approach. The goal is for the reader to obtain not just the medical perspective, but also nursing, occupational, physical and speech therapy, psychology, home care, etc., in providing the most comprehensive care for children. Manuscripts will be blinded and peer reviewed with appropriate feedback. Statistical analysis will be reviewed by the biostatistician. Readers are encouraged to submit and or suggest case reviews, commentaries, editorials, original research, conference schedules, or reviews.
Abstract: Children with traumatic brain injury (TBI) often experience memory deficits, although the nature, functional implication, and recovery trajectory of such difficulties are poorly understood. The present fMRI study examined the neural activation patterns in a group of young children who sustained moderate TBI in early childhood (n=7), and a group of healthy control children (n=13) during a verbal paired associate learning (PAL) task that promoted the use of two mnemonic strategies differing…in efficacy. The children with TBI demonstrated intact memory performance and were able to successfully utilize the mnemonic strategies. However, the TBI group also demonstrated altered brain activation patterns during the task compared to the control children. These findings suggest early childhood TBI may alter activation within the network of brain regions supporting associative memory even in children who show good behavioral performance.
Abstract: Objective: Examine relationships of diffusion tensor imaging (DTI) fractional anisotropy (FA) to executive function (EF) and attention measures following early childhood (3–7 years) traumatic brain injury (TBI). Design: Exploratory correlation and comparison study. Setting: Children's hospital outpatient facilities. Participants: 9 children with a history of TBI (age=7.89 ± 1.00~years; Glasgow Coma Scale (GCS)= 10.11 ± 4.68) were compared to 12 children with OI (age=7.51 ± 0.95). All children were at least 12 months post…injury at time of evaluation. Main Outcome Measures: FA in various regions of interest (ROI), EF and attention measures. Results: FA values primarily in the frontal white matter tracks correlated with EF measures. Separate tasks of inhibition and switching correlated significantly with FA in bilateral frontal lobes. Tasks combining both inhibition and switching correlated significantly with FA values in the left frontal lobe. Tasks of attention negatively correlated with FA values in the right frontal white matter and the superior longitudinal fasciculus. Conclusions: Associations between late measurement of FA and EF measures following early childhood TBI suggest that persistent white matter changes, especially in the frontal white matter, may provide an index of EF deficits.
Keywords: Brain injuries, child, diffusion magnetic resonance imaging, neuropsychology
Abstract: Objective: To examine social information processing (SIP) skills, behavior problems, and social competence following adolescent TBI and to determine whether SIP skills were predictive of behavior problems and social competence. Design: Cross-sectional analyses of adolescents with TBI recruited and enrolled in a behavioral treatment study currently in progress. Setting: Two tertiary care children's hospitals with Level 1 trauma centers. Participants: Adolescents aged 11 to 18 years with severe TBI (n=19) and…moderate TBI (n=24) who were injured up to 24 months prior to recruitment. Assessment of risk factors: TBI severity, race, maternal education, and age at testing. Main outcome measurements: a measure of SIP skills, Child Behavior Checklist (CBCL), Youth Self Report (YSR), and Home and Community Social Behavior Scale (HCSBS). Results: The severe TBI group did not obtain significantly lower scores on the SIP measures than the moderate TBI group. In comparison to adolescents with moderate TBI, those with severe TBI had significantly more parent-reported externalizing behaviors and self-reported weaknesses in social competence. SIP skills were strong predictors of problems and social competence in adolescents with TBI. More specifically, an aggressive SIP style predicted externalizing problems and a passive SIP style predicted internalizing problems. Both passive and aggressive SIP skills were related to social competence and social problems. Conclusions: Adolescents with TBI are at risk for deficits in social and behavioral outcomes. SIP skills are strongly related to behavior problems and social competence in adolescents with TBI. SIP skills, social competence, and behavior problems are important targets for intervention that may be amenable to change and lead to improved functional outcomes following TBI.
Abstract: After pediatric traumatic brain injury (TBI), early prognosis of expected function is important for optimizing care. The power of several common brain injury severity measures for predicting functional outcome in children with TBI was investigated; the severity variables studied were Glasgow Coma Scale (GCS) score, time to follow commands (TFC), duration of post-traumatic amnesia (PTA), and total duration of impaired consciousness (TFC+PTA). Outcome was assessed using the Functional Independence Measure for Children…(WeeFIM) at discharge from inpatient rehabilitation (n=120) and, in a subset of children, at 3 months following discharge. Correlations and multiple linear regression analyses were conducted using GCS, TFC, PTA, and TFC+PTA to predict age-corrected WeeFIM scores. Models in which TFC and PTA duration were entered as separate variables and as a combined variable (TFC+PTA) were all significantly predictive of WeeFIM scores at discharge; however, TFC accounted for the greatest portion of variance in WeeFIM scores. Among children with moderate to severe TBI who received inpatient rehabilitation, TFC was the best predictor of general functional outcome at discharge and follow-up. Our findings highlight the need for careful and consistent assessment of TFC to assist in predicting functional outcomes as early and accurately as possible.
Abstract: Acquired brain injury from traumatic brain injury, cardiac arrest (CA), stroke, and central nervous system infection is a leading cause of morbidity and mortality in the pediatric population and reason for admission to inpatient rehabilitation. Therapeutic hypothermia is the only intervention shown to have efficacy from bench to bedside in improving neurological outcome after birth asphyxia and adult arrhythmia-induced CA, thought to be due to its multiple mechanisms of action. Research to determine if therapeutic hypothermia…should be applied to other causes of brain injury and how to best apply it is underway in children and adults. Changes in clinical practice in the hospitalized brain-injured child may have effects on rehabilitation referral practices, goals and strategies of therapies offered, and may increase the degree of complex medical problems seen in children referred to inpatient rehabilitation.