Feedback learning and behavior problems after pediatric traumatic brain injury

2016 ◽  
Vol 46 (7) ◽  
pp. 1473-1484 ◽  
Author(s):  
M. Königs ◽  
L. W. E. van Heurn ◽  
R. J. Vermeulen ◽  
J. C. Goslings ◽  
J. S. K. Luitse ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Behavior Problems ◽  
Externalizing Problems ◽  
Parent Ratings ◽  
Pediatric Traumatic Brain Injury ◽  
Learning Context ◽  
Post Injury ◽  
Feedback Learning ◽  
Severe Tbi

BackgroundFeedback learning is essential for behavioral development. We investigated feedback learning in relation to behavior problems after pediatric traumatic brain injury (TBI).MethodChildren aged 6–13 years diagnosed with TBI (n= 112; 1.7 years post-injury) were compared with children with traumatic control (TC) injury (n= 52). TBI severity was defined as mild TBI without risk factors for complicated TBI (mildRF−TBI,n= 24), mild TBI with ⩾1 risk factor for complicated TBI (mildRF+TBI,n= 51) and moderate/severe TBI (n= 37). The Probabilistic Learning Test was used to measure feedback learning, assessing the effects of inconsistent feedback on learning and generalization of learning from the learning context to novel contexts. The relation between feedback learning and behavioral functioning rated by parents and teachers was explored.ResultsNo evidence was found for an effect of TBI on learning from inconsistent feedback, while the moderate/severe TBI group showed impaired generalization of learning from the learning context to novel contexts (p= 0.03,d= −0.51). Furthermore, the mildRF+TBI and moderate/severe TBI groups had higher parent and teacher ratings of internalizing problems (p's⩽ 0.04,d's ⩾ 0.47) than the TC group, while the moderate/severe TBI group also had higher parent ratings of externalizing problems (p= 0.006,d= 0.58). Importantly, poorer generalization of learning predicted higher parent ratings of externalizing problems in children with TBI (p= 0.03,β= −0.21) and had diagnostic utility for the identification of children with TBI and clinically significant externalizing behavior problems (area under the curve = 0.77,p= 0.001).ConclusionsModerate/severe pediatric TBI has a negative impact on generalization of learning, which may contribute to post-injury externalizing problems.

scholarly journals Serum Neurofilament Light as a Biomarker of Traumatic Brain Injury in the Presence of Concomitant Peripheral Injury

2021 ◽  
Vol 16 ◽  
pp. 117727192110534
Author(s):  
Ker Rui Wong ◽  
William T O’Brien ◽  
Mujun Sun ◽  
Glenn Yamakawa ◽  
Terence J O’Brien ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Elevated Serum ◽  
Serum Levels ◽  
Long Bone ◽  
Post Injury ◽  
Neurofilament Light ◽  
Peripheral Injury ◽  
Long Bone Fracture ◽  
Severe Tbi

Introduction: Serum neurofilament light (NfL) is an emerging biomarker of traumatic brain injury (TBI). However, the effect of peripheral injuries such as long bone fracture and skeletal muscle injury on serum NfL levels is unknown. Therefore, the aim of this study was to determine whether serum NfL levels can be used as a biomarker of TBI in the presence of concomitant peripheral injuries. Methods: Rats were randomly assigned to one of four injury groups: polytrauma (muscle crush + fracture + TBI; n = 11); peripheral injuries (muscle crush + fracture + sham-TBI; n = 12); TBI-only (sham-muscle crush + sham-fracture + TBI; n = 13); and triple-sham (n = 7). At 2-days post-injury, serum levels of NfL were quantified using a Simoa HD-X Analyzer. Results: Compared to triple-sham rats, serum NfL concentrations were higher in rats with peripheral injuries-only, TBI-only, and polytrauma. When compared to peripheral injury-only rats, serum NfL levels were higher in TBI-only and polytrauma rats. No differences were found between TBI-only and polytrauma rats. Conclusion: Serum NfL levels did not differ between TBI-only and polytrauma rats, indicating that significant peripheral injuries did not affect the sensitivity and specificity of serum NfL as a biomarker of moderate TBI. However, the finding of elevated serum NfL levels in rats with peripheral injuries in the absence of a TBI suggests that the presence of such injuries may limit the utility of NfL as a biomarker of less severe TBI (eg, concussion).

White Matter Disruption in Pediatric Traumatic Brain Injury: Results from ENIGMA Pediatric Moderate to Severe Traumatic Brain Injury

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012222
Author(s):  
Emily L Dennis ◽  
Karen Caeyenberghs ◽  
Kristen R Hoskinson ◽  
Tricia L Merkley ◽  
Stacy J Suskauer ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
White Matter ◽  
Behavioral Problems ◽  
Child Behavior Checklist ◽  
Injury Severity ◽  
Meta Analysis ◽  
Post Injury ◽  
Severe Tbi ◽  
Future Work

Objective:Our study addressed aims: (1) test the hypothesis that moderate-severe TBI in pediatric patients is associated with widespread white matter (WM) disruption; (2) test the hypothesis that age and sex impact WM organization after injury; and (3) examine associations between WM organization and neurobehavioral outcomes.Methods:Data from ten previously enrolled, existing cohorts recruited from local hospitals and clinics were shared with the ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Pediatric msTBI working group. We conducted a coordinated analysis of diffusion MRI (dMRI) data using the ENIGMA dMRI processing pipeline.Results:Five hundred and seven children and adolescents (244 with complicated mild to severe TBI [msTBI] and 263 controls) were included. Patients were clustered into three post-injury intervals: acute/subacute - <2 months, post-acute - 2-6 months, chronic - 6+ months. Outcomes were dMRI metrics and post-injury behavioral problems as indexed by the Child Behavior Checklist (CBCL). Our analyses revealed altered WM diffusion metrics across multiple tracts and all post-injury intervals (effect sizes ranging between d=-0.5 to -1.3). Injury severity is a significant contributor to the extent of WM alterations but explained less variance in dMRI measures with increasing time post-injury. We observed a sex-by-group interaction: females with TBI had significantly lower fractional anisotropy in the uncinate fasciculus than controls (𝞫=0.043), which coincided with more parent-reported behavioral problems (𝞫=-0.0027).Conclusions:WM disruption after msTBI is widespread, persistent, and influenced by demographic and clinical variables. Future work will test techniques for harmonizing neurocognitive data, enabling more advanced analyses to identify symptom clusters and clinically-meaningful patient subtypes.

Methodological Issues in Longitudinal Research on Cognitive Recovery after Traumatic Brain Injury: Evidence from a Systematic Review

2013 ◽  
Vol 14 (3) ◽  
pp. 450-474 ◽  
Author(s):  
Regina Schultz ◽  
Robyn L. Tate
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Longitudinal Research ◽  
Effect Sizes ◽  
Methodological Issues ◽  
Post Injury ◽  
Cognitive Recovery ◽  
Cognitive Domains ◽  
Severe Tbi

Background: Previous research addressing cognitive recovery after traumatic brain injury (TBI) in adults has predominately used cross-sectional methods. This systematic review examines longitudinal research into cognitive recovery in the first 2 years following moderate-to-severe TBI in adults and aims to identify apparent methodological issues with the existing literature.Design: Systematic review of the first 2 years post-trauma.Setting: Data were extracted from three electronic databases and manual searches of published articles until October 2012.Participants: Two hundred and forty-two participants with severe TBI and 281 comparison participants were used to calculate effect sizes.Results: Twenty papers met the selection criteria, with effect sizes computed from four studies. Moderate-to-large effect sizes were initially observed between the TBI and comparison groups on most measures (range: d = 0.2–2.8). Recovery continued in all five cognitive domains over the 2 years post-injury.Conclusions: Results demonstrated that cognitive recovery was continuous throughout the first 2 years following moderate-to-severe TBI. Findings also indicated different rates of recovery for the specific cognitive domains, highlighting the heterogeneous nature of cognitive recovery after TBI. The review highlighted several methodological issues within the limited existing literature; recommendations were developed to improve the evidence base.

scholarly journals Cognitive development after traumatic brain injury in young children

2009 ◽  
Vol 16 (1) ◽  
pp. 157-168 ◽  
Author(s):  
AIMEE GERRARD-MORRIS ◽  
H. GERRY TAYLOR ◽  
KEITH OWEN YEATES ◽  
NICOLAY CHERTKOFF WALZ ◽  
TERRY STANCIN ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Development ◽  
Young Children ◽  
Family Environment ◽  
Cognitive Skills ◽  
Visual Memory ◽  
Cognitive Outcomes ◽  
Post Injury ◽  
Severe Tbi

AbstractThe primary aims of this study were to examine post-injury cognitive development in young children with traumatic brain injury (TBI) and to investigate the role of the proximal family environment in predicting cognitive outcomes. Age at injury was 3–6 years, and TBI was classified as severe (n = 23), moderate (n = 21), and complicated mild (n = 43). A comparison group of children who sustained orthopedic injuries (OI, n = 117) was also recruited. Child cognitive assessments were administered at a post-acute baseline evaluation and repeated at 6, 12, and 18 months post-injury. Assessment of the family environment consisted of baseline measures of learning support and stimulation in the home and of parenting characteristics observed during videotaped parent–child interactions. Relative to the OI group, children with severe TBI group had generalized cognitive deficiencies and those with less severe TBI had weaknesses in visual memory and executive function. Although deficits persisted or emerged across follow-up, more optimal family environments were associated with higher scores for all injury groups. The findings confirm other reports of poor recovery of cognitive skills following early childhood TBI and suggest environmental influences on outcomes. (JINS, 2010,16, 157–168.)

Examining the Prospective Relationship between Family Affective Responsiveness and Theory of Mind in Chronic Paediatric Traumatic Brain Injury

2016 ◽  
Vol 18 (1) ◽  
pp. 88-101 ◽  
Author(s):  
Nicholas P. Ryan ◽  
Kim Mihaljevic ◽  
Miriam H. Beauchamp ◽  
Cathy Catroppa ◽  
Louise Crossley ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Theory Of Mind ◽  
Childhood And Adolescence ◽  
Post Injury ◽  
Related Factors ◽  
Lesion Location ◽  
Severe Tbi ◽  
The Impact ◽  
Affective Responsiveness

Childhood and adolescence coincide with rapid structural and functional maturation of brain networks implicated in Theory of Mind (ToM); however, the impact of paediatric traumatic brain injury (TBI) on the development of these higher order skills is not well understood. ToM can be partitioned intoconative ToM, defined as the ability to understand how indirect speech acts involving irony and empathy are used to influence the mental or affective state of the listener; andaffective ToM, concerned with understanding that facial expressions are often used for social purposes to convey emotions that we want people to think we feel. In a sample of 84 children with mild-severe TBI and 40 typically developing controls, this study examined the effect of paediatric TBI on affective and conative ToM; and evaluated the respective contributions of injury-related factors (injury severity/lesion location) and non-injury-related environmental variables (socio-economic status (SES)/family functioning) to long-term ToM outcomes. Results showed that the poorest ToM outcomes were documented in association with mild-complicated and moderate TBI, rather than severe TBI. Lesion location and SES did not significantly contribute to conative or affective ToM. Post-injury family affective responsiveness was the strongest and most significant predictor of conative ToM. Results suggest that clinicians should exercise caution when prognosticating based on early clinical indicators, and that group and individual-level outcome prediction should incorporate assessment of a range of injury- and non-injury-related factors. Moreover, the affective quality of post-injury family interactions represents a potentially modifiable risk factor, and might be a useful target for family-centred interventions designed to optimise social cognitive outcomes after paediatric TBI.

Diffusion tensor imaging in moderate-to-severe pediatric traumatic brain injury: changes within an 18 month post-injury interval

2012 ◽  
Vol 6 (3) ◽  
pp. 404-416 ◽  
Author(s):  
Elisabeth A. Wilde ◽  
Kareem W. Ayoub ◽  
Erin D. Bigler ◽  
Zili D. Chu ◽  
Jill V. Hunter ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Diffusion Tensor Imaging ◽  
Brain Injury ◽  
Diffusion Tensor ◽  
Pediatric Traumatic Brain Injury ◽  
Post Injury

Bidirectional child–family influences on outcomes of traumatic brain injury in children

2001 ◽  
Vol 7 (6) ◽  
pp. 755-767 ◽  
Author(s):  
H. GERRY TAYLOR ◽  
KEITH OWEN YEATES ◽  
SHARI L. WADE ◽  
DENNIS DROTAR ◽  
TERRY STANCIN ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Behavior Problems ◽  
Child Behavior ◽  
Structural Equation ◽  
Child Behavior Problems ◽  
Equation Modeling ◽  
Post Injury ◽  
Family Outcomes ◽  
Related Family

Child behavior problems, injury-related family burden, and parent psychological distress were assessed longitudinally over the first year post injury in 40 children with severe traumatic brain injury (TBI), 52 with moderate TBI, and 55 with orthopedic injuries not involving brain insult. Parents rated children's preinjury behavior soon after injury. Postinjury child behavior and family outcomes were assessed at 6- and 12-month follow-ups. Findings from path analysis revealed both direct and indirect effects of TBI on child behavior and family outcomes, as well as cross-lagged child-family associations. Higher parent distress at 6 months predicted more child behavior problems at 12 months, controlling for earlier behavior problems; and more behavior problems at 6 months predicted poorer family outcomes at 12 months, controlling for earlier family outcomes. Support for bidirectional influences is tentative given that limited sample size precluded use of structural equation modeling. The findings nevertheless provide impetus for considering the influences of person-environment interactions on outcomes of TBI. (JINS, 2001, 7, 755–767.)

Treatment of ADHD secondary to traumatic brain injury

2011 ◽  
Vol 26 (S2) ◽  
pp. 1246-1246
Author(s):  
L.J. Irastorza
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Behavioral Problems ◽  
Interpersonal Relations ◽  
Memory Loss ◽  
Extended Period ◽  
Post Injury ◽  
Severe Tbi ◽  
Inhibition Control ◽  
And Behavior

Attention-deficit/hyperactivity disorder secondary to traumatic brain injury (ADHD/TBI) is one of the most common neurobehavioral consequences of TBI, occurring in 20% to 50% of individuals post-injury. Some of the most persistent problems include impairment in memory, attention and concentration, language, executive skills, social judgment, social behavior, and impulsiveness.A female patient is presented with TBI and cognitive symptoms and behavior compatible with ADHD. The treatment with methylphenidate was useful for the behavioral problems. The 23 years old woman suffered 3 years earlier a car accident, causing severe TBI and polytrauma. She was in a coma with a CGS of 4 and 41 days in the intensive care unit. She received rehabilitation and continued to suffer from diplopia and posture alteration, semantic paraphasia, child-like behavior, and neuropsychological problems (reading comprehension, slow mental processing, inhibition control deficit, and memory loss).During her visits to my MHC, she was often euphoric and made inappropriate comments and occasionally became angry. She did not have psychiatric antecedents prior to the TBI. Scales were used to diagnose post-traumatic ADHD. The patient was then treated with methylphenidate. After titration, the dosage reached was 0,3 mg/kg. After 4 months, the child-like behavior disappeared and interpersonal relations became more fluid, with less irritability.Stimulants have frequently been used in the treatment of behavioral and cognitive consequences of TBI in both children and adults. This clinical case demonstrates that the use of methylphenidate is favored for an extended period of time in patients suffering from behavioral and emotional consequences of TBI.

scholarly journals Temporal Lobe Activation Predicts Episodic Memory Following Traumatic Brain Injury

2020 ◽  
Author(s):  
Abbie S. Taing ◽  
Matthew E. Mundy ◽  
Jennie L. Ponsford ◽  
Gershon Spitz
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Episodic Memory ◽  
Temporal Lobe ◽  
Post Injury ◽  
Complex Stimuli ◽  
Neuronal Processes ◽  
Significant Impairment ◽  
Severe Tbi ◽  
Episodic Memories

AbstractThe temporal lobes are critical for episodic memories and are preferentially affected following a traumatic brain injury (TBI). As such, episodic memory difficulties are common following TBI; however, the underlying neural changes that precipitate or maintain these difficulties in the early phase of recovery remains poorly understood. Here, we use functional magnetic resonance imaging (fMRI) to interrogate the relationship of temporal lobe activation in response to face, scene, and animal stimuli. Twenty-five patients with moderate to severe TBI were recruited an average of 2 months’ post-injury and compared with 21 demographically similar healthy controls. Findings indicate that memory for faces was preferentially impaired, compared to scene and animal stimuli. Decreased activity in temporal lobe structures was present for both face (right transverse temporal gyrus) and scene stimuli (right fusiform gyrus), but not for animals. Greater activation in these structures was associated with better long-term recognition. These findings provide evidence to suggest that TBI: a) preferentially affects memory for complex stimuli such as faces and scenes, and b) causes aberrant neuronal processes despite lack of evidence of significant impairment in behavioural performance. The mechanisms underpinning these findings are discussed in terms of differences in strategy use and reduced neural efficiency.

scholarly journals Functional Outcome 6 Months after Severe Traumatic Brain Injury Following Admission to Intensive Care Unit: A Follow-Up Study in Two Neuro-Center Hospitals

2017 ◽  
Vol 16 (1) ◽  
Author(s):  
Norain Abdul Rashid ◽  
Mohd Basri Mat Nor ◽  
Mohamed Saufi Awang ◽  
Salizar Mohamed Ludin
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Outcome ◽  
Sofa Score ◽  
Small Sample ◽  
Post Injury ◽  
Saps Ii ◽  
Saps Ii Score ◽  
Severe Tbi

Introduction: Traumatic brain injury (TBI) is a major medical and socioeconomic problem. Patients with severe TBI shows physical and functional improvement but remain with cognitive and psycho-social problem throughout recovery. Despite all the issues, the impact of TBI on long-term survivors in Malaysia is unknown. The aim of this study is to measure the functional level of ICU survivors with severe TBI within 6 months post injury. Materials and method: A cohort study was employed for this study. 33 participants from Hospital Tengku Ampuan Afzan (HTAA) Kuantan, Pahang and Hospital Sultanah Nur Zahirah (HSNZ) Kuala Terengganu with severe TBI were included in this study. The functional assessment of Glasgow Outcome Scale Extended (GOSE) was measured in all samples within in a 6 month period. Results: The participants mean age was 31.79 with ranged from 16 to 73 years old. The result of this study showed that within 3 months after discharged from the hospital, all the participants still had poor recovery n=33 (100.0%). Meanwhile, at 6 months after discharge from the hospital, n= 16 (48.5%) participants were scored good recovery. In this case, the SOFA and SAPS II score contributed significantly to the prediction (SOFA score p=0.045, SAPS II score p= 0.028) of functional outcome. Conclusion: The functional outcome of severe TBI improved in six months post injury. The SOFA score and SAPS II score become significant predictors for functional outcome in this study. However, there were some limitations to this study, which are small sample size and short follow-up duration. This study emphasized the importance of SOFA and SAPS II score in predicting functional outcome; thus early care plan should be done if severe TBI have higher SOFA or SAPS II score.

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