Memory and Attention Profiles in Pediatric Traumatic Brain Injury (original) (raw)
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Applied neuropsychology. Child, 2015
Recent studies have examined heterogeneous neuropsychological outcomes in childhood traumatic brain injury (TBI) using cluster analysis. These studies have identified homogeneous subgroups based on tests of IQ, memory, and other cognitive abilities that show some degree of association with specific cognitive, emotional, and behavioral outcomes, and have demonstrated that the clusters derived for children with TBI are different from those observed in normal populations. However, the extent to which these subgroups are stable across abilities has not been examined, and this has significant implications for the generalizability and clinical utility of TBI clusters. The current study addressed this by comparing IQ and memory profiles of 137 children who sustained moderate-to-severe TBI. Cluster analysis of IQ and memory scores indicated that a four-cluster solution was optimal for the IQ scores and a five-cluster solution was optimal for the memory scores. Three clusters on each battery...
Recovery in memory function in the first year following TBI in children
Brain Injury, 2002
Primary objective: To examine memory skills, at acute, 6-and 12-monthly stages, following childhood traumatic brain injury (TBI). Research design: Prospective, longitudinal, between-group design, comparing pre-injury and postinjury intellectual and memory measures, across three levels of injury severity. Methods and procedures: Investigation of memory skills in a group of 76 children who had sustained a mild, moderate or severe TBI. Specific tests were used to measure immediate and short-term memory, and more complex multi-trial learning. Main outcomes and results: The severe TBI group exhibited greater deficits on memory tasks, irrespective of modality, in the acute, 6-and 12-month post-injury stages, in comparison to mild and moderate TBI groups. Performance was dependent on both injury severity and task demands. Conclusions: Memory difficulties are present during the acute, 6-and 12-months following childhood TBI. With a clearer understanding of the memory deficits following TBI, appropriate strategies can be taught and interventions implemented for these children.
Neurocognitive outcomes and recovery after pediatric TBI: Meta-analytic review of the literature
Neuropsychology, 2009
Traumatic Brain Injury (TBI) continues to be one of the leading causes of death and disability in the pediatric population. Although the literature on neurocognitive outcomes is relatively rich, studies vary significantly in the methods used to group subjects on several moderating variables, including age at injury, injury severity, and time since injury, making it difficult to combine and summarize the data for comparison. Further complicating this effort is the wide range of measures used to document functional outcomes in key neurocognitive domains. In this meta-analytic review, 28 publications (1988 to 2007) that met inclusion criteria were summarized based on three distinct injury severity and time post injury groups for 14 key neurocognitive domains. Effect sizes were calculated to reflect the extent to which the above groups differed in case-control and case-case studies, as well as address recovery based on longitudinal studies. To the best of our knowledge, this is the first published quantitative summary of the literature on neurocognitive outcomes after pediatric TBI. Limitations of the current state of the literature as well as recommendations for future studies are discussed.
Archives of Clinical Neuropsychology, 2010
Research suggests that IQ profiles identify subgroups of children with traumatic brain injury (TBI) based on sparing and impairment of cognitive abilities, but little information is available regarding whether these subgroups are differentiated on variables that are important for TBI outcome, such as behavioral functioning. The current study examined behavioral disturbances in 123 children with TBI in association with profiles of intellectual abilities identified using cluster analysis. On the basis of prior research, four clusters were hypothesized. Consistent with the hypothesis, cluster analysis identified four IQ clusters in the current sample. Comparisons among the clusters on behavior variables assessed from the Behavioral Assessment System for Children parent ratings indicated significant differences among the four IQ clusters, with the most impaired cluster exhibiting the severest disturbances. Results of the current study indicate that subgroups of children with TBI can be identified using IQ tests and that these subgroups are stable across different samples, and more importantly are moderately associated with behavioral disturbances that persist during the recovery period.
Neurocognitive Evaluation of Mild Traumatic Brain Injury in the Hospitalized Pediatric Population
Annals of Surgery, 2009
Objective: To test the feasibility of inpatient neurocognitive testing and measure the degree of disability in children hospitalized with mild traumatic brain injury (MTBI). Summary Background Data: MTBI is common in the pediatric population. A standardized approach to identify neurocognitive impairment and determine optimal time to return to exertional activities (eg, school, sports) is lacking. Methods: For a 2-year period, children (age: 11-17 years) hospitalized at a level 1 urban Pediatric Trauma Center with MTBI were prospectively enrolled. Neurocognitive performance was assessed utilizing previously validated computer-based tests (Immediate Postconcussion Assessment and Cognitive Testing) as inpatient and in follow-up clinic after discharge. The feasibility of inpatient testing and the degree neurocognitive impairment and symptomatology were assessed. This study was approved by the IRB and registered with clinicaltrials.gov (NCT00715949). Results: For the 2 years of study, 116 subjects were prospectively enrolled and tested. The population had a mean age of 14 years and 69.8% were male. On initial in-hospital testing, the overall population demonstrated considerable neurocognitive deficits (mean values for all 4 subtests below 25th percentile, norm 50%) with at least one subtest score below 25% in 95.7% and an abnormal symptom score in 83.4% of patients. In comparing initial testing to follow-up testing (N ϭ 63), significant improvements were noted for all subtests (verbal memory: 28.0% vs. 37.5%, respectively, norm 50%, P ϭ 0.02; visual memory: 24.9% vs. 38.1%, respectively, norm 50%, P Ͻ 0.01; visual motor: 21.8% vs. 31.1%, respectively, norm 50%, P ϭ 0.01; reaction time: 21.8% vs. 30.3%, respectively, norm 50%, P ϭ 0.05), with a decline in the symptom score (26.9 vs. 9.2, respectively, norm 0-8, P Ͻ 0.01) as well. Patients not seen in follow-up (N ϭ 53) did not differ demographically from those seen in clinic. Conclusions: Inpatient neurocognitive testing was feasible in pediatric MTBI patients. Neurocognitive abnormalities were nearly universally present on initial evaluation with significant improvements demonstrated at the time of outpatient follow-up. Return to activity recommendations are thus best deferred for most hospitalized MTBI children until formal assessment can be performed after discharge.
Parsing neurocognitive heterogeneity in pediatric traumatic brain injury
2007
Parsing Neurocognitive Heterogeneity in Pediatrie Traumatie Brain Injury by Brian Leany, B.A. Dr. Daniel Allen, Examination Committee Chair Associate Professor of Psychology University of Nevada, Las Vegas Traumatic brain injuries (TBI) occur quite frequently in children and adolescents. One difficulty in understanding and treating TBI lies in the heterogeneous nature of its acquisition and mechanism of injury, and the resulting neurocognitive impairment. While there are instruments that exist to identify such impairment, they typically are divided into very broad domains of academic performance. Tests such as the Wechsler Intelligence Scale for Children (WISC) and the Woodcock Johnson are helpful in identifying impairment within the realm of academic aptitude, but have thus far not provided specific enough information as to the impairment of the underlying neurocognitive process that may be causing the degraded performance. In recent years, however, there has been an increase in te...