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Drury KM, Hall TA, Orwoll B, Adhikary S, Kirby A, Williams CN. Exposure to Sedation and Analgesia Medications: Short-term Cognitive Outcomes in Pediatric Critical Care Survivors With Acquired Brain Injury. J Intensive Care Med 2024; 39:374-386. [PMID: 37885235 PMCID: PMC11132562 DOI: 10.1177/08850666231210261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background/Objective: Pediatric intensive care unit (PICU) survivors risk significant cognitive morbidity, particularly those with acquired brain injury (ABI) diagnoses. Studies show sedative and analgesic medication may potentiate neurologic injury, but few studies evaluate impact on survivor outcomes. This study aimed to evaluate whether exposures to analgesic and sedative medications are associated with worse neurocognitive outcome. Methods: A retrospective cohort study was conducted of 91 patients aged 8 to 18 years, undergoing clinical neurocognitive evaluation approximately 1 to 3 months after PICU discharge. Electronic health data was queried for sedative and analgesic medication exposures, including opioids, benzodiazepines, propofol, ketamine, and dexmedetomidine. Doses were converted to class equivalents, evaluated by any exposure and cumulative dose exposure per patient weight. Cognitive outcome was derived from 8 objective cognitive assessments with an emphasis on executive function skills using Principal Components Analysis. Then, linear regression was used to control for baseline cognitive function estimates to calculate a standardized residualized neurocognitive index (rNCI) z-score. Multivariable linear regression evaluated the association between rNCI and medication exposure controlling for covariates. Significance was defined as P < .05. Results: Most (n = 80; 88%) patients received 1 or more study medications. Any exposure and higher cumulative doses of benzodiazepine and ketamine were significantly associated with worse rNCI in bivariate analyses. When controlling for Medicaid, preadmission comorbid conditions, length of stay, delirium, and receipt of other medication classes, receipt of benzodiazepine was associated with significantly worse rNCI (β-coefficient = -0.48, 95% confidence interval = -0.88, -0.08). Conclusions: Exposure to benzodiazepines was independently associated with worse acute phase cognitive outcome using objective assessments focused on executive function skills when controlling for demographic and illness characteristics. Clinician decisions regarding medication regimens in the PICU may serve as a modifiable factor to improve outcomes. Additional inquiry into associations with long-term cognitive outcome and optimal medication regimens is needed.
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Affiliation(s)
- Kurt M. Drury
- Department of Pediatrics, Division of Critical Care, Oregon Health & Science University
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health & Science University
| | - Benjamin Orwoll
- Department of Pediatrics, Division of Critical Care, Oregon Health & Science University
| | - Sweta Adhikary
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University
- School of Medicine, Oregon Health and Science University
| | - Aileen Kirby
- Department of Pediatrics, Division of Critical Care, Oregon Health & Science University
| | - Cydni N. Williams
- Department of Pediatrics, Division of Critical Care, Oregon Health & Science University
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University
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2
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Brandt AE, Rø TB, Finnanger TG, Hypher RE, Lien E, Lund B, Catroppa C, Andersson S, Risnes K, Stubberud J. Intelligence and executive function are associated with age at insult, time post-insult, and disability following chronic pediatric acquired brain injury. Front Neurol 2024; 14:1192623. [PMID: 38249741 PMCID: PMC10796693 DOI: 10.3389/fneur.2023.1192623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
Background Pediatric acquired brain injury (pABI) profoundly affects cognitive functions, encompassing IQ and executive functions (EFs). Particularly, young age at insult may lead to persistent and debilitating deficits, affecting daily-life functioning negatively. This study delves into the intricate interplay of age at insult, time post-insult, and their associations with IQ and EFs during chronic (>1 year) pABI. Additionally, we investigate cognitive performance across different levels of global function, recognizing the multifaceted nature of developmental factors influencing outcomes. Methods Drawing upon insult data and baseline information analyzing secondary outcomes from a multicenter RCT, including comprehensive medical and neuropsychological assessments of participants aged 10 to 17 years with pABI and parent-reported executive dysfunctions. The study examined associations between age at insult (early, EI; ≤7y vs. late, LI; > 7y) and time post-insult with IQ and EFs (updating, shifting, inhibition, and executive attention). Additionally, utilizing the Pediatric Glasgow Outcome Scale-Extended, we explored cognitive performance across levels of global functioning. Results Seventy-six participants, median 8 years at insult and 5 years post-insult, predominantly exhibiting moderate disability (n = 38), were included. Notably, participants with LI demonstrated superior IQ, executive attention, and shifting compared to EI, [adjusted mean differences with 95% Confidence Intervals (CIs); 7.9 (1.4, 14.4), 2.48 (0.71, 4.24) and 1.73 (0.03, 3.43), respectively]. Conversely, extended post-insult duration was associated with diminished performances, evident in mean differences with 95% CIs for IQ, updating, shifting, and executive attention compared to 1-2 years post-insult [-11.1 (-20.4, -1.7), -8.4 (-16.7, -0.1), -2.6 (-4.4, -0.7), -2.9 (-4.5, -1.2), -3.8 (-6.4, -1.3), -2.6 (-5.0, -0.3), and -3.2 (-5.7, -0.8)]. Global function exhibited a robust relationship with IQ and EFs. Conclusion Early insults and prolonged post-insult durations impose lasting tribulations in chronic pABI. While confirmation through larger studies is needed, these findings carry clinical implications, underscoring the importance of vigilance regarding early insults. Moreover, they dispel the notion that children fully recover from pABI; instead, they advocate equitable rehabilitation offerings for pABI, tailored to address cognitive functions, recognizing their pivotal role in achieving independence and participation in society. Incorporating disability screening in long-term follow-up assessments may prove beneficial.
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Affiliation(s)
- Anne Elisabeth Brandt
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torstein B. Rø
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torun G. Finnanger
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ruth E. Hypher
- Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Espen Lien
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bendik Lund
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cathy Catroppa
- Brain and Mind, Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Psychology, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | | | - Kari Risnes
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jan Stubberud
- Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
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Larson KR, Demers LA, Holding EZ, Williams CN, Hall TA. Variability Across Caregiver and Performance-Based Measures of Executive Functioning in an Acute Pediatric Neurocritical Care Population. Neurotrauma Rep 2023; 4:97-106. [PMID: 36895819 PMCID: PMC9989517 DOI: 10.1089/neur.2022.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Youth admitted to the pediatric intensive care unit (PICU) for traumatic brain injury (TBI) commonly struggle with long-term residual effects in the domains of physical, cognitive, emotional, and psychosocial/family functioning. In the cognitive domain, executive functioning (EF) deficits are often observed. The Behavior Rating Inventory of Executive Functioning, Second Edition (BRIEF-2) is a parent/caregiver-completed measure that is regularly utilized to assess caregivers' perspectives of daily EF abilities. Using parent/caregiver-completed measures like the BRIEF-2 in isolation as outcome measures for capturing symptom presence and severity might be problematic given that caregiver ratings are vulnerable to influence from external factors. As such, this study aimed to investigate the association between the BRIEF-2 and performance-based measures of EF in youth during the acute recovery period post-PICU admission for TBI. A secondary aim was to explore associations among potential confounding factors, including family-level distress, injury severity, and the impact of pre-existing neurodevelopmental conditions. Participants included 65 youths, 8-19 years of age, admitted to the PICU for TBI, who survived hospital discharge and were referred for follow-up care. Non-significant correlations were found between BRIEF-2 outcomes and performance-based measures of EF. Measures of injury severity were strongly correlated with scores from performance-based EF measures, but not BRIEF-2. Parent/caregiver-reported measures of their own health-related quality of life were related to caregiver responses on the BRIEF-2. Results demonstrate the differences captured by performance-based versus caregiver-report measures of EF, and also highlight the importance of considering other morbidities related to PICU admission.
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Affiliation(s)
- Kera R Larson
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Lauren A Demers
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Emily Z Holding
- Developmental Medical Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Cydni N Williams
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Trevor A Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
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Byom LJ, Whalen M, Turkstra LS. Working Memory for Emotions in Adolescents and Young Adults with Traumatic Brain Injury. BRAIN IMPAIR 2022; 22:296-310. [PMID: 36703704 PMCID: PMC9873224 DOI: 10.1017/brimp.2021.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This preliminary study investigated the interaction between working memory and social cognition in adolescents and young adults with traumatic brain injury (TBI). It was hypothesized that participants with or without TBI would better recognize social information when working memory or social cognitive load was low, and that adolescents and young adults with TBI would be more affected by increased cognitive demand than their uninjured peers. Eight adolescents and young adults with complicated mild-severe TBI (aged 14-22 years) and eight age- and sex-matched typically developing (TD) adolescents completed computer-based n-back tasks requiring recognition of either face identity or facial affect, with 0-back, 1-, and 2-back conditions. The TBI group had lower scores overall than the TD group, and scores for both groups were lower for affect recognition than identity recognition. Scores for both groups were lower in conditions with a higher working memory load. There was a significant group-by-working memory interaction, with larger group differences in high-working memory conditions. Study results and their potential implications for social outcomes are discussed.
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Affiliation(s)
- Lindsey J Byom
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
| | - Meaghan Whalen
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
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Crumlish L, Wallace SJ, Copley A, Rose TA. Exploring the measurement of pediatric cognitive-communication disorders in traumatic brain injury research: A scoping review. Brain Inj 2022; 36:1207-1227. [PMID: 36303459 DOI: 10.1080/02699052.2022.2111026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To synthesize information about the constructs measured, measurement instruments used, and the timing of assessment of cognitive-communication disorders (CCDs) in pediatric traumatic brain injury (TBI) research. METHODS AND PROCEDURES Scoping review conducted in alignment with Arksey and O'Malley's five-stage methodological framework and reported per the PRISMA extension for Scoping Reviews. Inclusion criteria: (a) cohort description, case-control, and treatment studies; (b) participants with TBI aged 5-18 years; (c) communication or psychosocial outcomes; and (d) English full-text journal articles. The first author reviewed all titles, abstracts, and full-text articles; 10% were independently reviewed. OUTCOMES AND RESULTS Following screening, a total of 687 articles were included and 919 measurement instruments, measuring 2134 unique constructs, were extracted. The Child Behavior Checklist was the most used measurement instrument and 'Global Outcomes/Recovery' was the construct most frequently measured. The length of longitudinal monitoring ranged between ≤3 months and 16 years. CONCLUSIONS AND IMPLICATIONS We found considerable heterogeneity in the constructs measured, the measurement instruments used, and the timing of CCD assessment in pediatric TBI research. A consistent approach to measurement may support clinical decision-making and the efficient use of data beyond individual studies in systematic reviews and meta-analyses.
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Affiliation(s)
- Lauren Crumlish
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Queensland Aphasia Research Centre, Australia
| | - Anna Copley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Tanya A Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Queensland Aphasia Research Centre, Australia
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Sleep and Executive Functioning in Pediatric Traumatic Brain Injury Survivors after Critical Care. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050748. [PMID: 35626925 PMCID: PMC9139390 DOI: 10.3390/children9050748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022]
Abstract
Over 50,000 children are hospitalized annually for traumatic brain injury (TBI) and face long-term cognitive morbidity. Over 50% develop sleep/wake disturbances (SWDs) that can affect brain development and healing. We hypothesized SWDs would portend worse executive function outcomes in children aged 3−18 years with TBI 1−3 months after hospital discharge. SWDs were defined using the Sleep Disturbances Scale for Children (t-scores ≥ 60). Outcomes included the Global Executive Composite (GEC, t-score) from the Behavior Rating Inventory of Executive Function, Second and Preschool Editions, and multiple objective executive function assessments combined through Principal Components Analysis into a Neurocognitive Index (NCI, z-score). Multiple linear regression evaluated associations between SWDs and executive function outcomes, controlling for covariates. Among 131 children, 68% had clinically significant SWDs, which were associated with significantly worse median scores on the GEC (56 vs. 45) and NCI (−0.02 vs. 0.42; both p < 0.05). When controlling for baseline characteristics and injury severity in multivariable analyses, SWDs were associated with worse GEC (β-coefficient = 7.8; 95% Confidence Interval = 2.5, 13.1), and worse NCI (β-coefficient = −0.4; 95% Confidence Interval = −0.8, −0.04). SWDs in children with TBI are associated with worse executive function outcomes after hospital discharge, and may serve as modifiable targets to improve outcomes.
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Câmara-Costa H, Viot S, Francillette L, Opatowski M, Toure H, Brugel D, Laurent-Vannier A, Meyer P, Watier L, Dellatolas G, Chevignard M. Memory functioning 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l'Enfant study. J Neuropsychol 2021; 16:183-210. [PMID: 33856121 DOI: 10.1111/jnp.12247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore memory functioning 7 years after severe paediatric traumatic brain injury (TBI), associated factors, and relationships with other outcomes. METHOD Children aged 0-15 years (n = 65), consecutively admitted over a 3-year period in a single trauma centre, who survived after severe non-inflicted TBI, were included in a prospective longitudinal study. Memory assessments were performed 7 years post-injury using the Children's Memory Scale or the Wechsler Memory Scale (WMS IV), according to age. The General Memory Score (GMS-7) was the primary outcome. RESULTS Thirty-seven patients were available for assessment at 7 years post-injury. Mean GMS-7 was in the low average range (M = 84.9, SD = 12.1). Lower GMS-7 was significantly associated with markers of higher injury severity, such as length of coma. One year post-injury functional and disability outcomes explained 74% of the variance of GMS-7. Concurrent intellectual ability and type of ongoing education correlated strongly with GMS-7. Age at injury and parental education were not associated with memory outcome. CONCLUSIONS Memory functioning is variable but often strongly impaired several years after severe paediatric TBI, and is mostly related to injury severity, functional outcomes measured 1 year post-injury, and concomitant cognitive and educational outcomes. GMS-7 was lower at 7 years than one year post-injury, supporting the importance of long term follow-up.
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Affiliation(s)
- Hugo Câmara-Costa
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France.,Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCre), Paris, France
| | - Solène Viot
- Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France.,Physical and Rehabilitation Medicine Unit, Bordeaux University Hospital, Bordeaux, France
| | - Leila Francillette
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France
| | - Marion Opatowski
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM. UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Hanna Toure
- Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Dominique Brugel
- Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Anne Laurent-Vannier
- Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Philippe Meyer
- Pediatric Anesthesiology Department, Hôpital Necker Enfants Malades, Paris, France.,Faculté de Médecine René Descartes, Université Paris 5, Paris, France
| | - Laurence Watier
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM. UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Georges Dellatolas
- Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCre), Paris, France
| | - Mathilde Chevignard
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France.,Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCre), Paris, France.,Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
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8
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Viot S, Câmara-Costa H, Laurence W, Francillette L, Toure H, Brugel D, Laurent-Vannier A, Dellatolas G, Gillibert A, Meyer P, Chevignard M. Assessment of memory functioning over two years following severe childhood traumatic brain injury: results of the TGE cohort. Brain Inj 2019; 33:1208-1218. [PMID: 31237456 DOI: 10.1080/02699052.2019.1631485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aims of this study were (1) to prospectively measure memory functioning following severe childhood Traumatic Brain Injury (TBI), and its evolution over 2 years; (2) to assess demographic and medical factors associated with memory function and recovery; (3) to explore relations between memory and other TBI outcomes. Methods: Children (aged 0-15 years; n= 65) consecutively admitted in a single trauma center over a 3-year period, who survived severe non-inflicted TBI, were included in a prospective longitudinal study. Memory was assessed in 38 children aged 5-15 years at injury, using the Children's Memory Scale at 3, 12, and 24 months post-injury. Results: Mean general memory score was low at 3 months (M = 90.2, SD = 20.3) but within the normal range at 12 and 24 months (M = 100.6, SD = 23.1 and M = 108.6, SD = 24.1, respectively), with high variability. Improvement was stronger for immediate visual memory than for other memory indices. Lower general memory score was associated with higher injury severity, lower intellectual ability and functional status, higher overall disability, and ongoing education. Conclusion: Memory functioning is highly variable following severe childhood TBI, related to injury severity and functional, cognitive and educational outcomes; improvement is significant during the first-year post-injury, but varies according to the type of memory.
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Affiliation(s)
- Solène Viot
- a Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury; Hôpitaux de Saint Maurice , Saint Maurice , France
| | - Hugo Câmara-Costa
- b UVSQ, CESP, INSERM, Université Paris-Saclay, Université Paris-SUD , Paris , France.,c Laboratoire d'Imagerie Biomédicale, Sorbonne Université, LIB , Paris , France
| | - Watier Laurence
- d Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM. UVSQ, Institut Pasteur, Université Paris-Saclay , Paris , France
| | - Leila Francillette
- c Laboratoire d'Imagerie Biomédicale, Sorbonne Université, LIB , Paris , France
| | - Hanna Toure
- a Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury; Hôpitaux de Saint Maurice , Saint Maurice , France
| | - Dominique Brugel
- a Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury; Hôpitaux de Saint Maurice , Saint Maurice , France
| | - Anne Laurent-Vannier
- a Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury; Hôpitaux de Saint Maurice , Saint Maurice , France
| | - Georges Dellatolas
- b UVSQ, CESP, INSERM, Université Paris-Saclay, Université Paris-SUD , Paris , France
| | - André Gillibert
- e Biostatistics Department, Rouen University Hospital , Rouen , France.,f Faculté de Médecine Paris-Sud, INSERM UMR-1178, CESP, Université Paris-Sud , Le Kremlin Bicêtre , France
| | - Philippe Meyer
- g Pediatric Anesthesiology Department, Hôpital Necker Enfants Malades , Paris , France.,h Faculté de Médecine René Descartes, Université Paris 5 , Paris , France
| | - Mathilde Chevignard
- a Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury; Hôpitaux de Saint Maurice , Saint Maurice , France.,c Laboratoire d'Imagerie Biomédicale, Sorbonne Université, LIB , Paris , France.,i Groupe de Recherche Clinique Handicap Cognitif et Réadaptation (HanCRe), Sorbonne Université , Paris , France
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Wilde EA, Ware AL, Li X, Wu TC, McCauley SR, Barnes A, Newsome MR, Biekman BD, Hunter JV, Chu ZD, Levin HS. Orthopedic Injured versus Uninjured Comparison Groups for Neuroimaging Research in Mild Traumatic Brain Injury. J Neurotrauma 2018; 36:239-249. [PMID: 29786476 DOI: 10.1089/neu.2017.5513] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
To address controversy surrounding the most appropriate comparison group for mild traumatic brain injury (mTBI) research, mTBI patients 12-30 years of age were compared with an extracranial orthopedic injury (OI) patient group and an uninjured, typically developing (TD) participant group with comparable demographic backgrounds. Injured participants underwent subacute (within 96 h) and late (3 months) diffusion tensor imaging (DTI); TD controls underwent DTI once. Group differences in fractional anisotropy (FA) and mean diffusivity (MD) of commonly studied white matter tracts were assessed. For FA, subacute group differences occurred in the bilateral inferior frontal occipital fasciculus (IFOF) and right inferior longitudinal fasciculus (ILF), and for MD, differences were found in the total corpus callosum, right uncinate fasciculus, IFOF, ILF, and bilateral cingulum bundle (CB). In these analyses, differences (lower FA and higher MD) were generally observed between the mTBI and TD groups but not between the mTBI and OI groups. After a 3 month interval, groups significantly differed in left IFOF FA and in right IFOF and CB MD; the TD group had significantly higher FA and lower MD than both injury groups, which did not differ. There was one exception to this pattern, in which the OI group demonstrated significantly lower FA in the left ILF than the TD group, although neither group differed from the mTBI group. The mTBI and OI groups had generally similar longitudinal results. Findings suggest that different conclusions about group-level DTI analyses could be drawn, depending on the selected comparison group, highlighting the need for additional research in this area. Where possible, mTBI studies may benefit from the inclusion of both OI and TD controls.
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Affiliation(s)
- Elisabeth A Wilde
- 1 Michael E. DeBakey VA Medical Center, Houston, Texas.,2 George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.,4 Department of Neurology, Baylor College of Medicine, Houston, Texas.,5 Department of Radiology, and Baylor College of Medicine, Houston, Texas.,7 Department of Neurology, University of Utah, Salt Lake City, Utah
| | - Ashley L Ware
- 3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.,8 Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics (TIMES), University of Houston, Houston, Texas
| | - Xiaoqi Li
- 3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Trevor C Wu
- 3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.,9 Hauenstein Neurosciences, Mercy Health St. Mary's, Grand Rapids, Michigan
| | - Stephen R McCauley
- 3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.,4 Department of Neurology, Baylor College of Medicine, Houston, Texas.,6 Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Amanda Barnes
- 10 Department of Obstetrics and Gynecology, University of Southern California Medical Center, Los Angeles, California
| | - Mary R Newsome
- 1 Michael E. DeBakey VA Medical Center, Houston, Texas.,3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Brian D Biekman
- 3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.,8 Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics (TIMES), University of Houston, Houston, Texas
| | - Jill V Hunter
- 3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.,5 Department of Radiology, and Baylor College of Medicine, Houston, Texas.,11 Department of Pediatric Radiology, Texas Children's Hospital, Houston, Texas
| | - Zili D Chu
- 5 Department of Radiology, and Baylor College of Medicine, Houston, Texas.,11 Department of Pediatric Radiology, Texas Children's Hospital, Houston, Texas
| | - Harvey S Levin
- 1 Michael E. DeBakey VA Medical Center, Houston, Texas.,3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.,4 Department of Neurology, Baylor College of Medicine, Houston, Texas.,6 Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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10
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Chai WJ, Abd Hamid AI, Abdullah JM. Working Memory From the Psychological and Neurosciences Perspectives: A Review. Front Psychol 2018; 9:401. [PMID: 29636715 PMCID: PMC5881171 DOI: 10.3389/fpsyg.2018.00401] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/09/2018] [Indexed: 11/29/2022] Open
Abstract
Since the concept of working memory was introduced over 50 years ago, different schools of thought have offered different definitions for working memory based on the various cognitive domains that it encompasses. The general consensus regarding working memory supports the idea that working memory is extensively involved in goal-directed behaviors in which information must be retained and manipulated to ensure successful task execution. Before the emergence of other competing models, the concept of working memory was described by the multicomponent working memory model proposed by Baddeley and Hitch. In the present article, the authors provide an overview of several working memory-relevant studies in order to harmonize the findings of working memory from the neurosciences and psychological standpoints, especially after citing evidence from past studies of healthy, aging, diseased, and/or lesioned brains. In particular, the theoretical framework behind working memory, in which the related domains that are considered to play a part in different frameworks (such as memory’s capacity limit and temporary storage) are presented and discussed. From the neuroscience perspective, it has been established that working memory activates the fronto-parietal brain regions, including the prefrontal, cingulate, and parietal cortices. Recent studies have subsequently implicated the roles of subcortical regions (such as the midbrain and cerebellum) in working memory. Aging also appears to have modulatory effects on working memory; age interactions with emotion, caffeine and hormones appear to affect working memory performances at the neurobiological level. Moreover, working memory deficits are apparent in older individuals, who are susceptible to cognitive deterioration. Another younger population with working memory impairment consists of those with mental, developmental, and/or neurological disorders such as major depressive disorder and others. A less coherent and organized neural pattern has been consistently reported in these disadvantaged groups. Working memory of patients with traumatic brain injury was similarly affected and shown to have unusual neural activity (hyper- or hypoactivation) as a general observation. Decoding the underlying neural mechanisms of working memory helps support the current theoretical understandings concerning working memory, and at the same time provides insights into rehabilitation programs that target working memory impairments from neurophysiological or psychological aspects.
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Affiliation(s)
- Wen Jia Chai
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Aini Ismafairus Abd Hamid
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Jafri Malin Abdullah
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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11
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Green SL, Keightley ML, Lobaugh NJ, Dawson DR, Mihailidis A. Changes in working memory performance in youth following concussion. Brain Inj 2017; 32:182-190. [DOI: 10.1080/02699052.2017.1358396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Stephanie L Green
- University of Toronto, Rehabilitation Sciences Institute, Toronto, Canada
| | - Michelle L. Keightley
- Holland Bloorview Kids Rehab, Bloorview Research Institute and Rehabilitation Sciences Institute and Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Nancy J. Lobaugh
- Research Imaging Center, Centre for Addiction and Mental Health and Division of Neurology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Deirdre R. Dawson
- Rotman Research Institute, Baycrest and Rehabilitation Sciences Institute and Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Alex Mihailidis
- Toronto Rehab Institute, University Health Network and Occupational Science and Occupational Therapy and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
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12
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Masalha W, Auslander G. Coping strategies used by parents of children with traumatic brain injury: A cross-sectional study of Palestinians and Israelis. SOCIAL WORK IN HEALTH CARE 2017; 56:964-983. [PMID: 28762891 DOI: 10.1080/00981389.2017.1353568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study examined the use and helpfulness of coping strategies and patterns among parents of children with traumatic brain injury (TBI). Participants were 122 Arab-Israeli, Jewish-Israeli, and Palestinian parents of 65 children with TBI following their discharge from pediatric rehabilitation hospital. Family-focused strategies were highly prevalent and most helpful among both mothers and fathers. Jewish mothers reported that support coping pattern (but not medical or family) was more helpful than did Arab-Israeli and Palestinian mothers. The findings highlight the need to promote effective coping among mothers of children with TBI with low levels of income and education and underscore the need for continuous long-term professional support to parents of children with TBI after hospital discharge.
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Affiliation(s)
| | - Gail Auslander
- b Zena Harman Professor of Social Work, School of Social Work & Social Welfare , Hebrew University of Jerusalem , Jerusalem , Israel
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13
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MacDonald S. Introducing the model of cognitive-communication competence: A model to guide evidence-based communication interventions after brain injury. Brain Inj 2017; 31:1760-1780. [DOI: 10.1080/02699052.2017.1379613] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Sheila MacDonald
- Adjunct Lecturer, Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- Owner, Sheila MacDonald & Associates, Guelph, Ontario, Canada
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14
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Gorman S, Barnes MA, Swank PR, Ewing-Cobbs L. Recovery of Working Memory Following Pediatric Traumatic Brain Injury: A Longitudinal Analysis. Dev Neuropsychol 2017; 42:127-145. [PMID: 28497984 DOI: 10.1080/87565641.2017.1315581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In a prospective longitudinal study, the trajectory of verbal and visual-spatial working memory (WM) development was examined 2-, 6-, 12-, and 24-months following complicated-mild to severe pediatric traumatic brain injury (TBI; n = 55) relative to an orthopedic injury comparison group (n = 47). Individual growth curve modeling revealed an interaction of age, severity, and time for verbal, but not visual-spatial WM. The youngest children with severe TBI had the lowest scores and slowest verbal WM growth. WM outcome is best understood in light of age at injury and TBI severity. Findings support the early vulnerability hypothesis and highlight the need for long-term follow-up.
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Affiliation(s)
- Stephanie Gorman
- a Department of Psychology , University of Houston , Houston , Texas
| | - Marcia A Barnes
- b Department of Special Education , University of Texas at Austin , Austin , Texas
| | - Paul R Swank
- c Children's Learning Institute, Department of Pediatrics , University of Texas Health Science Center at Houston , Houston , Texas
| | - Linda Ewing-Cobbs
- c Children's Learning Institute, Department of Pediatrics , University of Texas Health Science Center at Houston , Houston , Texas
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15
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Singh R, Turner RC, Nguyen L, Motwani K, Swatek M, Lucke-Wold BP. Pediatric Traumatic Brain Injury and Autism: Elucidating Shared Mechanisms. Behav Neurol 2016; 2016:8781725. [PMID: 28074078 PMCID: PMC5198096 DOI: 10.1155/2016/8781725] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 11/23/2016] [Indexed: 02/08/2023] Open
Abstract
Pediatric traumatic brain injury (TBI) and autism spectrum disorder (ASD) are two serious conditions that affect youth. Recent data, both preclinical and clinical, show that pediatric TBI and ASD share not only similar symptoms but also some of the same biologic mechanisms that cause these symptoms. Prominent symptoms for both disorders include gastrointestinal problems, learning difficulties, seizures, and sensory processing disruption. In this review, we highlight some of these shared mechanisms in order to discuss potential treatment options that might be applied for each condition. We discuss potential therapeutic and pharmacologic options as well as potential novel drug targets. Furthermore, we highlight advances in understanding of brain circuitry that is being propelled by improved imaging modalities. Going forward, advanced imaging will help in diagnosis and treatment planning strategies for pediatric patients. Lessons from each field can be applied to design better and more rigorous trials that can be used to improve guidelines for pediatric patients suffering from TBI or ASD.
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Affiliation(s)
- Rahul Singh
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Ryan C. Turner
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Linda Nguyen
- Department of Basic Pharmaceutical Sciences, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Kartik Motwani
- Department of Medical Sciences, University of Florida School of Medicine, Gainesville, FL 32611, USA
| | - Michelle Swatek
- Department of Psychology, North Carolina State University, Raleigh, NC 27695, USA
| | - Brandon P. Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
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16
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Faber J, Wilde EA, Hanten G, Ewing-Cobbs L, Aitken ME, Yallampalli R, MacLeod MC, Mullins SH, Chu ZD, Li X, Hunter JV, Noble-Haeusslein L, Levin HS. Ten-year outcome of early childhood traumatic brain injury: Diffusion tensor imaging of the ventral striatum in relation to executive functioning. Brain Inj 2016; 30:1635-1641. [PMID: 27680309 DOI: 10.1080/02699052.2016.1199910] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVE The long-term effects of TBI on verbal fluency and related structures, as well as the relation between cognition and structural integrity, were evaluated. It was hypothesized that the group with TBI would evidence poorer performance on cognitive measures and a decrease in structural integrity. RESEARCH DESIGN Between a paediatric group with TBI and a group of typically-developing children, the long-term effects of traumatic brain injury were investigated in relation to both structural integrity and cognition. Common metrics for diffusion tensor imaging (DTI) were used as indicators of white matter integrity. METHODS AND PROCEDURES Using DTI, this study examined ventral striatum (VS) integrity in 21 patients aged 10-18 years sustaining moderate-to-severe traumatic brain injury (TBI) 5-15 years earlier and 16 demographically comparable subjects. All participants completed Delis-Kaplan Executive Functioning System (D-KEFS) sub-tests. MAIN OUTCOMES AND RESULTS The group with TBI exhibited lower fractional anisotropy (FA) and executive functioning performance and higher apparent diffusion coefficient (ADC). DTI metrics correlated with D-KEFS performance (right VS FA with Inhibition errors, right VS ADC with Letter Fluency, left VS FA and ADC with Category Switching). CONCLUSIONS TBI affects VS integrity, even in a chronic phase, and may contribute to executive functioning deficits.
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Affiliation(s)
- J Faber
- a Rice University , Houston , TX , USA.,b Department of Physical Medicine and Rehabilitation
| | - E A Wilde
- b Department of Physical Medicine and Rehabilitation.,c Department of Neurology.,d Department of Radiology , Baylor College of Medicine , Houston , TX , USA.,e Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
| | - G Hanten
- b Department of Physical Medicine and Rehabilitation
| | - L Ewing-Cobbs
- f Children's Learning Institute and Department of Pediatrics , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - M E Aitken
- g Department of Pediatrics , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - R Yallampalli
- b Department of Physical Medicine and Rehabilitation.,e Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
| | - M C MacLeod
- b Department of Physical Medicine and Rehabilitation
| | - S H Mullins
- g Department of Pediatrics , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Z D Chu
- d Department of Radiology , Baylor College of Medicine , Houston , TX , USA.,h Department of Pediatric Radiology , Texas Children's Hospital , Houston , TX , USA
| | - X Li
- b Department of Physical Medicine and Rehabilitation
| | - J V Hunter
- b Department of Physical Medicine and Rehabilitation.,d Department of Radiology , Baylor College of Medicine , Houston , TX , USA.,h Department of Pediatric Radiology , Texas Children's Hospital , Houston , TX , USA
| | - L Noble-Haeusslein
- i Departments of Neurosurgical Surgery and Physical Therapy and Rehabilitation Science , University of California , San Francisco , CA , USA
| | - H S Levin
- b Department of Physical Medicine and Rehabilitation.,c Department of Neurology.,e Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
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17
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Gorman S, Barnes MA, Swank PR, Prasad M, Cox CS, Ewing-Cobbs L. Does processing speed mediate the effect of pediatric traumatic brain injury on working memory? Neuropsychology 2016; 30:263-73. [PMID: 26214659 PMCID: PMC4729671 DOI: 10.1037/neu0000214] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Processing speed (PS) and working memory (WM), core abilities that support learning, are vulnerable to disruption following traumatic brain injury (TBI). Developmental increases in WM are related to age-related changes in PS. The purpose of this study was to investigate whether WM deficits in children with TBI are mediated by PS. METHOD The performance of children with complicated mild, moderate, and severe TBI (n = 77) was examined relative to an orthopedic injury (n = 30) and a healthy comparison group (n = 40) an average of 4 years after injury (range 8 months to 12 years). Coding was utilized as a measure of PS, while the WM measures included complex verbal and visual-spatial span tasks with parallel processing requirements. Mediation analysis examined whether TBI might have an indirect effect on WM through PS. RESULTS Children in the TBI group performed more poorly than the combined comparison groups on coding and visual-spatial WM. Verbal WM scores were lower in TBI and the healthy comparison relative to the orthopedic group. TBI severity group differences were found on coding, but not WM measures. The relation between coding and both the WM tasks was similar. Bootstrap regression analyses suggested that PS, as measured by coding, might partially mediate the effect of group performance on WM. CONCLUSIONS TBI disrupts core PS and WM abilities that scaffold more complex abilities. Importantly, slowed PS was associated with WM deficits commonly identified following pediatric TBI. Implications of our findings regarding the relation between PS and WM may suggest interventions for children and adolescents following TBI.
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Affiliation(s)
- Stephanie Gorman
- Department of Pediatrics and Children's Learning Institute, University of Texas Health Science Center at Houston
| | - Marcia A Barnes
- Department of Pediatrics and Children's Learning Institute, University of Texas Health Science Center at Houston
| | - Paul R Swank
- School of Public Health, University of Texas Health Science Center at Houston
| | - Mary Prasad
- Department of Pediatrics and Children's Learning Institute, University of Texas Health Science Center at Houston
| | - Charles S Cox
- Department of Pediatric Surgery, University of Texas Health Sciences Center at Houston
| | - Linda Ewing-Cobbs
- Department of Pediatrics and Children's Learning Institute, University of Texas Health Science Center at Houston
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18
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Van Beek L, Ghesquière P, Lagae L, De Smedt B. Mathematical Difficulties and White Matter Abnormalities in Subacute Pediatric Mild Traumatic Brain Injury. J Neurotrauma 2015; 32:1567-78. [DOI: 10.1089/neu.2014.3809] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Leen Van Beek
- Parenting and Special Education Research Unit, University of Leuven, Belgium
| | - Pol Ghesquière
- Parenting and Special Education Research Unit, University of Leuven, Belgium
| | - Lieven Lagae
- Department of Development and Regeneration, University of Leuven, Belgium
| | - Bert De Smedt
- Parenting and Special Education Research Unit, University of Leuven, Belgium
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19
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Phillips NL, Parry L, Mandalis A, Lah S. [Formula: see text]Working memory outcomes following traumatic brain injury in children: A systematic review with meta-analysis. Child Neuropsychol 2015; 23:26-66. [PMID: 26397711 DOI: 10.1080/09297049.2015.1085500] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of this review is to systematically examine the literature concerning multicomponent working memory (WM)-comprising a central executive (CE), two storage components (phonological loop, PL and visuo-spatial sketchpad, VSSP), and episodic buffer (EB)-in pediatric traumatic brain injury (TBI). Electronic searches were conducted of MEDLINE, PsychINFO and EMBASE up to October 2014 with the inclusion criteria of children and adolescents with TBI, and quantitative methods to assess at least one component of WM. Meta-analytic procedures calculated pooled effect sizes for WM outcomes. Of the studies examined, 27 met the inclusion criteria. Children with TBI exhibited deficits in the CE and PL, but not in the VSSP, and no study could be found which examined the EB. Qualitative analysis found that greater TBI severity was associated with poorer CE functioning in five out of nine studies. Differences in patterns of brain activation were evident in four out of five fMRI studies that examined WM in TBI children and controls. Deficits in CE were associated with poorer mathematical skills in the only study that examined relations between WM and academic deficits. Notwithstanding the heterogeneity of the studies reviewed, TBI places children at risk of WM deficits. Moreover, this meta-analysis suggests that various components of WM have differential vulnerability to pediatric TBI, with significant deficits found in the CE and PL, but not in the VSSP (although the VSSP has rarely been examined to date). Future studies should be theoretically driven, employ tasks assessing all components of the WM model and examine the functional ramifications (including academic outcomes) of WM deficits in this population.
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Affiliation(s)
- Natalie Lynette Phillips
- a School of Psychology , The University of Sydney , Sydney , New South Wales , Australia.,b ARC Centre of Excellence in Cognition and its Disorders , Sydney , New South Wales , Australia
| | - Louise Parry
- c Brain Injury Rehabilitation Program , Sydney Children's Hospital , Sydney , New South Wales , Australia.,d Department of Psychology , Sydney Children's Hospital , Sydney , New South Wales , Australia
| | - Anna Mandalis
- d Department of Psychology , Sydney Children's Hospital , Sydney , New South Wales , Australia
| | - Suncica Lah
- a School of Psychology , The University of Sydney , Sydney , New South Wales , Australia.,b ARC Centre of Excellence in Cognition and its Disorders , Sydney , New South Wales , Australia
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20
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Schaffer Y, Geva R. Memory outcomes following cognitive interventions in children with neurological deficits: A review with a focus on under-studied populations. Neuropsychol Rehabil 2015; 26:286-317. [PMID: 25730385 DOI: 10.1080/09602011.2015.1016537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Given the primary role of memory in children's learning and well-being, the aim of this review was to examine the outcomes of memory remediation interventions in children with neurological deficits as a function of the affected memory system and intervention method. Fifty-seven studies that evaluated the outcome of memory interventions in children were identified. Thirty-four studies met the inclusion criteria, and were included in a systematic review. Diverse rehabilitation methods for improving explicit and implicit memory in children were reviewed. The analysis indicates that teaching restoration strategies may improve, and result in the generalisation of, semantic memory and working memory performance in children older than 7 years with mild to moderate memory deficits. Factors such as longer protocols, emotional support, and personal feedback contribute to intervention efficacy. In addition, the use of compensation aids seems to be highly effective in prospective memory tasks. Finally, the review unveiled a lack of studies with young children and the absence of group interventions. These findings point to the importance of future evidence-based intervention protocols in these areas.
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Affiliation(s)
- Yael Schaffer
- a Department of Psychology , The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University , Ramat Gan , Israel
| | - Ronny Geva
- a Department of Psychology , The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University , Ramat Gan , Israel
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21
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Turkstra LS, Politis AM, Forsyth R. Cognitive-communication disorders in children with traumatic brain injury. Dev Med Child Neurol 2015; 57:217-22. [PMID: 25283953 DOI: 10.1111/dmcn.12600] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2014] [Indexed: 11/28/2022]
Abstract
Children with moderate to severe traumatic brain injury (TBI) are at risk of developing cognitive-communication disorders that have devastating effects on their school life, family life, and social life. These problems can be difficult for families to describe and may be overlooked by community-based providers who are unfamiliar with TBI sequelae. To support the identification and management of cognitive-communication disorders, we review the common signs and symptoms of these disorders in children with TBI and discuss principles of assessment and intervention.
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Affiliation(s)
- Lyn S Turkstra
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
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22
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23
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Brunetti R, Del Gatto C, Delogu F. eCorsi: implementation and testing of the Corsi block-tapping task for digital tablets. Front Psychol 2014; 5:939. [PMID: 25228888 PMCID: PMC4151195 DOI: 10.3389/fpsyg.2014.00939] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/06/2014] [Indexed: 11/18/2022] Open
Abstract
The Corsi block-tapping task is a widely used test to assess visuo-spatial working memory. The test is traditionally administered using nine square blocks positioned on a wooden board, but numerous digital versions have been developed. In this study, we tested one-hundred and seven participants divided into two age groups (18–30 and over 50) in forward, backward and supraspan-forward conditions with eCorsi, a tablet version of the Corsi task. Compared to the traditional physical board, eCorsi has several advantages, including: simple installation, set-up, and use; considerably increased accuracy in presentation timing, automatic measures of span and reaction times, in both the forward and backward response modalities. Results showed that average span and error rates were essentially analogous to the ones obtained in the main standardization studies, which have used the original physical version of the Corsi test. Furthermore, timing results provide new indications about the mechanisms underlying spatial sequence processing, suggesting that the subject's response is not planned during sequence presentation, but between the end of the presentation and the beginning of the response.
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Affiliation(s)
- Riccardo Brunetti
- Department of Human Sciences, Università Europea di Roma Rome, Italy
| | - Claudia Del Gatto
- Department of Human Sciences, Università Europea di Roma Rome, Italy
| | - Franco Delogu
- Department of Humanities, Social Sciences, and Communication, College of Arts and Sciences, Lawrence Technological University Southfield, MI, USA
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24
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Kearney-Ramos TE, Fausett JS, Gess JL, Reno A, Peraza J, Kilts CD, James GA. Merging clinical neuropsychology and functional neuroimaging to evaluate the construct validity and neural network engagement of the n-back task. J Int Neuropsychol Soc 2014; 20:736-50. [PMID: 24963641 PMCID: PMC4290162 DOI: 10.1017/s135561771400054x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The n-back task is a widely used neuroimaging paradigm for studying the neural basis of working memory (WM); however, its neuropsychometric properties have received little empirical investigation. The present study merged clinical neuropsychology and functional magnetic resonance imaging (fMRI) to explore the construct validity of the letter variant of the n-back task (LNB) and to further identify the task-evoked networks involved in WM. Construct validity of the LNB task was investigated using a bootstrapping approach to correlate LNB task performance across clinically validated neuropsychological measures of WM to establish convergent validity, as well as measures of related but distinct cognitive constructs (i.e., attention and short-term memory) to establish discriminant validity. Independent component analysis (ICA) identified brain networks active during the LNB task in 34 healthy control participants, and general linear modeling determined task-relatedness of these networks. Bootstrap correlation analyses revealed moderate to high correlations among measures expected to converge with LNB (|ρ|≥ 0.37) and weak correlations among measures expected to discriminate (|ρ|≤ 0.29), controlling for age and education. ICA identified 35 independent networks, 17 of which demonstrated engagement significantly related to task condition, controlling for reaction time variability. Of these, the bilateral frontoparietal networks, bilateral dorsolateral prefrontal cortices, bilateral superior parietal lobules including precuneus, and frontoinsular network were preferentially recruited by the 2-back condition compared to 0-back control condition, indicating WM involvement. These results support the use of the LNB as a measure of WM and confirm its use in probing the network-level neural correlates of WM processing.
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Affiliation(s)
- Tonisha E. Kearney-Ramos
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jennifer S. Fausett
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jennifer L. Gess
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ashley Reno
- University of Virginia School of Medicine, Charlottesville, Virginia
| | | | - Clint D. Kilts
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - G. Andrew James
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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25
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Treble A, Hasan KM, Iftikhar A, Stuebing KK, Kramer LA, Cox CS, Swank PR, Ewing-Cobbs L. Working memory and corpus callosum microstructural integrity after pediatric traumatic brain injury: a diffusion tensor tractography study. J Neurotrauma 2013; 30:1609-19. [PMID: 23627735 DOI: 10.1089/neu.2013.2934] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Deficits in working memory (WM) are a common consequence of pediatric traumatic brain injury (TBI) and are believed to contribute to difficulties in a range of cognitive and academic domains. Reduced integrity of the corpus callosum (CC) after TBI may disrupt the connectivity between bilateral frontoparietal neural networks underlying WM. In the present investigation, diffusion tensor imaging (DTI) tractography of eight callosal subregions (CC1-CC8) was examined in relation to measures of verbal and visuospatial WM in 74 children sustaining TBI and 49 typically developing comparison children. Relative to the comparison group, children with TBI demonstrated poorer visuospatial WM, but comparable verbal WM. Microstructure of the CC was significantly compromised in brain-injured children, with lower fractional anisotropy (FA) and higher axial and radial diffusivity metrics in all callosal subregions. In both groups of children, lower FA and/or higher radial diffusivity in callosal subregions connecting anterior and posterior parietal cortical regions predicted poorer verbal WM, whereas higher radial diffusivity in callosal subregions connecting anterior and posterior parietal, as well as temporal, cortical regions predicted poorer visuospatial WM. DTI metrics, especially radial diffusivity, in predictive callosal subregions accounted for significant variance in WM over and above remaining callosal subregions. Reduced microstructural integrity of the CC, particularly in subregions connecting parietal and temporal cortices, may act as a neuropathological mechanism contributing to long-term WM deficits. The future clinical use of neuroanatomical biomarkers may allow for the early identification of children at highest risk for WM deficits and earlier provision of interventions for these children.
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Affiliation(s)
- Amery Treble
- 1 Department of Psychology, University of Houston , Houston, Texas
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26
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Abstract
This study compared mathematical outcomes in children with predominantly moderate to severe traumatic brain injury (TBI; n550) or orthopedic injury (OI; n547) at 2 and 24 months post-injury. Working memory and its contribution to math outcomes at 24 months post-injury was also examined. Participants were administered an experimental cognitive addition task and standardized measures of calculation, math fluency, and applied problems; as well as experimental measures of verbal and visual-spatial working memory. Although children with TBI did not have deficits in foundational math fact retrieval, they performed more poorly than OIs on standardized measures of math. In the TBI group, performance on standardized measures was predicted by age at injury, socioeconomic status, and the duration of impaired consciousness. Children with TBI showed impairments on verbal, but not visual working memory relative to children with OI. Verbal working memory mediated group differences on math calculations and applied problems at 24 months post-injury. Children with TBI have difficulties in mathematics, but do not have deficits in math fact retrieval, a signature deficit of math disabilities. Results are discussed with reference to models of mathematical cognition and disability and the role of working memory in math learning and performance for children with TBI.
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