1
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Ramulu PK, Belagaje SR, Varadaraj V. Association of concussion/brain injury symptoms and diagnosis with mental and social well-being in 2020 National Health Interview Survey (NHIS) children. Brain Inj 2024; 38:620-629. [PMID: 38664868 DOI: 10.1080/02699052.2024.2328312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/05/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Population-based data regarding the associations between prior concussion or brain injury symptoms/diagnosis and mental/social well-being is lacking for U.S. children. METHODS Associations between prior concussion or brain injury symptoms/diagnosis (reported by parents of children ages 5-17 from the 2020 National Health Interview Survey) and current mental/social well-being were determined in multivariable models. RESULTS Amongst 2020 US children, 8.7% and 5.3% had previous symptoms and diagnosis of concussion/brain injury, respectively. 23% of children with symptoms were never checked for a concussion/brain injury, with younger children at higher risk of not getting checked after symptomatic head trauma. Prior concussion or brain injury symptoms/diagnosis was associated with a higher likelihood of current depressive symptoms (odds ratio [OR] = 1.60; 95% CI = 1.21-2.14; p < 0.001), anxiety (OR = 2.07; 95% CI = 1.52-2.82; p < 0.001), difficulty making friends (OR = 1.57; 95% = 1.06-2.33; p = 0.03), use of medications for mental/social/behavioral issues (OR = 1.69; CI = 1.21-2.36; p = 0.002), and mental health therapy/counseling (OR = 1.52; 95% CI = 1.13-2.04; p = 0.006). CONCLUSION U.S. children with prior concussion or brain injury symptoms/diagnosis have a higher rate of mental and social disturbances and a more frequent need for mental health services. Nearly one-quarter of children with significant symptoms after head trauma are never checked for a concussion/brain injury; routine concussion evaluation after head trauma should be emphasized especially in younger children.
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Affiliation(s)
| | - Samir R Belagaje
- Departments of Neurology and Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Varshini Varadaraj
- Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, MD, USA
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2
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Yumul JN, McKinlay A, Anderson V, Catroppa C. Behaviour outcomes three months after mild TBI in preschool children. Neuropsychol Rehabil 2024; 34:600-618. [PMID: 37354534 DOI: 10.1080/09602011.2023.2224030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/02/2023] [Indexed: 06/26/2023]
Abstract
This study examined parents' report of behaviour in preschoolers after a mild traumatic brain injury (mTBI), compared the proportion of preschoolers with elevated behaviour ratings between the mTBI and limb injury (LI) groups, and explored injury, premorbid child, and parent variables that may be associated with parents' report of behaviour at three months post-injury. Children aged 2-5 years with a mTBI (n = 13) or mild LI (n = 6) were recruited from the emergency department. Behaviour was assessed using the Child Behaviour Checklist. Preliminary findings showed that post-injury behaviour ratings remained in the normal range. The mTBI group had higher scores than the LI group at three months post-injury in terms of sleep; however, this may have been pre-existing. Two children with mTBI received borderline-clinically significant ratings on diagnostic-level anxiety problems at the three-month follow-up, while none of the limb-injured controls obtained elevated behaviour ratings. Parent-rated post-injury behaviour was significantly associated with premorbid child functioning and parental stress, which needs to be explored in greater detail using larger preschool mTBI samples.
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Affiliation(s)
- Joy Noelle Yumul
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Audrey McKinlay
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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3
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Bondi BC, Tassone VK, Bucsea O, Desrocher M, Pepler DJ. A Systematic Review of Neurodevelopmental Assessments in Infancy and Early Childhood: Developing a Conceptual Framework, Repository of Measures, and Clinical Recommendations. Neuropsychol Rev 2024:10.1007/s11065-024-09641-7. [PMID: 38693469 DOI: 10.1007/s11065-024-09641-7] [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] [Received: 07/24/2023] [Accepted: 04/01/2024] [Indexed: 05/03/2024]
Abstract
The first 6 years of life are when 90% of brain development occurs, setting the foundation for lifelong neurodevelopment. The field of infant and early childhood neurodevelopment has made marginal advancements since introduced in 1988. There remains a gap in knowledge around early neurodevelopmental domains and trajectories given that there are few established assessment procedures for infants and young children and controversies around reserving assessments until school age. Throughout this systematic review, we (1) identified neurodevelopmental assessment measures employed in the literature by domain and age of assessment, (2) compiled a repository of 608 domain-specific neurodevelopmental assessment measures, and (3) established a preliminary conceptual framework for cross-domain neurodevelopmental assessments across infancy and early childhood. This review adhered to PRISMA guidelines and spanned three databases (PsycINFO, MEDLINE, PubMed). Articles were reviewed for (1) infancy and early childhood (0-6 years), (2) neurodevelopmental measures, and (3) English language. This systematic review spanned 795 articles from 1978 to 2020 with international representation. Advancements in assessment methods (e.g. measures, domains, frameworks) are essential for the evaluation of early neurodevelopmental profiles to inform early interventions, thus harnessing the neuroplasticity and dynamic development notable during early childhood. We hope this work catalyzes future research and clinical guidelines around early assessments methods.
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Affiliation(s)
- Bianca C Bondi
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Vanessa K Tassone
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Oana Bucsea
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Mary Desrocher
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Debra J Pepler
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
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4
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Stein A, Vinh To X, Nasrallah FA, Barlow KM. Evidence of Ongoing Cerebral Microstructural Reorganization in Children With Persisting Symptoms Following Mild Traumatic Brain Injury: A NODDI DTI Analysis. J Neurotrauma 2024; 41:41-58. [PMID: 37885245 DOI: 10.1089/neu.2023.0196] [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] Open
Abstract
Approximately 300-550 children per 100,000 sustain a mild traumatic brain injury (mTBI) each year, of whom ∼25-30% have long-term cognitive problems. Following mTBI, free water (FW) accumulation occurs in white matter (WM) tracts. Diffusion tensor imaging (DTI) can be used to investigate structural integrity following mTBI. Compared with conventional DTI, neurite orientation dispersion and density imaging (NODDI) orientation dispersion index (ODI) and fraction of isolated free water (FISO) metrics may allow a more advanced insight into microstructural damage following pediatric mTBI. In this longitudinal study, we used NODDI to explore whole-brain and tract-specific differences in ODI and FISO in children with persistent symptoms after mTBI (n = 80) and in children displaying clinical recovery (n = 32) at 1 and 2-3 months post-mTBI compared with healthy controls (HCs) (n = 21). Two-way repeated measures analysis of variance (ANOVA) and voxelwise two-sample t tests were conducted to compare whole-brain and tract-specific diffusion across groups. All results were corrected at positive false discovery rate (pFDR) <0.05. We also examined the association between NODDI metrics and clinical outcomes, using logistical regression to investigate the value of NODDI metrics in predicting future recovery from mTBI. Whole-brain ODI was significantly increased in symptomatic participants compared with HCs at both 1 and 2 months post-injury, where the uncinate fasciculus (UF) and inferior fronto-occipital fasciculus (IFOF) were particularly implicated. Using region of interest (ROI) analysis in significant WM, bilateral IFOF and UF voxels, symptomatic participants had the highest ODI in all ROIs. ODI was lower in asymptomatic participants, and HCs had the lowest ODI in all ROIs. No changes in FISO were found across groups or over time. WM ODI was moderately correlated with a higher youth-reported post-concussion symptom inventory (PCSI) score. With 87% predictive power, ODI (1 month post-injury) and clinical predictors (age, sex, PCSI score, attention scores) were a more sensitive predictor of recovery at 2-3 months post-injury than fractional anisotropy (FA) and clinical predictors, or clinical predictors alone. FISO could not predict recovery at 2-3 months post-injury. Therefore, we found that ODI was significantly increased in symptomatic children following mTBI compared with HCs at 1 month post-injury, and progressively decreased over time alongside clinical recovery. We found no significant differences in FISO between groups or over time. WM ODI at 1 month was a more sensitive predictor of clinical recovery at 2-3 months post-injury than FA, FISO, or clinical measures alone. Our results show evidence of ongoing microstructural reorganization or neuroinflammation between 1 and 2-3 months post-injury, further supporting delayed return to play in children who remain symptomatic. We recommend future research examining the clinical utility of NODDI following mTBI to predict recovery or persistence of post-concussion symptoms and thereby inform management of mTBI.
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Affiliation(s)
- Athena Stein
- Acquired Brain Injury in Children Research Group, The University of Queensland, South Brisbane, Queensland, Australia
| | - Xuan Vinh To
- Queensland Brain Institute, The University of Queensland, South Brisbane, Queensland, Australia
| | - Fatima A Nasrallah
- Queensland Brain Institute, The University of Queensland, South Brisbane, Queensland, Australia
| | - Karen M Barlow
- Acquired Brain Injury in Children Research Group, The University of Queensland, South Brisbane, Queensland, Australia
- Queensland Pediatric Rehabilitation Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
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5
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Thompson RC, Vaughn D, Hirst RB, Murley R, Baldini D. Back from the sideline, but back to baseline? A pediatric case study examining neuropsychological functioning after sustaining multiple sport-related concussions. Neurocase 2023; 29:29-36. [PMID: 38678304 DOI: 10.1080/13554794.2024.2343154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
Most individuals recover quickly from a concussion; however, youth who sustain multiple concussions may be at risk for long-term cognitive impairments. This case study examines the neuropsychological performance of a 13-year-old malewith five head injuries. After his first concussion during study participation (fourth injury overall), several improvements were observed, likely due to practice effects, yet after sustaining another concussion <2 years later,declines were observed in visuoconstruction, verbal memory, and intellectual functioning. Across serial re-evaluation, his vocabulary knowledge declined, and fewer improvements were observed than anticipated when accounting for serial practice effects, highlighting the possible cumulative impact of multiple concussions.
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Affiliation(s)
- Ryan C Thompson
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Dylan Vaughn
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Rayna B Hirst
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Rachel Murley
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Daniel Baldini
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
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6
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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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7
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Omer M, Posti JP, Gissler M, Merikukka M, Bärnighausen T, Wilson ML. Birth order and pediatric traumatic brain injury. Sci Rep 2022; 12:14451. [PMID: 36002560 PMCID: PMC9402548 DOI: 10.1038/s41598-022-18742-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 08/18/2022] [Indexed: 11/22/2022] Open
Abstract
Pediatric traumatic brain injury (TBI) is a significant problem of public health importance worldwide. Large population-based studies on the effect of birth order on health phenomena are exceedingly rare. This study examines the relationship between birth order and risk for pediatric TBI among sibling groups. We performed a retrospective cohort study following 59,469 Finnish newborns from 1987 until age 18 years. Data on first diagnosis of TBI was recorded within the 1987 Finnish Birth Cohort (FBC). Compared with first born siblings, later born siblings had an increased risk of TBI during the follow-up period (hazard ratio [HR] 1.02; 95% confidence interval [CI] 0.91–1.14 for second born, HR 1.09; 95% CI 0.95 1.26 for third born, HR 1.28; 95% CI 1.08–1.53 for fourth or higher). When adjusted for sex and maternal age at child’s birth, HRs (95% CIs) for TBI during the follow-up period were 1.12 (0.99–1.26) for second born, 1.31 (1.12–1.53) for third born and 1.61 (1.33–1.95) for fourth born or higher children, respectively. Within this large register-based population-wide study, order of birth modified risk for pediatric TBI among sibling groups. Taken together, these study findings may serve to stimulate further inquiry into genetic, psychological, or psychosocial factors which underlie differences in risk and depth of effect within and between sibling groups.
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Affiliation(s)
- Mazin Omer
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany. .,Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland.
| | - Jussi P Posti
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, National Institute for Health and Welfare (THL), Helsinki, Finland.,Academic Primary Health Care Centre, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Marko Merikukka
- Children, Adolescents and Families, National Institute for Health and Welfare (THL), Oulu, Finland.,ITLA Children's Foundation, Helsinki, Finland
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany
| | - Michael Lowery Wilson
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany
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8
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Schmidt J, Brown KE, Feldman SJ, Babul S, Zwicker JG, Boyd LA. Evidence of altered interhemispheric communication after pediatric concussion. Brain Inj 2021; 35:1143-1161. [PMID: 34384288 DOI: 10.1080/02699052.2021.1929485] [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: 10/20/2022]
Abstract
OBJECTIVES: To investigate neurophysiological alterations within the typical symptomatic period after concussion (1-month) and throughout recovery (6-months) in adolescents; and (2) to examine relationships between neurophysiological and upper limb kinematic outcomes.METHODS: 18 adolescents with concussion were compared to 17 healthy controls. Transcranial magnetic stimulation (TMS) was used to assess neurophysiological differences between groups including: short- and long-interval intracortical inhibition, intracortical facilitation, short- and long-latency afferent inhibition, afferent facilitation, and transcallosal inhibition (TCI). Behavioral measures of upper limb kinematics were assessed with a robotic device.RESULTS: Mixed model analysis of neurophysiological data identified two key findings. First, participants with concussion demonstrated delayed onset of interhemispheric inhibition, as indexed by TCI, compared to healthy controls. Second, our exploratory analysis indicated that the magnitude of TCI onset delay in adolescents with concussion was related to upper limb kinematics.CONCLUSIONS: Our findings indicate that concussion in adolescence alters interhemispheric communication. We note relationships between neurophysiological and kinematic data, suggesting an affinity for individuals with less concussion-related physiological change to improve their motor behavior over time. These data serve as an important step in future development of assessments (neurobiological and clinical) and interventions for concussion.
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Affiliation(s)
- Julia Schmidt
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katlyn E Brown
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, UK.,Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samantha J Feldman
- Graduate Program in Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shelina Babul
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Emergency Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jill G Zwicker
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Sunny Hill Health Centre at BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Lara A Boyd
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Saarinen M, Erkinjuntti N, Koskinen S, Himanen L, Vahlberg T, Tenovuo O, Lähdesmäki T. Prolonged injury symptoms and later visits to psychiatric care after mild traumatic brain injury in school-age. Brain Inj 2021; 35:690-697. [PMID: 33678108 DOI: 10.1080/02699052.2021.1895316] [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: 10/22/2022]
Abstract
OBJECTIVE To investigate demographic and pre-injury factors in Finnish school-aged children admitted to pediatric neurology services after mild traumatic brain injury (mTBI). The relation of these factors to prolonged injury symptoms and later visits into psychiatric care was assessed. METHODS Demographic information, pre-injury learning status, and neuropsychological test results of 120 patients aged 7-16 years were retrospectively collected from the hospital medical records. Data were compared with self- or parent-reported injury symptoms at 1-3 months post-injury and later visits to psychiatric care. RESULTS According to medical records, 14.2% of the children with mTBI had a diagnosed neurobehavioral or psychiatric condition pre-injury. Additionally, 53.3% of the children had some neurobehavioral or psychiatric concerns or traits prior to the injury. Over half (56.7%) of the children studied were symptomatic at 1-3 months following the injury. Female gender and presence of prolonged symptoms were predictive for later visit into psychiatric care. CONCLUSIONS Pre-injury neurobehavioral or psychiatric problems may predict prolonged injury symptoms following pediatric mTBI. In this retrospective patient series, prolonged symptoms and female gender seem to predict the need for later psychiatric care. Monitoring the recovery of children with mTBI and pre-injury risk factors is important for timely interventions.
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Affiliation(s)
- M Saarinen
- Department of Pediatric Neurology, University of Turku, Turku, Finland
| | - N Erkinjuntti
- Department of Pediatric Neurology, University of Turku, Turku, Finland.,Department of Pediatric Neurology, Turku University Hospital, Turku, Finland
| | - S Koskinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - L Himanen
- Department of Psychology, University of Turku, Turku, Finland
| | - T Vahlberg
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - O Tenovuo
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - T Lähdesmäki
- Department of Pediatric Neurology, University of Turku, Turku, Finland.,Department of Pediatric Neurology, Turku University Hospital, Turku, Finland
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10
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Seah PZ, Chee JNZH, Feng JXY, Ting YS, Chong SL. Risk Stratification of Paediatric Sports Injuries Seen at a Tertiary Hospital. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020; 49:955-962. [PMID: 33463653 DOI: 10.47102/annals-acadmedsg.2020262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION In this study, we described paediatric sports injuries seen in the paediatric emergency department of a large, tertiary paediatric hospital in Singapore and evaluated risk factors for severe sports injuries. METHODS This is a retrospective review of a paediatric trauma surveillance registry from February 2012 to October 2017, including patient demographics, type of sports, circumstances, type of injuries, and clinical management in the hospital. Patients 5 to 17 years old with a sports-related injury were included. We performed logistic regression to identify predictors of severe sports injuries (defined by Injury Severity Score of ≥9), injuries requiring hospitalisation, trauma team activation, resuscitation, or those that resulted in death. RESULTS Among 10,951 patients analysed, the most common injuries sustained were fractures (4,819, 44.0%), sprains and contusions (3,334, 30.4%). For patients with severe injuries, the median length of hospital stay was 2 days (IQR 1-3 days), and time away from sports was 162 days (IQR 104-182 days). Predictors for severe injuries include transportation by emergency medical service (aOR 6.346, 95% CI 5.147-7.823), involvement in rugby (aOR 2.067, 95% CI 1.446-2.957), neurological injuries (aOR 4.585, 95% CI 2.393-4.365), dislocations (aOR 2.779, 95% CI 1.744-4.427), fractures (aOR 1.438, 95% CI 1.039-1.990), injuries to the head and neck (aOR 2.274, 95% CI 1.184-4.365), and injuries to the abdomen and pelvis (aOR 5.273, 95% CI 3.225-8.623). CONCLUSION Predictors for severe sports injuries identified may aid in risk stratification and resource allocation.
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Affiliation(s)
- Pei Zhen Seah
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
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11
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Ramos-Usuga D, Benito-Sánchez I, Pérez-Delgadillo P, Valdivia-Tangarife R, Villaseñor-Cabrera T, Olabarrieta-Landa L, Arango-Lasprilla J. Trajectories of neuropsychological functioning in Mexican children with traumatic brain injury over the first year after injury. NeuroRehabilitation 2019; 45:295-309. [DOI: 10.3233/nre-192834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- D. Ramos-Usuga
- Biomedical Research Doctorate Program, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - I. Benito-Sánchez
- Biomedical Research Doctorate Program, University of the Basque Country (UPV/EHU), Leioa, Spain
- BioCruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - P. Pérez-Delgadillo
- Rusk Rehabilitation at New York University Langone Health, New York, NY, USA
| | | | - T. Villaseñor-Cabrera
- Department of Psychology, University of Guadalajara, Guadalajara, Mexico
- Department of Neurosciences, University of Guadalajara, Guadalajara, Mexico
| | - L. Olabarrieta-Landa
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, Spain
| | - J.C. Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute, Barakaldo, Spain
- Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), Leioa, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
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12
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Results of scoping review do not support mild traumatic brain injury being associated with a high incidence of chronic cognitive impairment: Commentary on McInnes et al. 2017. PLoS One 2019; 14:e0218997. [PMID: 31525205 PMCID: PMC6746392 DOI: 10.1371/journal.pone.0218997] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 01/06/2023] Open
Abstract
A recently published review of 45 studies concluded that approximately half of individuals who sustain a single mild traumatic brain injury (MTBI) experience long-term cognitive impairment (McInnes et al. Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS ONE 2017;12:e0174847). Stratified by age, they reported that 50% of children and 58% of adults showed some form of cognitive impairment. We contend that the McInnes et al. review used a definition of “cognitive impairment” that was idiosyncratic, not applicable to individual patients or subjects, inconsistent with how cognitive impairment is defined in clinical practice and research, and resulted in a large number of false positive cases of cognitive impairment. For example, if a study reported a statistically significant difference on a single cognitive test, the authors concluded that every subject with a MTBI in that study was cognitively impaired–an approach that cannot be justified statistically or psychometrically. The authors concluded that impairment was present in various cognitive domains, such as attention, memory, and executive functioning, but they did not analyze or report the results from any of these specific cognitive domains. Moreover, their analyses and conclusions regarding many published studies contradicted the interpretations provided by the original authors of those studies. We re-reviewed all 45 studies and extracted the main conclusions from each. We conclude that a single MTBI is not associated with a high incidence of chronic cognitive impairment.
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13
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Ryder C, Mackean T, Hunter K, Williams H, Clapham K, Holland AJA, Ivers R. Equity in functional and health related quality of life outcomes following injury in children - a systematic review. CRITICAL PUBLIC HEALTH 2019. [DOI: 10.1080/09581596.2019.1581918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Courtney Ryder
- The George Institute for Global Health, UNSW, Sydney, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Tamara Mackean
- The George Institute for Global Health, UNSW, Sydney, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Kate Hunter
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Hayley Williams
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Kathleen Clapham
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Andrew J. A. Holland
- Discipline of Child & Adolescent Health, The Children’s Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, UNSW, Sydney, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
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14
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Dégeilh F, Bernier A, Gravel J, Beauchamp MH. Developmental trajectories of adaptive functioning following early mild traumatic brain injury. Dev Psychobiol 2018; 60:1037-1047. [PMID: 30276812 DOI: 10.1002/dev.21786] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/03/2018] [Accepted: 08/24/2018] [Indexed: 01/05/2023]
Abstract
Adaptive behavior impairments have been reported in children with severe traumatic brain injury (TBI) but are not typically found following mild TBI. It is possible that mild TBI induces subtle changes in adaptive functioning that are not captured in conventional group comparisons. This study aimed to explore time course changes in adaptive functioning following early mild TBI. Parents of 63 children with mild TBI and 53 children with orthopedic injuries aged between 1.5 and 5 years at the time of injury completed the Adaptive Behavior Assessment System-II at three time points: retrospectively to assess pre-injury functioning, then at 6 and 18 months post-injury. Developmental trajectories of adaptive functioning domains (practical, conceptual, and social) reported by parents were modeled using linear mixed-model analyses. Findings suggest that mild TBI may disrupt the expected developmental progression of children's social adaptive behavior, but does not appear to alter practical and conceptual domains.
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Affiliation(s)
- Fanny Dégeilh
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada.,Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Annie Bernier
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada.,Sainte-Justine Research Center, Montreal, Quebec, Canada
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15
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Schmidt J, Hayward KS, Brown KE, Zwicker JG, Ponsford J, van Donkelaar P, Babul S, Boyd LA. Imaging in Pediatric Concussion: A Systematic Review. Pediatrics 2018; 141:peds.2017-3406. [PMID: 29678928 DOI: 10.1542/peds.2017-3406] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Pediatric mild traumatic brain injury (mTBI) is a common and poorly understood injury. Neuroimaging indexes brain injury and outcome after pediatric mTBI, but remains largely unexplored. OBJECTIVE To investigate the differences in neuroimaging findings in children/youth with mTBI. Measures of behavior, symptoms, time since injury, and age at injury were also considered. DATA SOURCES A systematic review was conducted up to July 6, 2016. STUDY SELECTION Studies were independently screened by 2 authors and included if they met predetermined eligibility criteria: (1) children/youth (5-18 years of age), (2) diagnosis of mTBI, and (3) use of neuroimaging. DATA EXTRACTION Two authors independently appraised study quality and extracted demographic and outcome data. RESULTS Twenty-two studies met the eligibility criteria, involving 448 participants with mTBI (mean age = 12.7 years ± 2.8). Time postinjury ranged from 1 day to 5 years. Seven different neuroimaging methods were investigated in included studies. The most frequently used method, diffusion tensor imaging (41%), had heterogeneous findings with respect to the specific regions and tracts that showed group differences. However, group differences were observed in many regions containing the corticospinal tract, portions of the corpus callosum, or frontal white-matter regions; fractional anisotropy was increased in 88% of the studies. LIMITATIONS This review included a heterogeneous sample with regard to participant ages, time since injury, symptoms, and imaging methods which prevented statistical pooling/modelling. CONCLUSIONS These data highlight essential priorities for future research (eg, common data elements) that are foundational to progress the understanding of pediatric concussion.
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Affiliation(s)
- Julia Schmidt
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada; .,School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Kathryn S Hayward
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,Florey Institute of Neuroscience and Mental Health, National Health and Medical Research Council and University of Melbourne, Parkville, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Katlyn E Brown
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Jill G Zwicker
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | | | - Paul van Donkelaar
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Shelina Babul
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | - Lara A Boyd
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
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16
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Cooksley R, Maguire E, Lannin NA, Unsworth CA, Farquhar M, Galea C, Mitra B, Schmidt J. Persistent symptoms and activity changes three months after mild traumatic brain injury. Aust Occup Ther J 2018; 65:168-175. [PMID: 29498077 DOI: 10.1111/1440-1630.12457] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Approximately, 80% of traumatic brain injuries are considered mild in severity. Mild traumatic brain injury (mTBI) may cause temporary or persisting impairments that can adversely affect an individual's ability to participate in daily occupations and life roles. This study aimed to identify symptoms, factors predicting level of symptoms and functional and psycho-social outcomes for participants with mTBI three months following injury. METHOD Patients discharged from the Emergency Department of a major metropolitan hospital with a diagnosis of mTBI were contacted by telephone three months after injury. An interview with two questionnaires was administered: The Concussion Symptom Inventory (CSI) Scale and the Rivermead Head Injury Follow-Up Questionnaire (RHIFUQ). Data obtained were used to determine the type and prevalence of post-concussion symptoms and their impact on activity change. RESULTS Sixty-three people with mTBI participated in the study. The majority of participants (81%) reported that all symptoms had resolved within the three-month time frame. Of those still experiencing symptoms, workplace fatigue (22%) and an inability to maintain previous workload/standards (17%) were reported. CONCLUSION There is a small, but clinically significant, subgroup of patients who continue to experience symptoms three-month post-mTBI. Symptoms experienced beyond the expected three-month recovery timeframe have the potential to adversely affect an individual's ability to participate in daily occupation and return to work.
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Affiliation(s)
- Rebecca Cooksley
- Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | | | - Natasha A Lannin
- Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | - Carolyn A Unsworth
- Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,Occupational Therapy, School of Health, Medical and Applied Sciences, Central Queensland University, Melbourne, Victoria, Australia
| | | | - Claire Galea
- Cerebral Palsy Alliance, The University of Sydney, Sydney, New South Wales, Australia
| | - Biswadev Mitra
- Alfred Health, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Julia Schmidt
- Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Environmental enrichment, alone or in combination with various pharmacotherapies, confers marked benefits after traumatic brain injury. Neuropharmacology 2018; 145:13-24. [PMID: 29499273 DOI: 10.1016/j.neuropharm.2018.02.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/21/2018] [Accepted: 02/26/2018] [Indexed: 12/20/2022]
Abstract
Traumatic brain injury (TBI) is a significant health care issue that affects over ten million people worldwide. Treatment options are limited with numerous failures resulting from single therapies. Fortunately, several preclinical studies have shown that combination treatment strategies may afford greater improvement and perhaps can lead to successful clinical translation, particularly if one of the therapies is neurorehabilitation. The aim of this review is to highlight TBI studies that combined environmental enrichment (EE), a preclinical model of neurorehabilitation, with pharmacotherapies. A series of PubMed search strategies yielded only nine papers that fit the criteria. The consensus is that EE provides robust neurobehavioral, cognitive, and histological improvement after experimental TBI and that the combination of EE with some pharmacotherapies can lead to benefits beyond those revealed by single therapies. However, it is noted that EE can be challenged by drugs such as the acetylcholinesterase inhibitor, donepezil, and the antipsychotic drug, haloperidol, which attenuate its efficacy. These findings may help shape clinical neurorehabilitation strategies to more effectively improve patient outcome. Potential mechanisms for the EE and pharmacotherapy-induced effects are also discussed. This article is part of the Special Issue entitled "Neurobiology of Environmental Enrichment".
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18
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Chavez-Arana C, Catroppa C, Yáñez Téllez G, Godfrey C, Prieto-Corona B, de León MA, García A, Anderson V. Feasibility and effectiveness of a parenting programme for Mexican parents of children with acquired brain injury-Case report. Brain Inj 2017; 32:276-285. [DOI: 10.1080/02699052.2017.1394491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Clara Chavez-Arana
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
- Universidad Nacional Autónoma de México, FES Iztacala, Mexico City, Mexico
| | - Cathy Catroppa
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
- Royal Children’s Hospital, Child Neuropsychology, Melbourne, Victoria, Australia
| | | | - Celia Godfrey
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
- Royal Children’s Hospital, Child Neuropsychology, Melbourne, Victoria, Australia
| | | | - Miguel A. de León
- Iskalti Centre of Psychological and Educational Support S.C., Mexico City, Mexico
| | - Antonio García
- Unit of High Specialty “La Raza” IMSS, Paediatric Neurosurgery, Mexico City, Mexico
| | - Vicki Anderson
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
- Royal Children’s Hospital, Child Neuropsychology, Melbourne, Victoria, Australia
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19
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Lambregts S, Smetsers J, Verhoeven I, de Kloet A, van de Port I, Ribbers G, Catsman-Berrevoets C. Cognitive function and participation in children and youth with mild traumatic brain injury two years after injury. Brain Inj 2017; 32:230-241. [DOI: 10.1080/02699052.2017.1406990] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S.A.M Lambregts
- Department of Rehabilitation Medicine Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Revant Rehabilitation Centres, Breda, The Netherlands
| | - J.E.M Smetsers
- Department of Neuropsychology, Utrecht University, Utrecht, The Netherlands
| | - I.M.A.J Verhoeven
- Expertise Group, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - A.J de Kloet
- Expertise Group, The Hague University of Applied Sciences, The Hague, The Netherlands
- Department of Rehabilitation Medicine, Sophia Rehabilitation Centre, The Hague, The Netherlands
| | - I.G.L van de Port
- Department of Rehabilitation Medicine, Revant Rehabilitation Centres, Breda, The Netherlands
| | - G.M Ribbers
- Department of Rehabilitation Medicine Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Rijndam Rehabilitation Institute, Rotterdam, The Netherlands
| | - C.E Catsman-Berrevoets
- Department of Pediatric Neurology Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Baseline Performance and Psychometric Properties of the Child Sport Concussion Assessment Tool 3 (Child-SCAT3) in 5- to 13-year-old Athletes. Clin J Sport Med 2017; 27:381-387. [PMID: 27428682 PMCID: PMC5237625 DOI: 10.1097/jsm.0000000000000369] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the normative, baseline performance and psychometric properties of the Child Sport Concussion Assessment Tool 3 (Child-SCAT3) in 5- to 13-year-old athletes. DESIGN Cross-sectional study. SETTING Practice fields. PARTICIPANTS Contact sport athletes (N = 155) 5 to 13 years old. INDEPENDENT VARIABLES Age, gender, verbal intellectual functioning (receptive vocabulary). MAIN OUTCOME MEASURES Child-SCAT3: self-reported and parent-reported symptoms, cognitive performance (child form of the Standardized Assessment of Concussion; SAC-C), and balance (modified Balance Error Scoring System, mBESS-C; tandem gait). A subset of the sample repeated the Child-SCAT3 at another date. Some subjects also completed the Adult-SCAT3 version of the symptom checklist and mBESS. RESULTS Small-to-medium-sized effects of age were observed on all Child-SCAT3 components. Effects of gender and receptive vocabulary were observed on select components of the SCAT3. Younger age and lower receptive vocabulary were independently associated with greater symptom endorsement, yet parents rated higher symptom burden for older children. Internal consistency reliability and stability of symptom ratings was good to excellent. Stability was more modest for SAC-C and tandem gait scores and very poor for mBESS-C scores, perhaps due to restricted variance. Inter-rater reliability (self-rated vs parent-rated symptoms) was fair. CONCLUSIONS The Child-SCAT3 self-report symptom checklist may be inappropriate to administer to younger school-aged children. Some of the age effects observed warrant use of demographically appropriate norms in Child-SCAT3 interpretation. The findings can provide guidance for clinicians assessing children of varying ages and point to directions for further development of refined approaches for pediatric concussion assessment.
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21
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McInnes K, Friesen CL, MacKenzie DE, Westwood DA, Boe SG. Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS One 2017; 12:e0174847. [PMID: 28399158 PMCID: PMC5388340 DOI: 10.1371/journal.pone.0174847] [Citation(s) in RCA: 279] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/16/2017] [Indexed: 11/26/2022] Open
Abstract
Mild traumatic brain injury (mTBI), or concussion, is the most common type of traumatic brain injury. With mTBI comes symptoms that include headaches, fatigue, depression, anxiety and irritability, as well as impaired cognitive function. Symptom resolution is thought to occur within 3 months post-injury, with the exception of a small percentage of individuals who are said to experience persistent post-concussion syndrome. The number of individuals who experience persistent symptoms appears to be low despite clear evidence of longer-term pathophysiological changes resulting from mTBI. In light of the incongruency between these longer-term changes in brain pathology and the number of individuals with longer-term mTBI-related symptoms, particularly impaired cognitive function, we performed a scoping review of the literature that behaviourally assessed short- and long-term cognitive function in individuals with a single mTBI, with the goal of identifying the impact of a single concussion on cognitive function in the chronic stage post-injury. CINAHL, Embase, and Medline/Ovid were searched July 2015 for studies related to concussion and cognitive impairment. Data relating to the presence/absence of cognitive impairment were extracted from 45 studies meeting our inclusion criteria. Results indicate that, in contrast to the prevailing view that most symptoms of concussion are resolved within 3 months post-injury, approximately half of individuals with a single mTBI demonstrate long-term cognitive impairment. Study limitations notwithstanding, these findings highlight the need to carefully examine the long-term implications of a single mTBI.
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Affiliation(s)
- Kerry McInnes
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christopher L. Friesen
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Diane E. MacKenzie
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David A. Westwood
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shaun G. Boe
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
- * E-mail:
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22
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Predictors of Post-concussive Symptoms in Young Children: Injury versus Non-injury Related Factors. J Int Neuropsychol Soc 2016; 22:793-803. [PMID: 27619107 DOI: 10.1017/s1355617716000709] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES A notable minority of children will experience persistent post-concussive symptoms (PCS) following mild traumatic brain injury (mTBI), likely maintained by a combination of injury and non-injury related factors. Adopting a prospective longitudinal design, this study aimed to investigate the relative influence of child, family, and injury factors on both acute and persistent PCS in young children. METHODS Participants were 101 children aged 2-12 who presented to an Emergency Department, with either mTBI or minor bodily trauma (control). PCS were assessed at time of injury, 1 week, and 1, 2, and 3 months post-injury. Predictors included injury and demographic variables, premorbid child behavior, sleep hygiene, and parental stress. Random effects ordinal logistic regression models were used to analyze the relative influence of these predictors on PCS at early (acute - 1 week) and late (1-3 month) post-injury phases. RESULTS Presence of mTBI was a stronger predictor of PCS in the early [odds ratio (OR)=18.2] compared with late (OR=7.3) post-injury phase. Older age at injury and pre-existing learning difficulties were significant predictors of PCS beyond 1 month post-injury. Family factors, including higher levels of parental stress, higher socio-economic status, and being of Anglo-Saxon descent, consistently predicted greater PCS. CONCLUSIONS Injury characteristics were significantly associated with PCS for 3 months following mTBI but the association weakened over time. On the other hand, pre-existing child and family factors displayed an increasingly strong association with PCS over time. Follow-up for these "at-risk" children which also addresses family stress may minimize longer-term complications. (JINS, 2016, 22, 793-803).
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23
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Symptoms of Persistent Behavior Problems in Children With Mild Traumatic Brain Injury. J Head Trauma Rehabil 2016; 30:302-10. [PMID: 25629259 DOI: 10.1097/htr.0000000000000106] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate the effects of mild traumatic brain injury (mTBI) in children on symptom ratings of behavior problems across the first-year postinjury. SETTING Emergency departments of 2 regional children's hospitals. PARTICIPANTS Parents of 176 children with mTBI and 90 children with orthopedic injury aged 8 to 15 years. DESIGN Group comparisons of postinjury parent and teacher ratings of child behavior problems controlling for background factors. MAIN MEASURES Child Behavior Checklist and Teacher's Report Form. RESULTS For younger but not older children in the sample, children with mTBI compared with children with orthopedic injury had higher postinjury ratings on the Child Behavior Checklist Total Behavior Problem scale (t264 = 3.34, P < .001) and higher rates of T-scores of 60 or more on this scale (odds ratio = 3.00; 95% confidence interval, 1.33-6.77; P = .008). For children with mTBI, hospitalization, motor vehicle accidents, loss of consciousness, and magnetic resonance imaging abnormality were associated with higher parent or teacher ratings. CONCLUSIONS School-aged children with mTBI are at risk for persistent symptoms of behavior problems, especially if mTBI is more severe or occurs at a younger age. The findings justify monitoring of behavior long after injury and further research to identify risk factors for these symptoms and their association with clinical disorders.
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24
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Lee MS, Kim H. Development and application of cognitive-pragmatic language ability assessment protocol for traumatic brain injury. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 23:436-48. [PMID: 27218873 DOI: 10.1080/23279095.2016.1178644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The study aim was to introduce a newly-developed multifaceted cognitive-pragmatic language assessment protocol. This study was also designed to assess the reliability and validity of the assessment protocol in the discrimination between mild traumatic brain injury (mTBI) and normal control. Individuals in this study were 25 to 64 years old. Ten mTBIs and twenty-two control group were recruited for the preliminary study. Their mean ages were 45.20 and 41.23, respectively. For the main study, we recruited 39 mTBIs and 100 healthy individuals whose mean ages were 44.67 and 40.84, respectively. The newly-developed protocol was completed through a systematic review based on an item analysis. We administered the CAPTBI based on nine domains, 22 subcategories, and 57 items. All nine domains of the CAPTBI were found to be significant variables by which mTBI individuals can be distinguished from normal individuals (p < .001). We also presented the cut-off points by education level to maximize the validity of differentiating the two groups. This study is the first attempt to evaluate mTBI by means of the cognitive-linguistic protocol with multiple domains. The CAPTBI is an appropriate tool for differentiating the cognitive-pragmatic language abilities between mTBI and control group.
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Affiliation(s)
- Mi Sook Lee
- a Graduate School of Special Education (Speech Rehabilitation & Therapy) , Kongju National University , Gongju , Korea
| | - HyangHee Kim
- b Graduate Program in Speech-Language Pathology , Yonsei University , Seoul , Korea.,c Department & Research Institute of Rehabilitation Medicine , Yonsei University College of Medicine , Seoul , Korea
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5-hydroxytryptamine1A (5-HT1A) receptor agonists: A decade of empirical evidence supports their use as an efficacious therapeutic strategy for brain trauma. Brain Res 2015; 1640:5-14. [PMID: 26612522 DOI: 10.1016/j.brainres.2015.11.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/10/2015] [Accepted: 11/13/2015] [Indexed: 11/20/2022]
Abstract
Traumatic brain injury (TBI) is a significant and enduring health care issue with limited treatment options. While several pre-clinical therapeutic approaches have led to enhanced motor and/or cognitive performance, the benefits of these treatments have not translated to the clinic. One plausible explanation is that the therapies may not have been rigorously evaluated, thus rendering the bench-to-bedside leap premature and subsequently unsuccessful. An approach that has undergone considerable empirical research after TBI is pharmacological targeting of 5-HT1A receptors with agonists such as repinotan HCl, 8-hydroxy-2-(di-n-propylamino) tetralin (8-OH-DPAT), and buspirone. The goal of this review is to integrate and interpret the findings from a series of studies that evaluated the efficacy of 5-HT1A receptor agonists on functional, histological, and molecular outcome after acquired brain injury. The overwhelming consensus of this exhaustive review is that a decade of empirical evidence supports their use as an efficacious therapeutic strategy for brain trauma. This article is part of a Special Issue entitled SI:Brain injury and recovery.
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26
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Do Children and Adolescents With Mild Traumatic Brain Injury and Persistent Symptoms Benefit From Treatment? A Systematic Review. J Head Trauma Rehabil 2015; 30:324-33. [DOI: 10.1097/htr.0000000000000114] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
There is evidence to suggest that social skills, such as the ability to understand the perspective of others (theory of mind), may be affected by childhood traumatic brain injuries; however, studies to date have only considered moderate and severe traumatic brain injury (TBI). This study aimed to assess theory of mind after early, mild TBI (mTBI). Fifty-one children who sustained mTBI between 18 and 60 months were evaluated 6 months post-injury on emotion and desires reasoning and false-belief understanding tasks. Their results were compared to that of 50 typically developing children. The two groups did not differ on baseline characteristics, except for pre- and post-injury externalizing behavior. The mTBI group obtained poorer scores relative to controls on both the emotion and desires task and the false-belief understanding task, even after controlling for pre-injury externalizing behavior. No correlations were found between TBI injury characteristics and theory of mind. This is the first evidence that mTBI in preschool children is associated with theory of mind difficulties. Reduced perspective taking abilities could be linked with the social impairments that have been shown to arise following TBI.
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28
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de Kloet AJ, Gijzen R, Braga LW, Meesters JJL, Schoones JW, Vliet Vlieland TPM. Determinants of participation of youth with acquired brain injury: A systematic review. Brain Inj 2015; 29:1135-1145. [DOI: 10.3109/02699052.2015.1034178] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McKinlay A, Ligteringen V, Than M. A comparison of concussive symptoms reported by parents for preschool versus school-aged children. J Head Trauma Rehabil 2015; 29:233-8. [PMID: 23982792 DOI: 10.1097/htr.0b013e3182a2dd7f] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare parental report of symptoms of concussion for children with superficial head injury versus children with a diagnosis of a mild traumatic brain injury (mTBI). SETTING Urban hospital emergency department. PARTICIPANTS Parents of 159 children aged 2 to 12 years who presented with an injury to the head. PROCEDURE Parents were contacted within 1 week of injury and assigned into 3 groups according to their child's age and medical diagnosis (group 1, parents of 2- to 5-year-olds with mTBI (n = 39); group 2, parents of 6- to 12-year-olds with mTBI (n = 41); and group 3, parents of 2- to 12-year-olds with superficial injury to the head (n = 35). RESULTS Symptoms of concussion were reported in all groups; however, significantly fewer symptoms were reported for children with superficial injuries to the head than for children with mTBI (M = 2.51 vs M = 6.91; P < .001). For mTBI, parents of younger children reported significantly fewer symptoms than parents of older children (M = 5.23 vs M = 8.51; P < .001). CONCLUSIONS A careful approach needs to be taken when evaluating the severity of mTBI for preschool children. Failure to do so may result in misidentification and subsequent lack of management.
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Affiliation(s)
- Audrey McKinlay
- School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia (Dr McKinlay); University of Canterbury (Dr McKinlay), and Canterbury District Health Board (Ms Ligteringen); and Christchurch Hospital Emergency Department (Dr Than), Christchurch, New Zealand
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Post-concussive symptoms and neuropsychological performance in the post-acute period following pediatric mild traumatic brain injury. J Int Neuropsychol Soc 2014; 20:982-93. [PMID: 25382292 DOI: 10.1017/s1355617714000927] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is evidence that children after mild traumatic brain injuries (mTBI) suffer ongoing post-concussive symptoms (PCS). However, results concerning neuropsychological outcome after mTBI are controversial. Thus, our aim was to examine group differences regarding neuropsychological outcome and PCS. Additionally, we explored the influence of current and pre-injury everyday attention problems on neuropsychological outcome in children after mTBI. METHOD In a prospective short-term longitudinal study, 40 children (aged 6-16 years) after mTBI and 38 children after orthopedic injury (OI) underwent neuropsychological, socio-behavioral and PCS assessments in the acute stage and at 1 week, at 4 weeks, and 4 months after the injury. RESULTS Parents of children after mTBI observed significantly more PCS compared to parents of children after OI, especially in the acute stage. Our results revealed no neuropsychological or socio-behavioral differences over time between both groups. However, in children after mTBI, we found negative correlations between elevated levels of everyday attention problems and reduced neuropsychological performance. Furthermore, there was a negative influence of pre-injury everyday attention problems on neuropsychological performance in children after mTBI. CONCLUSION In accordance with earlier studies, parents of children after mTBI initially observed significantly more PCS compared to parents of children after OI. There were no neuropsychological or socio-behavioral group differences between children after mTBI and OI in the post-acute period. However, our exploratory findings concerning the influence of everyday attention problems on neuropsychological outcome indicate that current and pre-injury everyday attention problems were negatively associated with neuropsychological performance in children after mTBI.
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Monaco CM, Gebhardt KM, Chlebowski SM, Shaw KE, Cheng JP, Henchir JJ, Zupa MF, Kline AE. A combined therapeutic regimen of buspirone and environmental enrichment is more efficacious than either alone in enhancing spatial learning in brain-injured pediatric rats. J Neurotrauma 2014; 31:1934-41. [PMID: 25050595 DOI: 10.1089/neu.2014.3541] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Buspirone, a 5-HT1A receptor agonist, and environmental enrichment (EE) enhance cognition and reduce histopathology after traumatic brain injury (TBI) in adult rats, but have not been fully evaluated after pediatric TBI, which is the leading cause of death in children. Hence, the aims of this study were to assess the efficacy of buspirone alone (Experiment 1) and in combination with EE (Experiment 2) in TBI postnatal day-17 male rats. The hypothesis was that both therapies would confer cognitive and histological benefits when provided singly, but their combination would be more efficacious. Anesthetized rats received a cortical impact or sham injury and then were randomly assigned to receive intraperitoneal injections of buspirone (0.08 mg/kg, 0.1 mg/kg, and 0.3 mg/kg) or saline vehicle (1.0 mL/kg) 24 h after surgery and once daily for 16 days (Experiment 1). Spatial learning and memory were assessed using the Morris water maze (MWM) on post-operative days 11-16, and cortical lesion volume was quantified on day 17. Sham controls for each condition were significantly better than all TBI groups. In the TBI groups, buspirone (0.1 mg/kg) enhanced MWM performance versus vehicle and buspirone (0.08 mg/kg and 0.3 mg/kg) (p<0.05) and reduced lesion volume relative to vehicle (p=0.038). In Experiment 2, buspirone (0.1 mg/kg) or vehicle was combined with EE after TBI, and the data were compared to the standard (STD)-housed groups from Experiment 1. EE lead to a significant enhancement of spatial learning and a reduction in lesion size versus STD. Moreover, the combined treatment group (buspirone+EE) performed markedly better than the buspirone+STD and vehicle+EE groups, which suggests an additive effect and supports the hypothesis. The data replicate previous studies assessing these therapies in adult rats. These novel findings may have important rehabilitation-relevant implications for clinical pediatric TBI.
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Affiliation(s)
- Christina M Monaco
- 1 Physical Medicine & Rehabilitation, University of Pittsburgh , Pittsburgh, Pennsylvania
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Mychasiuk R, Hehar H, van Waes L, Esser MJ. Diet, age, and prior injury status differentially alter behavioral outcomes following concussion in rats. Neurobiol Dis 2014; 73:1-11. [PMID: 25270295 DOI: 10.1016/j.nbd.2014.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/25/2014] [Accepted: 09/12/2014] [Indexed: 02/07/2023] Open
Abstract
Mild traumatic brain injury (mTBI) or concussion affects a large portion of the population and although many of these individuals recover completely, a small subset of people experience lingering symptomology and poor outcomes. Little is known about the factors that affect individual susceptibility or resilience to poor outcomes after mTBI and there are currently no biomarkers to delineate mTBI diagnosis or prognosis. Based upon the growing literature associated with caloric intake and altered neurological aging and the ambiguous link between repetitive mTBI and progressive neurodegeneration, the current study was designed to examine the effect of a high fat diet (HFD), developmental age, and repetitive mTBI on behavioral outcomes following a mTBI. In addition, telomere length was examined before and after experimental mTBI. Sprague Dawley rats were maintained on a HFD or standard rat chow throughout life (including the prenatal period) and then experienced an mTBI/concussion at P30, P30 and P60, or only at P60. Behavioral outcomes were examined using a test battery that was administered between P61-P80 and included; beam-walking, open field, elevated plus maze, novel context mismatch, Morris water task, and forced swim task. Animals with a P30 mTBI often demonstrated lingering symptomology that was still present during testing at P80. Injuries at P30 and P60 rarely produced cumulative effects, and in some tests (i.e., beam walking), the first injury may have protected the brain from the second injury. Exposure to the high fat diet exacerbated many of the behavioral deficits associated with concussion. Finally, telomere length was shortened following mTBI and was influenced by the animal's dietary intake. Diet, age at the time of injury, and the number of prior concussion incidents differentially contribute to behavioral deficits and may help explain individual variations in susceptibility and resilience to poor outcomes following an mTBI.
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Affiliation(s)
- Richelle Mychasiuk
- Alberta Children's Hospital Research Institute, University of Calgary, Faculty of Medicine, Heritage Medical Research Building, Room 274, 3330 Hospital Drive NW, Calgary, AB T2N1N4, Canada
| | - Harleen Hehar
- Alberta Children's Hospital Research Institute, University of Calgary, Faculty of Medicine, Canada
| | - Linda van Waes
- University of British Columbia, Faculty of Medicine, Canada
| | - Michael J Esser
- Alberta Children's Hospital Research Institute, University of Calgary, Faculty of Medicine, Canada
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Keightley ML, Sinopoli KJ, Davis KD, Mikulis DJ, Wennberg R, Tartaglia MC, Chen JK, Tator CH. Is there evidence for neurodegenerative change following traumatic brain injury in children and youth? A scoping review. Front Hum Neurosci 2014; 8:139. [PMID: 24678292 PMCID: PMC3958726 DOI: 10.3389/fnhum.2014.00139] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 02/24/2014] [Indexed: 11/13/2022] Open
Abstract
While generalized cerebral atrophy and neurodegenerative change following traumatic brain injury (TBI) is well recognized in adults, it remains comparatively understudied in the pediatric population, suggesting that research should address the potential for neurodegenerative change in children and youth following TBI. This focused review examines original research findings documenting evidence for neurodegenerative change following TBI of all severities in children and youth. Our relevant inclusion and exclusion criteria identified a total of 16 articles for review. Taken together, the studies reviewed suggest there is evidence for long-term neurodegenerative change following TBI in children and youth. In particular both cross-sectional and longitudinal studies revealed volume loss in selected brain regions including the hippocampus, amygdala, globus pallidus, thalamus, periventricular white matter, cerebellum, and brain stem as well as overall decreased whole brain volume and increased CSF and ventricular space. Diffusion Tensor Imaging (DTI) studies also report evidence for decreased cellular integrity, particularly in the corpus callosum. Sensitivity of the hippocampus and deep limbic structures in pediatric populations are similar to findings in the adult literature and we consider the data supporting these changes as well as the need to investigate the possibility of neurodegenerative onset in childhood associated with mild traumatic brain injury (mTBI).
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Affiliation(s)
- Michelle L Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital Toronto, ON, Canada ; Department of Occupational Science and Occupational Therapy, University of Toronto Toronto, ON, Canada ; Graduate Department of Rehabilitation Science, University of Toronto ON, Canada ; Department of Psychology, University of Toronto ON, Canada ; Cognitive Neurorehabilitation Sciences, Toronto Rehabilitation Institute Toronto, ON, Canada
| | - Katia J Sinopoli
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital Toronto, ON, Canada ; Department of Psychology and Division of Neurology, Sickids Hospital for Sick Children Toronto, ON, Canada
| | - Karen D Davis
- Division of Brain, Imaging and Behaviour - Systems Neuroscience, Toronto Western Research Institute, University Health Network Toronto, ON, Canada ; Department of Surgery and Institute of Medical Science, University of Toronto Toronto, ON, Canada
| | - David J Mikulis
- Division of Brain, Imaging and Behaviour - Systems Neuroscience, Toronto Western Research Institute, University Health Network Toronto, ON, Canada
| | - Richard Wennberg
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network and University of Toronto Toronto, ON, Canada
| | - Maria C Tartaglia
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network and University of Toronto Toronto, ON, Canada
| | - Jen-Kai Chen
- Neuropsychology/Cognitive Neuroscience Unit, Montreal Neurological Institute Montreal, QC, Canada
| | - Charles H Tator
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network and University of Toronto Toronto, ON, Canada
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Psychosocial Consequences of Mild Traumatic Brain Injury in Children: Results of a Systematic Review by the International Collaboration on Mild Traumatic Brain Injury Prognosis. Arch Phys Med Rehabil 2014; 95:S192-200. [DOI: 10.1016/j.apmr.2013.12.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 12/30/2013] [Indexed: 11/16/2022]
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36
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Davis GA, Purcell LK. The evaluation and management of acute concussion differs in young children: Table 1. Br J Sports Med 2013; 48:98-101. [PMID: 23613516 DOI: 10.1136/bjsports-2012-092132] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Gavin A Davis
- Department of Neurosurgery, Cabrini Health, Austin Health and Murdoch Childrens Research Institute, , Melbourne, Victoria, Australia
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Abstract
Pediatric mild traumatic brain injury (pmTBI) is the most prevalent neurological insult in children and is associated with both acute and chronic neurobehavioral sequelae. However, little is known about underlying pathophysiology and how injuries change as a function of recovery. Fractional anisotropy, axial diffusivity, and radial diffusivity were examined in 15 semi-acute pmTBI patients and 15 well-matched controls, with a subset of participants returning for a second visit. A novel analytic strategy was applied to capture spatially heterogeneous white matter injuries (lesions) in addition to standard analyses. Evidence of cognitive dysfunction after pmTBI was observed in the domains of attention (p = 0.02, d = -0.92) and processing speed (p = 0.05, d = -0.73) semi-acutely. Region of interest (ROI) and voxelwise analyses indicated increased anisotropic diffusion for pmTBI patients, with an elevated number of clusters with high anisotropy. Metrics of increased anisotropy were able to objectively classify pmTBI from healthy controls at 90% accuracy but were not associated with neuropsychological deficits. Little evidence of recovery in white matter abnormalities was observed over a 4-month interval in returning patients, indicating that physiological recovery may lag behind subjective reports of normality. Increased anisotropic diffusion has been previously linked with cytotoxic edema after TBI, and the magnitude and duration of these abnormalities appear to be greater in pediatric patients. Current findings suggest that developing white matter may be more susceptible to initial mechanical injury forces and that anisotropic diffusion provides an objective biomarker of pmTBI.
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Abstract
AbstractPurpose: The purpose of this article is to inform speech-language pathologists in the schools about issues related to the care of children with traumatic brain injury.Method: Literature review of characteristics, outcomes and issues related to the needs serving children.Results: Due to acquired changes in cognition, children with traumatic brain injury have unique needs in a school setting.Conclusions: Speech-Language Pathologists in the school can take a leadership role with taking care of children after a traumatic brain injury and coordination of medical and educational information.
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Affiliation(s)
- Julie Haarbauer-Krupa
- Researcher, Children's Healthcare of Atlanta Health Scientist, Traumatic Brain Injury Team, Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention Atlanta, GA
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Loher S, Fatzer ST, Roebers CM. Executive Functions After Pediatric Mild Traumatic Brain Injury: A Prospective Short-Term Longitudinal Study. APPLIED NEUROPSYCHOLOGY-CHILD 2012; 3:103-14. [DOI: 10.1080/21622965.2012.716752] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Knuepffer C, Murdoch BE, Lloyd D, Lewis FM, Hinchliffe FJ. Reduced N400 semantic priming effects in adult survivors of paediatric and adolescent traumatic brain injury. BRAIN AND LANGUAGE 2012; 123:52-63. [PMID: 22819620 DOI: 10.1016/j.bandl.2012.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 05/05/2012] [Accepted: 06/24/2012] [Indexed: 06/01/2023]
Abstract
The immediate and long-term neural correlates of linguistic processing deficits reported following paediatric and adolescent traumatic brain injury (TBI) are poorly understood. Therefore, the current research investigated event-related potentials (ERPs) elicited during a semantic picture-word priming experiment in two groups of highly functioning individuals matched for various demographic variables and behavioural language performance. Participants in the TBI group had a recorded history of paediatric or adolescent TBI involving injury mechanisms associated with diffuse white matter pathology, while participants in the control group never sustained any insult to the brain. A comparison of N400 Mean Amplitudes elicited during three experimental conditions with varying semantic relatedness between the prime and target stimuli (congruent, semantically related, unrelated) revealed a significantly smaller N400 response in the unrelated condition in the TBI group, indicating residual linguistic processing deviations when processing demands required the quick detection of a between-category (unrelated) violation of semantic expectancy.
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Affiliation(s)
- C Knuepffer
- Centre for Neurogenic Communication Disorders Research, The University of Queensland, Brisbane, Australia.
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41
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Paget SP, Beath AWJ, Barnes EH, Waugh MC. Use of the King's Outcome Scale for Childhood Head Injury in the evaluation of outcome in childhood traumatic brain injury. Dev Neurorehabil 2012; 15:171-7. [PMID: 22582847 DOI: 10.3109/17518423.2012.671381] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the inter-rater reliability of The King's Outcome Scale for Childhood Head Injury (KOSCHI) with clinicians of varying experience in paediatric traumatic brain injury (TBI); and to examine change in outcome during long-term follow-up of children following traumatic brain injury (TBI) using KOSCHI. METHOD Retrospective assessment of detailed clinic reports of 97 children followed-up by a tertiary specialist paediatric brain injury service. Investigators were blinded to each other's scores. RESULTS Inter-rater reliability was substantial (weighted kappa 0.71) and similar for investigators of varying experience. KOSCHI outcome was strongly associated with markers of injury severity (p = 0.028). In longitudinal follow-up, KOSCHI score worsened in 7 (23%) children who were injured under 8 years but in no older children (p = 0.02). CONCLUSION KOSCHI has high inter-rater reliability for investigators of different experience. Long-term KOSCHI outcome is associated with injury severity. Some young children may develop worse disability over time.
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Affiliation(s)
- Simon Paul Paget
- Kids Rehab, The Children's Hospital at Westmead, Westmead, Sydney, New South Wales, Australia.
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42
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Yang Z, Yeo RA, Pena A, Ling JM, Klimaj S, Campbell R, Doezema D, Mayer AR. An FMRI study of auditory orienting and inhibition of return in pediatric mild traumatic brain injury. J Neurotrauma 2012; 29:2124-36. [PMID: 22533632 DOI: 10.1089/neu.2012.2395] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Studies in adult mild traumatic brain injury (mTBI) have shown that two key measures of attention, spatial reorienting and inhibition of return (IOR), are impaired during the first few weeks of injury. However, it is currently unknown whether similar deficits exist following pediatric mTBI. The current study used functional magnetic resonance imaging (fMRI) to investigate the effects of semi-acute mTBI (<3 weeks post-injury) on auditory orienting in 14 pediatric mTBI patients (age 13.50±1.83 years; education: 6.86±1.88 years), and 14 healthy controls (age 13.29±2.09 years; education: 7.21±2.08 years), matched for age and years of education. The results indicated that patients with mTBI showed subtle (i.e., moderate effect sizes) but non-significant deficits on formal neuropsychological testing and during IOR. In contrast, functional imaging results indicated that patients with mTBI demonstrated significantly decreased activation within the bilateral posterior cingulate gyrus, thalamus, basal ganglia, midbrain nuclei, and cerebellum. The spatial topography of hypoactivation was very similar to our previous study in adults, suggesting that subcortical structures may be particularly affected by the initial biomechanical forces in mTBI. Current results also suggest that fMRI may be a more sensitive tool for identifying semi-acute effects of mTBI than the procedures currently used in clinical practice, such as neuropsychological testing and structural scans. fMRI findings could potentially serve as a biomarker for measuring the subtle injury caused by mTBI, and documenting the course of recovery.
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Affiliation(s)
- Zhen Yang
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
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43
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Rosema S, Crowe L, Anderson V. Social function in children and adolescents after traumatic brain injury: a systematic review 1989-2011. J Neurotrauma 2012; 29:1277-91. [PMID: 22260408 DOI: 10.1089/neu.2011.2144] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Clinical reports and case studies suggest that traumatic brain injury (TBI) can have significant social consequences, with social dysfunction reported to be the most debilitating problem for child and adolescent survivors. From a social neuroscience perspective, evidence suggests that social skills are not localized to a specific brain region, but are mediated by an integrated neural network. Many components of this network are susceptible to disruption in the context of TBI. In early development, a brain injury can disrupt this neural network while it is in the process of being established, resulting in social dysfunction. In order to clarify the prevalence and nature of social dysfunction after child TBI, studies of social outcomes in children and adolescents after TBI over the last 23 years have been reviewed. Despite casting a wide net initially, only 28 articles met review criteria. These studies were characterized by methodological weaknesses, including variations in definitions of TBI, limited assessment tools, reliance on parent reports, small sample sizes, and absent control groups. Despite these limitations, the weight of evidence confirmed an elevated risk of social impairment in the context of moderate and severe injury. While rarely examined, younger age at insult, pathology to frontal regions and the corpus callosum, and social disadvantage and family dysfunction may also increase the likelihood of social difficulties. More research is needed to obtain an accurate picture of social outcomes post-brain injury.
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Affiliation(s)
- Stefanie Rosema
- Child Neuropsychology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
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Babikian T, Satz P, Zaucha K, Light R, Lewis RS, Asarnow RF. The UCLA longitudinal study of neurocognitive outcomes following mild pediatric traumatic brain injury. J Int Neuropsychol Soc 2011; 17:886-95. [PMID: 21813031 PMCID: PMC4579245 DOI: 10.1017/s1355617711000907] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Comprehensive reviews of neurocognitive outcomes following mild, uncomplicated traumatic brain injury (TBI) in children have shown minimal effects on neurocognition, especially in methodologically rigorous studies. In this study, we report longitudinal (1, 6, and 12 months post injury) results in four domains of neurocognitive functioning in a large sample of children with mild TBI (n = 124, ages 8-17 at injury) relative to two demographically matched control groups (other injury: n = 94 and non-injury: n = 106). After accounting for age and parental education, significant main effects of group were observed on 7 of the 10 neurocognitive tests. However, these differences were not unique to the TBI sample but were found between both the TBI and other injury groups relative to the non-injured group, suggesting a general injury effect. Effects were primarily within the domains measuring memory, psychomotor processing speed, and language. This is the largest longitudinal study to date of neurocognitive outcomes at discrete time points in pediatric mild TBI. When controlling for pre-injury factors, there is no evidence of long-term neurocognitive impairment in this group relative to another injury control group. The importance of longitudinal analyses and use of appropriate control groups are discussed in the context of evaluating the effects of mild TBI on cognition.
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Affiliation(s)
- Talin Babikian
- Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA 90024, USA.
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45
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Scherwath A, Sommerfeldt DW, Bindt C, Nolte A, Boiger A, Koch U, Petersen-Ewert C. Identifying children and adolescents with cognitive dysfunction following mild traumatic brain injury—Preliminary findings on abbreviated neuropsychological testing. Brain Inj 2011; 25:401-8. [DOI: 10.3109/02699052.2011.557351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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46
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Child and Proxy Perspectives of the Child's Health-Related Quality of Life 1 Month After a Mild Traumatic Brain Injury. J Trauma Nurs 2011. [DOI: 10.1097/jtn.0b013e31820e3f31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Noggle CA, Pierson EE. Pediatric TBI: prevalence and functional ramifications. ACTA ACUST UNITED AC 2010; 17:81-2. [PMID: 20467946 DOI: 10.1080/09084281003708795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The current article serves as an introduction to this special issue on the assessment and treatment of traumatic brain injury (TBI) in children and adolescents. The article provides a brief review of the importance of this topic to neuropsychology while stressing the importance of evaluating factors related to assessment and treatment not only from an injury severity and developmental perspective but also the importance of familial and social functioning. Neuropsychologists' knowledge and professional skills involving psychological skills and neurocognitive principles make them most adept at treating children with TBI and their families for a variety of issues addressed in the special issue.
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Affiliation(s)
- Chad A Noggle
- Department of Educational Psychology, Ball State University, Teachers College, Rm. 524, Muncie, IN 47306, USA.
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48
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Semrud-Clikeman M. Pediatric Traumatic Brain Injury: Rehabilitation and Transition to Home and School. ACTA ACUST UNITED AC 2010; 17:116-22. [DOI: 10.1080/09084281003708985] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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49
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Noggle CA, Pierson EE. Psychosocial and Behavioral Functioning Following Pediatric TBI: Presentation, Assessment, and Intervention. ACTA ACUST UNITED AC 2010; 17:110-5. [DOI: 10.1080/09084281003708977] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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50
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Crowe LM, Anderson V, Catroppa C, Babl FE. Head injuries related to sports and recreation activities in school-age children and adolescents: Data from a referral centre in Victoria, Australia. Emerg Med Australas 2010; 22:56-61. [DOI: 10.1111/j.1742-6723.2009.01249.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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