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Allonsius F, de Kloet AJ, van Markus-Doornbosch F, Vliet Vlieland TPM, van der Holst M. A longitudinal follow-up study of parent-reported family impact and quality of life in young patients with traumatic and non-traumatic brain injury. Disabil Rehabil 2024; 46:2240-2250. [PMID: 37295937 DOI: 10.1080/09638288.2023.2218657] [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: 11/29/2022] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Brain injuries (traumatic-/nontraumatic, TBI/nTBI) in young patients may lead to problems e.g., decreased health-related quality of life (HRQoL), and causes family impact. Knowledge regarding the family impact and the relationship with patients' HRQoL over time is scarce. This follow-up study describes family impact/HRQoL and their mutual relationship in young patients (5-24 years) after TBI/nTBI. MATERIALS AND METHODS Parents of patients that were referred to outpatient rehabilitation completed the PedsQL™Family-Impact-Module questionnaire to assess the family impact and the parent-reported PedsQL™Generic-core-set-4.0 to assess patients' HRQoL (lower scores: more family impact/worse HRQoL). Questionnaires were completed at the time of referral to rehabilitation (baseline) and one/two years later (T1/T2). Linear-mixed models were used to examine family impact/HRQoL change scores, and repeated-measure correlations (r) to determine longitudinal relationships. RESULTS Two-hundred-forty-six parents participated at baseline, 72 (at T2), median patient's age at baseline was 14 years (IQR:11-16), and 181 (74%) had TBI. Mean (SD) PedsQL™Family-Impact-Module score at baseline was 71.7 (SD:16.4) and PedsQL™Generic-core-set-4.0: 61.4 (SD:17.0). Over time, PedsQL™Family-Impact-Module scores remained stable, while PedsQL™Generic-core-set-4.0 scores improved significantly(p < 0.05). A moderately strong longitudinal correlation was found between family impact&HRQoL (r = 0.51). CONCLUSIONS Family impact does not tend to decrease over time but remained a considerable problem, although patients' HRQoL improved. Next to focusing on patients' HRQoL, it remains important to consider family impact and offer family support throughout rehabilitation.IMPLICATIONS FOR REHABILITATIONThis longitudinal study found that in young patients with traumatic brain injury (TBI) or non-traumatic brain injury (nTBI) referred for rehabilitation there is a considerable impact on the family until two years after referral, whereas the patients' health-related quality of life (HRQoL) improved significantly.Improvements in patients' quality of life status may not automatically lead to a decrease of family impact.Rehabilitation clinicians should monitor the impact on the family over time and provide long-term family support with special attention to parental worrying when needed.Clinicians should be aware that, despite significant differences between the clinical characteristics of patients with TBI and nTBI, the courses of family impact are very similar.
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Affiliation(s)
- F Allonsius
- Basalt Rehabilitation Center, Department of Innovation, Quality and Research, The Hague, The Netherlands
- Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - A J de Kloet
- Basalt Rehabilitation Center, Department of Innovation, Quality and Research, The Hague, The Netherlands
| | - F van Markus-Doornbosch
- Basalt Rehabilitation Center, Department of Innovation, Quality and Research, The Hague, The Netherlands
| | - T P M Vliet Vlieland
- Basalt Rehabilitation Center, Department of Innovation, Quality and Research, The Hague, The Netherlands
- Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - M van der Holst
- Basalt Rehabilitation Center, Department of Innovation, Quality and Research, The Hague, The Netherlands
- Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
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Jenkin T, D'Cruz K, Botchway E, Muscara F, Anderson V, Scheinberg A, Knight S. Family involvement in rehabilitation programmes for children and adolescents with acquired brain injury: A scoping literature review. Neuropsychol Rehabil 2024:1-54. [PMID: 38518075 DOI: 10.1080/09602011.2024.2330141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 12/22/2023] [Indexed: 03/24/2024]
Abstract
Paediatric acquired brain injury (ABI) can adversely impact families, and it is widely accepted that families should be involved in the rehabilitation of children/adolescents with ABI. However, there is limited guidance about how to best involve families in paediatric ABI rehabilitation. Several programmes involving the families of children/adolescents with ABI have been developed, but there are no published reviews outlining their characteristics. This scoping literature review aimed to synthesize information about these programmes and develop an understanding of how families are involved in them. Four databases were systematically searched to identify sources of evidence that described programmes in paediatric ABI rehabilitation that involve family members. One hundred and eight sources of evidence describing 42 programmes were included. Programmes were categorized as: service coordination (n = 11), psychosocial (n = 17), support groups (n = 4), training/instruction (n = 9), and education (n = 1). Families' involvement in these programmes varied across programme development, delivery, and evaluation stages. The findings of this scoping literature review outline how families can be involved in paediatric ABI rehabilitation. While this review outlines many approaches to supporting families, it also highlights the need for models of family-centred care to better articulate how clinicians and services can involve families in paediatric ABI rehabilitation.
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Affiliation(s)
- Taylor Jenkin
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | | | - Edith Botchway
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Frank Muscara
- Murdoch Children's Research Institute, Melbourne, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
| | - Adam Scheinberg
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
| | - Sarah Knight
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
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Riggall EA, Slomine BS, Suskauer SJ, Borda A, Lahey S, Ludwig NN. Caregiver and family functioning after pediatric disorder of consciousness: telephone-based outcome assessment. Brain Inj 2024; 38:99-107. [PMID: 38328910 DOI: 10.1080/02699052.2024.2304884] [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: 05/08/2023] [Accepted: 10/15/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Examine initial feasibility/utility of a telephone-administered measure in describing impact of child health on caregiver/family functioning in patients with a history of a disorder of consciousness (DoC) due to severe-acquired brain injury (ABI). METHOD Caregivers of patients admitted at least 1 year prior for inpatient rehabilitation with DoC completed a battery of measures administered via telephone examining the impact of child health on caregiver/family functioning (Pediatric Quality of Life Family Impact Module; PedsQL-FIM) and child functioning. RESULTS Forty-one caregivers of unique patients (age = 5-22 years; M = 14.9, SD = 5.1; 63% male; time since injury = 1-18 years; M = 5.3; SD = 4.2) completed the telephone measures. PedsQL-FIM floor and ceiling effects were minimal (administration time = 5-16 min, M = 7.4; SD = 2.8). Family functioning was lowest in Daily Activities and highest in Family Relationships. Relative to caregivers of patients with mild-severe ABI, caregivers reported lower caregiver/family functioning. Correlations were moderate between child functioning and caregiver/family functioning on some PedsQL-FIM scales. CONCLUSIONS Within this relatively small convenience sample, results indicate the PedsQL-FIM administered via telephone is feasible and useful in describing the impact of child health on caregiver/family functioning long after DoC associated with ABI. Future studies are needed to understand factors contributing to caregiver/family functioning to inform targeted interventions.
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Affiliation(s)
- Emily A Riggall
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Beth S Slomine
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Stacy J Suskauer
- Department of Rehabilitation, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department Physical Medicine and Rehabilitation and Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Allison Borda
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Sarah Lahey
- Neuropsychology, Brooks Rehabilitation, Jacksonville, Florida, USA
| | - Natasha N Ludwig
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Atkinson TB, Forsyth RJ. It's easier to relearn gross motor skills than learn them for the first time after injury: Empirical evidence informing the age at injury debate. Eur J Paediatr Neurol 2023; 47:67-71. [PMID: 37741169 DOI: 10.1016/j.ejpn.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/05/2023] [Accepted: 09/01/2023] [Indexed: 09/25/2023]
Abstract
The effect of age at injury on outcomes after brain injury has long been debated. Many have argued that the greater plasticity of the immature brain aids in its recovery from trauma, but others (notably Donald Hebb) have argued that early injury can impair the future ability of the brain to acquire new capabilities. This is difficult to assess empirically due to the presence of many age-dependent confounders. We performed Item Response Theory (IRT) analyses of two datasets of Gross Motor Function Measure (GMFM) observations, one in children with cerebral palsy (CP) and one in children with acquired brain injury (ABI) sustained at later ages. We used IRT to derive independent estimates of test item difficulty in the two populations. Additionally, where comparison between GMFM items and items in the Denver II Developmental Screening Test battery was possible we used the latter to obtain the ages at which these abilities are acquired in typically developing children. Item difficulty estimates for the two populations are highly correlated (adjusted r2=0.89, p<0.0005), but demonstrate significant bias with harder items (typically acquired at later ages) being more readily achieved by children with ABI compared to CP. These results support the Hebbian perspective that (when considering gross motor function) it is easier to maintain or recover previously established functions than to learn them for the first time in an injured brain. This argues for a more cautious outcome prognosis in injury at very young ages.
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Affiliation(s)
| | - Rob J Forsyth
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Jenkin T, D'Cruz K, Anderson V, Scheinberg A, Knight S. Family-centred service in paediatric acquired brain injury rehabilitation: perspectives of children and adolescents and their families. Disabil Rehabil 2023; 45:3087-3098. [PMID: 36106758 DOI: 10.1080/09638288.2022.2121864] [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: 01/30/2022] [Revised: 08/10/2022] [Accepted: 09/02/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Family-centred service is considered best practice in paediatric acquired brain injury (ABI) rehabilitation. However, there is no universal model to guide clinicians and services in implementing this approach with a lack of research evidence informed by the lived experience of families. This study explored experiences of family-centred service during rehabilitation from the perspectives of parents/caregivers, siblings, and children/adolescents with ABI. MATERIALS AND METHODS Semi-structured interviews were conducted with participants from eight families, and included 10 parents/caregivers, five siblings, and four children/adolescents with moderate to severe ABI. Interview transcripts and additional data were analysed using constructivist grounded theory methods. RESULTS Two themes and five sub-themes were developed: (1) Working together as a team: Valuing clinicians' expert knowledge; Doing rehabilitation together; and Sharing family knowledge; and (2) Navigating rehabilitation as a family: Recognising family needs; Juggling family life; and Making rehabilitation work for the family. Participants reflected on the centrality of the child/adolescent with ABI during rehabilitation, and the ways that family needs, life, and involvement in rehabilitation change over time. CONCLUSIONS These findings highlight the importance of clinicians actively seeking to understand families' unique contexts, needs, and priorities during rehabilitation through two-way information sharing with families. Through developing a greater understanding of families' unique contexts, clinicians can be better placed to tailor rehabilitation according to their unique circumstances and needs.Implications for rehabilitationRehabilitation involves active collaboration between families and clinicians that is responsive to changing needs over time.Family involvement in rehabilitation is shaped by family life, and families have unique needs following paediatric acquired brain injury.It is important that clinicians strive to develop an understanding of families' unique needs, values, preferences, and lives to determine how to best support and involve them in rehabilitation.
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Affiliation(s)
- Taylor Jenkin
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Kate D'Cruz
- Discipline of Occupational Therapy, La Trobe University, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Australia
| | - Adam Scheinberg
- Psychology Service, Royal Children's Hospital, Melbourne, Australia
- Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
| | - Sarah Knight
- Psychology Service, Royal Children's Hospital, Melbourne, Australia
- Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
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Letter to the editor: Caregiver burden by treatment and clinical characteristics of patients with glioblastoma. Support Care Cancer 2023; 31:206. [PMID: 36892637 DOI: 10.1007/s00520-023-07668-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/19/2022] [Indexed: 03/10/2023]
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Predicting Outcomes 2 Months and 1 Year After Inpatient Rehabilitation for Youth With TBI Using Duration of Impaired Consciousness and Serial Cognitive Assessment. J Head Trauma Rehabil 2023; 38:E99-E108. [PMID: 36883898 DOI: 10.1097/htr.0000000000000784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To examine predictive utility of the Glasgow Coma Scale (GCS), time to follow commands (TFC), length of posttraumatic amnesia (PTA), duration of impaired consciousness (TFC+PTA), and the Cognitive and Linguistic Scale (CALS) scores in predicting outcomes on the Glasgow Outcome Scale-Extended, Pediatric Revision (GOS-E Peds) for children with traumatic brain injury (TBI) at 2 months and 1 year after discharge from rehabilitation. SETTING A large, urban pediatric medical center and inpatient rehabilitation program. PARTICIPANTS Sixty youth with moderate-to-severe TBI (mean age at injury = 13.7 years; range = 5-20). DESIGN A retrospective chart review. MAIN MEASURES Lowest postresuscitation GCS, TFC, PTA, TFC+PTA, inpatient rehabilitation admission and discharge CALS scores, GOS-E Peds at 2-month and 1-year follow-ups. RESULTS CALS scores were significantly correlated with the GOS-E Peds at both time points (weak-to-moderate correlation for admission scores and moderate correlation for discharge scores). TFC and TFC+PTA were correlated with GOS-E Peds scores at a 2-month follow-up and TFC remained a predictor at a 1-year follow-up. The GCS and PTA were not correlated with the GOS-E Peds. In the stepwise linear regression model, only the CALS at discharge was a significant predictor of the GOS-E Peds at the 2-month and 1-year follow-ups. CONCLUSIONS In our correlational analysis, better performance on the CALS was associated with less long-term disability, and longer TFC was associated with more long-term disability, as measured by the GOS-E Peds. In this sample, the CALS at discharge was the only retained significant predictor of GOS-E Peds scores at 2-month and 1-year follow-ups, accounting for roughly 25% of the variance in GOS-E scores. As previous research suggests, variables related to rate of recovery may be better predictors of outcome than variables related to severity of injury at a single time point (eg, GCS). Future multisite studies are needed to increase sample size and standardize data collection methods for clinical and research purposes.
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Ni ZH, Lv HT, Wu JH, Wang F. Post-traumatic growth in caregivers of children hospitalized in the PICU due to traffic accident: a qualitative study. BMC Nurs 2023; 22:48. [PMID: 36814264 PMCID: PMC9948375 DOI: 10.1186/s12912-023-01213-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Globally, tens of millions of children are hospitalized every year for non-fatal traffic accident injuries, being confronted with an injured child can be extremely stressful for parents. Understandably, a significant level of psychological distress may ensue. Traumatic losses may lead parents to find new insights in life and develop a greater sense of spirituality and strength. METHOD Semi-structured interviews were conducted with caregivers of children who were hospitalized in the pediatric intensive care unit (PICU) with traffic accident injuries at children's hospitals in China between January and June 2022. Caregivers were selected using a purposive sampling method until no new data were generated (n = 24). RESULTS We identified eleven sub-themes and four higher-order themes based on these sub-themes: (1) changes in their life philosophy, (2) personal strength enhancement, (3) relationship improvements, and (4) effective responses. The findings of our research contribute to a better understanding of the psychological status of the caregivers of children injured by traffic accidents. CONCLUSION Professionals should guide caregivers from a positive perspective, stimulate their strengths and potential, increase personnel support and communication, promote positive coping, formulate targeted management countermeasures to improve the PTG level of caregivers, and develop strategies to maintain stable mental health and well-being.
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Affiliation(s)
- Zhi Hong Ni
- Children's Hospital of Soochow University, No. 92, Zhong nan St, Suzhou, 215025, China.
| | - Hai Tao Lv
- grid.452253.70000 0004 1804 524XChildren’s Hospital of Soochow University, No. 92, Zhong nan St, Suzhou, 215025 China
| | - Jin Hua Wu
- grid.452253.70000 0004 1804 524XChildren’s Hospital of Soochow University, No. 92, Zhong nan St, Suzhou, 215025 China
| | - Fang Wang
- grid.452253.70000 0004 1804 524XChildren’s Hospital of Soochow University, No. 92, Zhong nan St, Suzhou, 215025 China
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Jenkin T, Anderson VA, D'Cruz K, Scheinberg A, Knight S. Family-centred service in paediatric acquired brain injury rehabilitation: Bridging the gaps. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1085967. [PMID: 36619530 PMCID: PMC9816340 DOI: 10.3389/fresc.2022.1085967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
Background Children and adolescents who sustain an acquired brain injury (ABI) can experience acute and ongoing difficulties in a range of cognitive and functional domains, and their families often experience significant life changes and challenges. Family-centred service is therefore considered best practice in paediatric ABI rehabilitation. Despite widespread acceptance of family-centred service in this context, recent literature indicates that family needs are often unrecognised and unmet following paediatric ABI. Although family-centred service was introduced in the field of developmental disability over five decades ago, there remains a lack of clarity about how this approach is implemented in practice. Additionally, limited literature has discussed the implementation of family-centred service in paediatric ABI rehabilitation despite key differences between ABI and developmental disability, including nature and timing of onset, rehabilitation foci, and impacts on families. Aims In this review, we aim to: (i) outline common sequelae of paediatric ABI with a focus on family outcomes; (ii) summarise paediatric rehabilitation and highlight opportunities for family support and involvement; (iii) discuss and synthesise literature across paediatric ABI rehabilitation and family-centred service to highlight gaps in knowledge and practice; and (v) identify clinical implications and future research directions. Conclusions There is a clear need for greater clarity and consensus regarding the implementation of family-centred service in paediatric ABI rehabilitation. This review highlights the importance of providing professional development opportunities for clinicians to increase competency in practising in a family-centred manner, and opportunities to actively involve, empower and support families within rehabilitation. This review also emphasises the importance of services implementing relevant supports to address family needs where possible and developing clear referral pathways so that families can access further support elsewhere when needed.
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Affiliation(s)
- Taylor Jenkin
- Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Vicki A. Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Brain and Mind, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Psychology Service, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Kate D'Cruz
- Summer Foundation, Melbourne, VIC, Australia
| | - Adam Scheinberg
- Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Paediatric Rehabilitation Service, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sarah Knight
- Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Paediatric Rehabilitation Service, The Royal Children's Hospital, Melbourne, VIC, Australia
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10
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Analytis P, Warren N, Crichton A, Knight S, Ponsford J. Coping and wellbeing in families with a child with acquired brain injury compared with families in the community. Disabil Rehabil 2022; 44:7993-8000. [PMID: 34860632 DOI: 10.1080/09638288.2021.2008522] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Paediatric acquired brain injury (ABI) negatively impacts parental wellbeing and family functioning. Adaptive coping, that is behaviours promoting emotional wellbeing and addressing distressing problems, may support wellbeing and family functioning. This study compared wellbeing, coping, and family functioning between parents of a child with ABI and parents in the community, and examined coping as a predictor of wellbeing and family functioning. METHODS Forty parents of a child with ABI and 40 parents in the community participated in this cross-sectional survey using the Personal Wellbeing Index, Coping Scale for Adults Short Form, McMaster Family Assessment Device (General Functioning Subscale). RESULTS The ABI group had statistically significantly lower wellbeing, t(68.70) = -4.01, p < 0.001, lower adaptive coping, t(73.95) = -3.27, p = 0.002, and poorer family functioning, t(77) = 4.26, p < 0.001. Family composition (single-parent/couple), having a child with ABI, adaptive coping, and non-productive coping predicted 47.7% of the variance in wellbeing, F(5, 70) = 12.75, p < 0.001. Parental education, having a child with ABI, and non-productive coping predicted 35.9% of the variance in family functioning, F(5, 69) = 7.71, p < 0.001. CONCLUSIONS Adaptive coping may contribute to better family outcomes in paediatric ABI.Implications for rehabilitationPaediatric ABI may have a significant impact on the child with ABI and the family, leading to poorer outcomes for some families.This study suggested that parents of a child with ABI use adaptive coping less than parents in the community but do not differ in the use of non-productive coping.Families need long-term targeted support to meet the challenges paediatric ABI presents and may benefit from interventions which actively seek to change parental coping strategies.
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Affiliation(s)
- Penelope Analytis
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia.,Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Narelle Warren
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne, Australia
| | - Alison Crichton
- Victorian Fetal Alcohol Service, Monash Children's Hospital, Clayton, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia.,School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Sarah Knight
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Victorian Paediatric Rehabilitation Service and Children's Cancer Centre, Monash Children's Hospital, Clayton, Australia.,Victorian Paediatric Rehabilitation Service, The Royal Children's Hospital, Parkville, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia.,Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
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Hickey L, Anderson V, Jordan B. Australian parent and sibling perspectives on the impact of paediatric acquired brain injury on family relationships during the first 6 weeks at home. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5204-e5212. [PMID: 35880586 DOI: 10.1111/hsc.13938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/08/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
This study explores the impact of paediatric acquired brain injury (ABI) on family relationships. Twenty-three families (n = 18 mothers, n = 7 fathers, and n = 4 siblings) of children who sustained an ABI requiring treatment from inpatient acute and rehabilitation services reported on their perceptions regarding changes in family relationships since the injured child's return home. Thematic analysis of survey data was conducted. Family members (parents and siblings) described four themes: (1) negative changes in sibling interactions; (2) role changes arising from an increase in parental expectations of non-injured siblings; (3) family system challenges in balancing needs within the parent-child dyad and sibling subsystems; and (4) supporting emotional responses within the family system. Findings reveal a critical time for families as they resume full care of the injured child at home. Clinical implications for social workers and other rehabilitation clinicians are explored.
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Affiliation(s)
- Lyndal Hickey
- The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brigid Jordan
- The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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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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13
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LaRovere KL, Tang Y, Li K, Wadhwani N, Zhang B, Tasker RC, Yang G. Effectiveness of Training Programs for Reducing Adverse Psychological Outcomes in Parents of Children with Acquired Brain Injury: A Systematic Review and Meta-Analysis. Neurol Ther 2022; 11:1691-1704. [PMID: 36048333 DOI: 10.1007/s40120-022-00399-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/15/2022] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Parental stress following critical illness in their child has the potential to impact functional outcomes and quality of life for the child and whole family. Parent emotional functioning may also be an important clinical target to optimize child outcomes. This study assessed the effectiveness of training programs for parents aimed at reducing adverse psychological outcomes in parents of children with acute brain injury (ABI). METHODS We conducted searches of Embase, PubMed, Web of Science, and Cochrane Library to November 13, 2020. Randomized controlled trials (RCTs) that compared parent training programs with usual care, or an active comparator, and assessed psychological outcomes (depression, anxiety, stress) in parents of children with ABI were included. Two reviewers independently extracted data on study characteristics, participants, interventions, outcome measures, and results before and after intervention. Risk of bias was assessed using the Cochrane risk-of-bias tool. RESULTS Four RCTs involving 318 parents of children with ABI were eligible for review. Compared with usual care or active comparator, parent training was associated with significant reduction in parent stress (four RCTs; standardized mean difference [SMD], - 0.32 on a numerical rating scale [95% CI, - 0.60, - 0.05]; I-squared = 7.5%, p = 0.356); significant reduction in parent depression (three RCTs; SMD, - 0.43 [95% CI, - 0.72, - 0.14]; I-squared = 0.0%, p = 0.393); and significant reduction in parent anxiety (two RCTs; SMD, - 0.63 [95% CI, - 1.05, - 0.21]; I-squared = 0.0%, p = 0.629). Overall risk of bias was high for randomization process (one RCT), missing outcome data (three RCTs), measurement of the outcome (three RCTs), and selection of reported result (two RCTs). Heterogeneity between studies by country of study origin was not significant. CONCLUSIONS Compared with usual care or an active comparator, parent training was associated with short-term reduction in stress, depression, and anxiety in parents of children with ABI. Future clinical trials of parent interventions are needed as there may be some short-term beneficial effects.
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Affiliation(s)
- Kerri L LaRovere
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Yuzhe Tang
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, TsingHua University, Beijing, China.,Harvard Medical School, Boston, MA, USA
| | - Kun Li
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, TsingHua University, Beijing, China.,Harvard Medical School, Boston, MA, USA
| | | | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.,Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert C Tasker
- Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Guang Yang
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China. .,Senior Department of Pediatrics, Seventh Medical Center, Chinese PLA General Hospital, 5 Nanmen Cang, Ten East and West, Dongcheng District, Beijing, 100700, China.
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14
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Ridings LE, Davidson TM, Walker J, Winkelmann J, Anton MT, Espeleta HC, Nemeth LS, Streck CJ, Ruggiero KJ. Caregivers' and Young Children's Emotional Health Needs After Pediatric Traumatic Injury. Clin Pediatr (Phila) 2022; 61:560-569. [PMID: 35581720 PMCID: PMC9329229 DOI: 10.1177/00099228221097498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pediatric traumatic injury (PTI) is associated with emotional health difficulties, but most US trauma centers do not adequately address emotional recovery needs. This study aimed to assess families' emotional health needs following PTI and determine how technology could be used to inform early interventions. Individual semi-structured, qualitative interviews were conducted with caregivers of children admitted to a Level I trauma center in the Southeastern United States to understand families' experiences in-hospital and post-discharge. Participants included 20 caregivers of PTI patients under age 12 (M = 6.4 years; 70% male, 45% motor vehicle collision). Thematic analysis was used to analyze data from interviews that were conducted until saturation. Caregivers reported varying emotional needs in hospital and difficulties adjusting after discharge. Families responded enthusiastically to the potential of a technology-enhanced resource for families affected by PTI. A cost-effective, scalable intervention is needed to promote recovery and has potential for widespread pediatric hospital uptake.
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Affiliation(s)
- Leigh E. Ridings
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Tatiana M. Davidson
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | | | - Jennifer Winkelmann
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Margaret T. Anton
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Hannah C. Espeleta
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Lynne S. Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Christian J. Streck
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J. Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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15
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Narad ME, Kaizar EE, Zhang N, Taylor HG, Yeates KO, Kurowski BG, Wade SL. The Impact of Preinjury and Secondary Attention-Deficit/Hyperactivity Disorder on Outcomes After Pediatric Traumatic Brain Injury. J Dev Behav Pediatr 2022; 43:e361-e369. [PMID: 35170571 PMCID: PMC9329149 DOI: 10.1097/dbp.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to examine the impact of preinjury attention-deficit/hyperactivity disorder (PADHD) and secondary ADHD (SADHD) on outcomes after pediatric traumatic brain injury (TBI). METHODS Two hundred eighty-four individuals aged 11 to 18 years hospitalized overnight for a moderate-to-severe TBI were included in this study. Parents completed measures of child behavior and functioning and their own functioning. Linear models examined the effect of ADHD status (PADHD vs SADHD vs no ADHD) on the child's executive functioning (EF), social competence, and functional impairment, and parental depression and distress. RESULTS ADHD status had a significant effect on EF [F(2,269] = 9.19, p = 0.0001), social competence (F[2,263] = 32.28, p < 0.0001), functional impairment (F[2,269] = 16.82, p < 0.0001), parental depression (F[2,263] = 5.53, p = 0.005), and parental distress (F[2,259] = 3.57, p = 0.03). PADHD and SADHD groups had greater EF deficits, poorer social competence, and greater functional impairment than the no ADHD group. The SADHD group had greater levels of parental depression than the no ADHD and PADHD groups, and the SADHD group had higher parental distress than the no ADHD group. CONCLUSION The results highlight the importance of early identification and management of ADHD symptoms after injury to mitigate downstream functional problems. Supporting parents managing new-onset ADHD symptoms may also be important.
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Affiliation(s)
- Megan E Narad
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Eloise E Kaizar
- Department of Statistics, The Ohio State University, Columbus, OH
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine
| | - H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, the Ohio State University, Columbus, OH
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Brad G Kurowski
- Division of Physical Medicine & Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; and
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Shari L Wade
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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16
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Association of Illness Severity With Family Outcomes Following Pediatric Septic Shock. Crit Care Explor 2022; 4:e0716. [PMID: 35733611 PMCID: PMC9203075 DOI: 10.1097/cce.0000000000000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
It is unknown which families are at risk for poor outcomes following a child’s critical illness.
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17
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Morcov MV, Pădure L, Morcov CG, Mirea A, Ghiță M, Onose G. Comparative Analysis of the Quality of Life in Families with Children or Adolescents Having Congenital versus Acquired Neuropathology. CHILDREN (BASEL, SWITZERLAND) 2022; 9:714. [PMID: 35626891 PMCID: PMC9139670 DOI: 10.3390/children9050714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
AIM This research aims to determine whether the time of injury (congenital or acquired) affects the quality of life (QOL) in families having a child or adolescent with neurological impairment. DESIGN Comparative, cross-sectional study. MATERIAL AND METHODS To find out if there are differences in the quality of life domains between these two groups, 66 subjects (31 mothers of patients with congenital disorders and 35 mothers of patients with acquired disorders) completed the PedsQL-Family Impact Module (PedsQL-FIM), the World Health Organization Quality of Life Instrument-Short Form (WHOQOL-BRIEF), and the Cognitive Emotion Regulation Questionnaire (CERQ). RESULTS Analyzing the PedsQL-FIM dimensions, we found significant differences between groups in terms of emotional functioning, communication, and worry, which favor the congenital group. There are no statistically significant differences between social functioning, cognitive functioning, and daily activities groups. No significant differences between groups when evaluating the WHOQOL-BRIEF's domains (physical health, psychological health, social relationships, environment) have been found. According to CERQ results, adaptive strategies had higher mean scores in the congenital than in the acquired group. The mean score for maladaptive strategies in the congenital group is higher than that in the acquired one, except for catastrophizing, which is higher for acquired. CONCLUSION Our findings show that the mothers of patients with acquired neuropathology have a lower quality of life in the emotional functioning, communication, and worry domains.
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Affiliation(s)
- Maria V. Morcov
- National Clinical Centre of Neurorehabilitation for Children “Dr. N. Robanescu”, 041408 Bucharest, Romania; (M.V.M.); (L.P.); (C.G.M.)
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 020022 Bucharest, Romania;
| | - Liliana Pădure
- National Clinical Centre of Neurorehabilitation for Children “Dr. N. Robanescu”, 041408 Bucharest, Romania; (M.V.M.); (L.P.); (C.G.M.)
- Faculty of Midwives and Nursing, University of Medicine and Pharmacy “Carol Davila”, 020022 Bucharest, Romania
| | - Cristian G. Morcov
- National Clinical Centre of Neurorehabilitation for Children “Dr. N. Robanescu”, 041408 Bucharest, Romania; (M.V.M.); (L.P.); (C.G.M.)
| | - Andrada Mirea
- National Clinical Centre of Neurorehabilitation for Children “Dr. N. Robanescu”, 041408 Bucharest, Romania; (M.V.M.); (L.P.); (C.G.M.)
- Faculty of Midwives and Nursing, University of Medicine and Pharmacy “Carol Davila”, 020022 Bucharest, Romania
| | - Marian Ghiță
- Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 050097 Bucharest, Romania;
| | - Gelu Onose
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 020022 Bucharest, Romania;
- Neuromuscular Rehabilitation Clinic Division, Teaching Emergency Hospital “Bagdasar-Arseni”, 041915 Bucharest, Romania
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18
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Palusak C, Shook B, Davies SC, Lundine JP. A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination personnel. INTERNATIONAL JOURNAL OF CARE COORDINATION 2022. [DOI: 10.1177/20534345211070647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction & Importance: Effective, patient-centered care coordination has been shown to improve outcomes for children with special healthcare needs (CSHCN), who often have complex, long-term involvement with multiple service providers. Traumatic brain injury (TBI) can result in long-term physical, intellectual, social, and emotional disabilities that persist long after acute treatment. Yet, even though it is a chronic condition, TBI remains an area with scarce standardization and research surrounding the complex, long-term care coordination need in this population. The purpose of this scoping review is to summarize current research on outcomes in CSHCN after implementation of care coordinators, whether individual or teams, to inform future research for youth with TBI. Methods: OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination and CSHCN. Results: 31 articles met inclusion criteria. Outcomes for children and families were grouped into 5 major categories: healthcare utilization, cost of care, disease status, parent and child quality of life, and healthcare satisfaction and perception of care. Discussion: Implementation of care coordinators, whether in the form of individuals, dyads, or teams, resulted in overall positive outcomes for CSHCN and their families across all 5 major outcome domains. Future research should be focused on the efficacy of care coordinators differing in profession, qualifications, and educational attainment specifically for the unique needs of children with TBI. Additionally, the application of care coordination within medical homes should be further investigated to increase proactive, preventative care of children with TBI and further reduce reactive, need-based treatment only.
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Affiliation(s)
- Cara Palusak
- Heritage College of Osteopathic Medicine, Ohio University Dublin Campus, Columbus, OH
| | - Brandy Shook
- Department of Speech & Hearing Science, The Ohio State University, Columbus, OH
| | - Susan C. Davies
- Department of Counselor Education and Human Services, University of Dayton, Dayton, OH
| | - Jennifer P. Lundine
- Department of Speech & Hearing Science, The Ohio State University, Columbus, OH
- Division of Clinical Therapies & Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH
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19
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Corrigan JD, Vuolo M, Bogner J, Botticello AL, Pinto SM, Whiteneck GG. Do state supports for persons with brain injury affect outcomes in the 5 Years following acute rehabilitation? Health Place 2021; 72:102674. [PMID: 34700065 DOI: 10.1016/j.healthplace.2021.102674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/11/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
While a substantial literature has examined the effects of individual and family-level factors on outcomes following traumatic brain injury (TBI), minimal attention has been directed to the potential influence of the larger environmental context on outcomes. The purpose of the current study was to investigate the effects of state-level resources and supports as an environmental factor influencing long-term outcomes from TBI using data from the TBI Model Systems. We examined the effects of U.S. state supports that specifically target people with TBI (federal funding for state brain injury programs, per capita revenue generated by brain injury trust funds, and expenditures for brain injury specific Medicaid waivers) and one measure of the relative quality of a state's Long-Term Services and Supports (LTSS) for all people with disabilities. The primary hypothesis was that community participation, global functioning, and life satisfaction will be higher on average among people with TBI living in states with more brain injury specific programs and resources and better LTSS. The results of multilevel and fixed-effects modeling indicated that state supports have a small but significant impact on participation and life satisfaction. The most consistent finding indicated that states with better LTSS had higher levels of community participation and life satisfaction on average for people with TBI over and above individual-level differences and fluctuations in these outcomes over time. There was some indication that more brain injury specific supports also result in better participation in the community. These findings deserve replication and extension to include other environmental factors, particularly community level characteristics, that might affect outcomes from TBI.
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Affiliation(s)
| | - Mike Vuolo
- The Ohio State University, Columbus, OH, USA
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20
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Yehene E, Steinberg P, Gerner M, Brezner A, Landa J. "Concurrent Ropes and Ladders": Mapping and Conceptualizing the Emotional Loss Experience of Parents Following Pediatric Acquired Brain Injury. QUALITATIVE HEALTH RESEARCH 2021; 31:1518-1533. [PMID: 34024215 PMCID: PMC8278457 DOI: 10.1177/10497323211012384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This grounded theory study aims to map, conceptualize, and theorize the emotional loss experienced by parents following their child's pediatric acquired brain injury (pABI). Data were obtained from 47 semi-structured interviews conducted with parents (72% mothers) at least 1 year following pABI. The study's theory of "concurrent ropes and ladders" emerged from a process of initial in vivo coding followed by focused and thematic coding. Codes were consolidated into five thematic categories capturing parents' emotional continuous loss experience: (a) comparing life before and after, (b) struggling to construct new realities, (c) recognizing instability and permanency, (d) adjusting and readjusting, and (e) grieving as an emotional shadow. These categories are at work simultaneously in parents' accounts, thus supporting a model of dynamic concurrency within and across their lived experiences. Recommendations for practitioners were derived from the theory to support parents' emotional coping with living loss throughout the chronic stage.
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Affiliation(s)
- Einat Yehene
- The Academic College of Tel Aviv–Yaffo, Tel Aviv, Israel
- Sheba Medical Center, Ramat Gan, Israel
| | | | | | | | - Jana Landa
- Sheba Medical Center, Ramat Gan, Israel
- Tel Aviv University, Tel Aviv, Israel
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21
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Chong SL, Dang H, Ming M, Mahmood M, Zheng CQS, Gan CS, Lee OPE, Ji J, Chan LCN, Ong JSM, Kurosawa H, Lee JH. Traumatic Brain Injury Outcomes in 10 Asian Pediatric ICUs: A Pediatric Acute and Critical Care Medicine Asian Network Retrospective Study. Pediatr Crit Care Med 2021; 22:401-411. [PMID: 33027240 DOI: 10.1097/pcc.0000000000002575] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Traumatic brain injury remains an important cause of death and disability. We aim to report the epidemiology and management of moderate to severe traumatic brain injury in Asian PICUs and identify risk factors for mortality and poor functional outcomes. DESIGN A retrospective study of the Pediatric Acute and Critical Care Medicine Asian Network moderate to severe traumatic brain injury dataset collected between 2014 and 2017. SETTING Patients were from the participating PICUs of Pediatric Acute and Critical Care Medicine Asian Network. PATIENTS We included children less than 16 years old with a Glasgow Coma Scale less than or equal to 13. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We obtained data on patient demographics, injury circumstances, and PICU management. We performed a multivariate logistic regression predicting for mortality and poor functional outcomes. We analyzed 380 children with moderate to severe traumatic brain injury. Most injuries were a result of road traffic injuries (174 [45.8%]) and falls (160 [42.1%]). There were important differences in temperature control, use of antiepileptic drugs, and hyperosmolar agents between the sites. Fifty-six children died (14.7%), and 104 of 324 survivors (32.1%) had poor functional outcomes. Poor functional outcomes were associated with non-high-income sites (adjusted odds ratio, 1.90; 95% CI, 1.11-3.29), Glasgow Coma Scale less than 8 (adjusted odds ratio, 4.24; 95% CI, 2.44-7.63), involvement in a road traffic collision (adjusted odds ratio, 1.83; 95% CI, 1.04-3.26), and presence of child abuse (adjusted odds ratio, 2.75; 95% CI, 1.01-7.46). CONCLUSIONS Poor functional outcomes are prevalent after pediatric traumatic brain injury in Asia. There is an urgent need for further research in these high-risk groups.
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Affiliation(s)
- Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Hongxing Dang
- Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Meixiu Ming
- Department of Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Maznisah Mahmood
- Department of Paediatrics, Institute of Paediatric, Kuala Lumpur, Malaysia
| | - Charles Q S Zheng
- Department of Epidemiology, Singapore Clinical Research Institute, Singapore
| | - Chin Seng Gan
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Olive P E Lee
- Department of Paediatrics, Sarawak General Hospital, Sarawak, Malaysia
| | - Jian Ji
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Lawrence C N Chan
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jacqueline S M Ong
- Khoo Teck Puat National University Children's Medical Institute, National University Hospital, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hiroshi Kurosawa
- Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Jan Hau Lee
- Duke-NUS Medical School, Singapore
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
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22
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Allonsius F, De Kloet AJ, Van Markus-Doornbosch F, Meesters JJL, Kromme CH, Vliet Vlieland TPM, Van Der Holst M. Parent-reported family impact in children and young adults with acquired brain injury in the outpatient rehabilitation setting. Brain Inj 2021; 35:563-573. [PMID: 33734919 DOI: 10.1080/02699052.2021.1891287] [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: 10/21/2022]
Abstract
Purpose: To increase knowledge/awareness on family impact (FI) after acquired brain injury (ABI) in rehabilitation settings, it is essential to investigate the associations between patient-functioning and impact on families. This has been explored in hospital-based cohorts, but not in rehabilitation settings.Methods: A cross-sectional, multi-center study among parents of children/young adults (aged 5-24 years) with ABI referred to rehabilitation was performed. Patient/injury/family-characteristics were noted, and parents completed the PedsQL™Family-Impact-Module and PedsQL™generic-core-4.0 to assess FI and health-related quality of life (HRQoL). Univariate- and multivariable-regression analyses were performed to investigate associations between HRQoL/patient/injury/family-related factors and FI.Results: 246 families participated; patients' median age was 14 year (IQR 11-16), 65 had non-traumatic-brain-injury (nTBI) (26%), 127 were female. FI was found to be considerable (median FIM-score 71.9, IQR:60-85). Especially referral to rehabilitation >6 months after onset, diminished patients' mental/emotional health and HRQoL (child/family factors), and premorbid problems were associated with higher FI.Conclusions: In this rehabilitation cohort, pediatric ABI caused considerably higher FI than in hospital-based studies with referral to rehabilitation >6 months, diminished child/family factors and presence of premorbid problems increasing FI. Assessing and monitoring FI and its associated factors enables professionals to individualize treatment, psychoeducation, support and follow-up.
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Affiliation(s)
- F Allonsius
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - A J De Kloet
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Centre of Expertsie in Health Innovations, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - F Van Markus-Doornbosch
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - J J L Meesters
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Centre of Expertsie in Health Innovations, The Hague University of Applied Sciences, The Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - C H Kromme
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands
| | - T P M Vliet Vlieland
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - M Van Der Holst
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
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23
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Miley AE, Fisher AP, Moscato EL, Culp A, Mitchell MJ, Hindert KC, Makoroff KL, Rhine TD, Wade SL. A mixed-methods analysis examining child and family needs following early brain injury. Disabil Rehabil 2021; 44:3566-3576. [PMID: 33459078 DOI: 10.1080/09638288.2020.1870757] [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
Purpose:To understand child and family needs following TBI in early childhood, 22 caregivers of children who were hospitalized for a moderate to severe TBI between the ages of 0 and 4 within the past 10 years (M = 3.27 years; Range = 3 months to 8 years) participated in a needs assessment.Methods: Through a convergent study design, including focus groups (FG), key informant interviews (KII), and standardized questionnaires, caregivers discussed challenges and changes in their child's behaviors and functioning in addition to resources that would be helpful post-injury. Standardized questionnaires assessing current psychological distress and parenting stress in addition to open-ended questions about their general experience were completed.Results: Results indicated some families continue to experience unresolved concerns relating to the child's injury, caregiver wellbeing, and the family system after early TBI, including notable variation in caregiver reported psychological distress and parenting stress. Caregivers noted unmet needs post-injury, such as child behavior management and caregiver stress and coping.Conclusion: Early TBI can have a long-term impact on the child, caregivers, and family system. Addressing the needs of the whole family system in intervention and rehabilitation efforts may optimize outcomes following early TBI. Study results will inform intervention development to facilitate post-injury coping and positive parenting.IMPLICATIONS FOR REHABILITATIONEarly TBI can result in unmet needs that have a lingering impact on the child, caregiver, and family.Caregivers need information and resources that address their own distress and stressors related to changes in the child post-injury.Our study suggests that stress management and self-care skills are possible targets of intervention for caregivers of children who experienced an early TBI.
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Affiliation(s)
- Aimee E Miley
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Allison P Fisher
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA
| | - Emily L Moscato
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA
| | - Aubrey Culp
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Monica J Mitchell
- Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kellana C Hindert
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathi L Makoroff
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tara D Rhine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shari L Wade
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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24
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West AN, Diaz-Thomas AM, Shafi NI. Evidence Limitations in Determining Sexually Dimorphic Outcomes in Pediatric Post-Traumatic Hypopituitarism and the Path Forward. Front Neurol 2020; 11:551923. [PMID: 33324312 PMCID: PMC7726201 DOI: 10.3389/fneur.2020.551923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/16/2020] [Indexed: 11/21/2022] Open
Abstract
Neuroendocrine dysfunction can occur as a consequence of traumatic brain injury (TBI), and disruptions to the hypothalamic-pituitary axis can be especially consequential to children. The purpose of our review is to summarize current literature relevant to studying sex differences in pediatric post-traumatic hypopituitarism (PTHP). Our understanding of incidence, time course, and impact is constrained by studies which are primarily small, are disadvantaged by significant methodological challenges, and have investigated limited temporal windows. Because hormonal changes underpin the basis of growth and development, the timing of injury and PTHP testing with respect to pubertal stage gains particular importance. Reciprocal relationships among neuroendocrine function, TBI, adverse childhood events, and physiological, psychological and cognitive sequelae are underconsidered influencers of sexually dimorphic outcomes. In light of the tremendous heterogeneity in this body of literature, we conclude with the common path upon which we must collectively arrive in order to make progress in understanding PTHP.
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Affiliation(s)
- Alina Nico West
- Division of Critical Care Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Alicia M Diaz-Thomas
- Division of Endocrinology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nadeem I Shafi
- Division of Critical Care Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
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25
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Lajud N, Roque A, Cheng JP, Bondi CO, Kline AE. Early Life Stress Preceding Mild Pediatric Traumatic Brain Injury Increases Neuroinflammation but Does Not Exacerbate Impairment of Cognitive Flexibility during Adolescence. J Neurotrauma 2020; 38:411-421. [PMID: 33040677 DOI: 10.1089/neu.2020.7354] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Early life stress (ELS) followed by pediatric mild traumatic brain injury (mTBI) negatively impacts spatial learning and memory and increases microglial activation in adolescent rats, but whether the same paradigm negatively affects higher order executive function is not known. Hence, we utilized the attentional set-shifting test (AST) to evaluate executive function (cognitive flexibility) and to determine its relationship with neuroinflammation and hypothalamic-pituitary-adrenal (HPA) axis activity after pediatric mTBI in male rats. ELS was induced via maternal separation for 180 min per day (MS180) during the first 21 post-natal (P) days, while controls (CONT) were undisturbed. At P21, fully anesthetized rats received a mild controlled cortical impact (2.2 mm tissue deformation at 4 m/sec) or sham injury. AST was evaluated during adolescence on P35-P40 and cytokine expression and HPA activity were analyzed on P42. The data indicate that pediatric mTBI produced a significant reversal learning deficit on the AST versus sham (p < 0.05), but that the impairment was not exacerbated further by MS180. Additionally, ELS produced an overall elevation in set-loss errors on the AST, and increased hippocampal interleukin (IL)-1β expression after TBI. A significant correlation was observed in executive dysfunction and IL-1β expression in the ipsilateral pre-frontal cortex and hippocampus. Although the combination of ELS and pediatric mTBI did not worsen executive function beyond that of mTBI alone (p > 0.05), it did result in increased hippocampal neuroinflammation relative to mTBI (p < 0.05). These findings provide important insight into the susceptibility to incur alterations in cognitive and neuroimmune functioning after stress exposure and TBI during early life.
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Affiliation(s)
- Naima Lajud
- División de Neurociencias, Centro de Investigación Biomédica de Michoacán - Instituto Mexicano del Seguro Social, Morelia, Michoacán, México
| | - Angélica Roque
- División de Neurociencias, Centro de Investigación Biomédica de Michoacán - Instituto Mexicano del Seguro Social, Morelia, Michoacán, México.,Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey P Cheng
- Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Corina O Bondi
- Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Neurobiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony E Kline
- Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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26
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A Randomized Comparative Effectiveness Trial of Family-Problem-Solving Treatment for Adolescent Brain Injury: Parent Outcomes From the Coping with Head Injury through Problem Solving (CHIPS) Study. J Head Trauma Rehabil 2020; 34:E1-E9. [PMID: 31033747 DOI: 10.1097/htr.0000000000000487] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine changes in depression and distress in parents of adolescents receiving family-problem-solving therapy (F-PST) following traumatic brain injury. METHOD Families of adolescents hospitalized for moderate to severe traumatic brain injury were randomized to face-to-face F-PST (34), therapist-guided online F-PST (56), or self-guided online F-PST (60). Outcomes were assessed pretreatment and 6 and 9 months later. Parents rated depression and distress on the Center for Epidemiological Studies Depression Scale and the Brief Symptom Inventory, respectively. Mixed modeling was used to examine changes over time and treatment moderators. RESULTS The therapist-guided online group had significant reductions in parental depression over time. Analyses of slopes of recovery revealed differential improvement on the Center for Epidemiological Studies Depression Scale between the 2 online groups, with no significant change in depressive symptoms following self-guided F-PST. On the Brief Symptom Inventory Global Severity Index, the therapist-guided online group reported significant improvement from baseline to 6 months that was maintained at 9 months. The face-to-face and self-guided online groups reported significant reductions in distress between 6 and 9 months with corresponding large effect sizes. Differences on the Center for Epidemiological Studies Depression Scale between therapist-guided and self-guided online groups at the 9-month follow-up were more pronounced in families of lower socioeconomic status, t103 = -2.87; P = .005. CONCLUSIONS Findings provide further support for the utility of therapist-guided online F-PST in reducing parental depression and distress following pediatric traumatic brain injury and offer limited evidence of the efficacy of self-guided online treatment for these outcomes. Families of lower socioeconomic status may benefit more from therapist involvement.
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27
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Peterson RK, Williams T, Dlamini N, Westmacott R. Parent experiences and developmental outcomes following neonatal stroke. Clin Neuropsychol 2020; 35:973-987. [PMID: 32924802 DOI: 10.1080/13854046.2020.1815855] [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: 10/23/2022]
Abstract
OBJECTIVE Parents of children with neonatal stroke offer critical insight into potential avenues to direct neuropsychological care from the time of diagnosis through the early years. The aims of this study were to (1) describe what parents remember about early prognostic discussions with the medical team and (2) to examine the relationships between initial prognoses and the child's current neurodevelopmental status and parents' mental health. Method: Thirty parents of children with neonatal stroke completed the Depression Anxiety Stress Scales (DASS) and Parent Experiences Questionnaire (PEQ). The children of these parents were also seen for neurodevelopmental/neuropsychological assessments. Results: Parents recalled discussions with the medical team about motor, language, cognitive, and academic outcomes, with fewer discussions about the impact of neonatal stroke on their child's social skills, behavior, attention, mental health, and adaptive functioning. Many parents recalled poor initial prognoses following their child's diagnosis, with better than expected outcomes 3 years later. Parent self-reported depression, anxiety, and stress were associated with higher ratings of externalizing symptoms in their child. There were no significant correlations between parent mental health and their perception of their child's internalizing symptoms, neurodevelopmental functioning, or any of the child's medical/demographic factors. Conclusions: This study highlights the role of the neuropsychologist in the child's care in educating families and monitoring outcomes, emphasizes mental health support for parents of children with a history of neonatal stroke, and reiterates how environmental factors outside of the neonatal stroke itself can impact the child's functioning.
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Affiliation(s)
- Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Tricia Williams
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, USA
| | - Nomazulu Dlamini
- Department of Neurology, The Hospital for Sick Children, Toronto, ON, USA
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, USA
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Longitudinal Trajectories of Caregiver Distress and Family Functioning After Community-Acquired Pediatric Septic Shock. Pediatr Crit Care Med 2020; 21:787-796. [PMID: 32541376 PMCID: PMC9125433 DOI: 10.1097/pcc.0000000000002404] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To identify trajectories and correlates of caregiver distress and family functioning in families of children who survived community-acquired septic shock. We hypothesized that: 1) a substantial subset of families would demonstrate trajectories of persistent elevated caregiver distress and impaired family functioning 12 months after hospitalization and 2) sociodemographic and clinical risk factors would be associated with trajectories of persistent distress and family dysfunction. DESIGN Prospective cohort. SETTING Fourteen PICUs in the United States. PATIENTS Caregivers of 260 children who survived community-acquired septic shock. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Caregivers completed ratings of distress on the Brief Symptom Inventory and of family functioning on the Family Assessment Device at baseline, 1, 3, 6, and 12 months after hospitalization. Results from group-based trajectory modeling indicated that 67% of the current sample was characterized by persistent low caregiver distress, 26% by persistent moderate to high distress that remained stable across 12 months (high-risk caregiver distress group), and 8% by initial high distress followed by gradual recovery. Forty percent of the sample was characterized by stable high family functioning, 15% by persistent high dysfunction across 12 months (high-risk family functioning group), 12% by gradually improving functioning, and 32% by deteriorating function over time. Independently of age, child race was associated with membership in the high-risk caregiver distress group (non-white/Hispanic; effect size, -0.12; p = 0.010). There were no significant sociodemographic or clinical correlates of the high-risk family functioning group in multivariable analyses. CONCLUSIONS Although the majority of families whose children survived community-acquired septic shock were characterized by resilience, a subgroup demonstrated trajectories of persistently elevated distress and family dysfunction during the 12 months after hospitalization. Results suggest a need for family-based psychosocial screening after pediatric septic shock to identify and support at-risk families.
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29
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Gan C, Van't Hooft I, Brookes N, Prasauskiene A, Wales L, Wright FV. First stage international validation of the pediatric family needs questionnaire (FNQ-P). Brain Inj 2020; 34:1074-1083. [PMID: 32594765 DOI: 10.1080/02699052.2020.1782474] [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: 10/24/2022]
Abstract
OBJECTIVES 1. Evaluate reliability and construct validity of the newly-developed Family Needs Questionnaire - Pediatric (FNQ-P), a 40-item measure assessing the extent to which family's needs are met after a child has an acquired brain injury (ABI). 2. Explore the impact of selected child characteristics on FNQ-P scores. RESEARCH DESIGN: MEASUREMENT STUDY Methods: Parents/caregivers of children with ABI (2-18 years) were recruited across four sites (Canada, Sweden, Lithuania, Australia) for FNQ-P test-retest evaluation. These sites plus a fifth (United Kingdom) completed construct validity evaluation with the Family Burden of Injury Inventory and Strengths and Difficulties Questionnaire. Associations between FNQ-P score and age, injury severity, time post-injury and site were evaluated via stepwise regression. RESULTS FNQ-P mean scores (n=61) were 64.1% (SD 22.3) and 58.8% (SD 22.6) on test and retest, respectively. Test-retest reliability was good overall (ICC=0.78, 95% CI 0.65-0.86). There was a weak association between FNQ-P and FBII (r=-0.23, P=0.049, n=71), but no association between FNQ-P and SDQ scores (maximum r=0.16, P>0.15). None of the variables studied predicted FNQ-P scores. CONCLUSION The FNQ-P demonstrated good test-retest reliability. Further validity assessment is recommended. Lack of relationship between FNQ-P and variables studied suggests independence of family needs.
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Affiliation(s)
- Caron Gan
- Bloorview Research Institute , Toronto, Ontario, Canada.,Holland Bloorview Kids Rehabilitation Hospital , Toronto, Ontario, Canada
| | - Ingrid Van't Hooft
- Astrid Lindgren Children's Hospital, Karolinska University Hospital , Stockholm, Sweden
| | - Naomi Brookes
- Rehab2Kids, Sydney Children's Hospital , Randwick, NSW, Australia
| | | | | | - F Virginia Wright
- Bloorview Research Institute , Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto , Toronto, Ontario, Canada
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30
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Davies SC. School-Based Support for Families of Students with Traumatic Brain Injuries. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2020. [DOI: 10.1080/15377903.2020.1734708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Susan C. Davies
- Department of Counselor Education, University of Dayton, Dayton, Ohio, USA
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31
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Lantagne A, Peterson RL, Kirkwood MW, Taylor HG, Stancin T, Yeates KO, Wade SL. Featured Article: Interpersonal Stressors and Resources as Predictors of Adolescent Adjustment Following Traumatic Brain Injury. J Pediatr Psychol 2019; 43:703-712. [PMID: 29617953 DOI: 10.1093/jpepsy/jsy020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/08/2018] [Indexed: 11/13/2022] Open
Abstract
Objective The present study sought to examine adolescents' perceptions of their interpersonal stressors and resources across parent, sibling, friend, and school relationships, and the longitudinal associations with self-reported adjustment after traumatic brain injury (TBI) over a 12-month period. Methods We examined the main effects of stressors and resources on internalizing and externalizing symptoms in 152 adolescents who had sustained complicated mild-to-severe TBI. We also investigated the conjoint effects of stressors and resources and the moderating effects of TBI severity with stressors and resources on outcomes. Results High stressors consistently predicted worse adjustment. High resources were generally only associated with fewer internalizing symptoms. Main effects were qualified by interactions between school stressors and resources in predicting externalizing symptoms and between friend stressors and resources in predicting internalizing and externalizing symptoms. For school stressors, the effects of resources on externalizing symptoms functioned as a buffer. In comparison, the buffering effects of friend resources on internalizing and externalizing symptoms disappeared at moderate-to-high levels of friend stress. Moderating effects of TBI severity were also observed, such that as family resources increased, only adolescents with complicated mild-to-moderate TBI, but not those with severe TBI, experienced decreases in internalizing and eternalizing symptoms. Conclusion Interpersonal stressors and social support have important implications for adolescent adjustment after TBI. Adolescents with low levels of school resources, with high levels of friend stress, and who sustain severe TBI are at greatest risk for difficulties with adjustment.
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Affiliation(s)
- Ann Lantagne
- Department of Rehabilitation, Children's Hospital Colorado.,Department of Child Clinical Psychology, University of Denver
| | - Robin L Peterson
- Department of Rehabilitation, Children's Hospital Colorado.,University of Colorado School of Medicine
| | - Michael W Kirkwood
- Department of Rehabilitation, Children's Hospital Colorado.,University of Colorado School of Medicine
| | - H Gerry Taylor
- Case Western Reserve University.,Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Terry Stancin
- Case Western Reserve University.,Department of Psychiatry, MetroHealth Medical Center
| | | | - Shari L Wade
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
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32
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Hutchison JS, Emery C, Gagnon I, Léger C, Riopelle R, Wellington C, Wilson E, Turgeon AF. The Canadian Traumatic Brain Injury Research Consortium: Epitomizing Collaborative Research in Canada. J Neurotrauma 2019; 35:1858-1863. [PMID: 30074867 DOI: 10.1089/neu.2018.5871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of death in the first half of life and a chronic disability for Canadians of all ages. Despite the recognized importance of TBI, there is no integrated national strategy for research and best practices in Canada. We therefore created the Canadian TBI Research Consortium (CTRC) to build an ideal model of collaboration between Canadian TBI researchers. Our objectives were to: (1) Create a collaborative Canadian research network, (2) improve patient survival, functional outcome, and health through sustainable and scalable evidence-based practice implementation, (3) strengthen the healthcare system for patients with TBI, (4) provide international leadership and collaboration in TBI research, (5) build stronger links with patients and their representatives to help set the research agenda, and to participate in analysis of its impacts, and (6) support current researchers and prepare the next generation of leaders in TBI research. Building on the highly successful 30-year history of the Canadian Critical Care Trials Group, we developed a highly collaborative research group that integrates the multi-disciplinary network of TBI researchers in Canada. The CTRC conducts multi-center clinically relevant practice changing research. Our research is developed around investigator-led project-based research using a programmatic approach and multiple methodologies. Through strong and sustainable career development and mentorship programs, we train and develop the next generation of TBI researchers. Our group is composed of more than 100 Canadian researchers from coast to coast, most of them funded by the Canadian Institutes of Health Research and other granting agencies. In conclusion, the CTRC prioritizes investigator-led TBI research and broadens the research agenda by integrating researchers from different disciplines in the field of TBI research to optimize delivery of care and improve the health of Canadians with TBI. Our goals are being accomplished across the whole continuum of care by conducting clinically relevant and practice-changing research.
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Affiliation(s)
- James S Hutchison
- 1 Department of Critical Care, The Hospital for Sick Children , Toronto, Ontario, Canada .,2 Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute , Toronto, Ontario, Canada .,3 Interdepartmental Division of Critical Care, The University of Toronto , Toronto, Ontario, Canada .,4 Institute of Medical Science, The University of Toronto , Toronto, Ontario, Canada
| | - Carolyn Emery
- 5 Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary , Calgary, Alberta, Canada .,6 Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary , Calgary, Alberta, Canada
| | - Isabelle Gagnon
- 7 School of Physical and Occupational Therapy, McGill University , Montréal, Québec, Canada .,8 Trauma Center, Montreal Children's Hospital, McGill University Health Center , Montréal, Québec, Canada
| | - Caroline Léger
- 9 CHU de Québec - Université Laval Research Center , Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Québec City, Québec, Canada
| | - Richard Riopelle
- 10 Ontario Neurotrauma Foundation , Toronto, Ontario, Canada .,11 Brain Injury Canada , Ottawa, Ontario, Canada
| | - Cheryl Wellington
- 12 Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, British Columbia, Canada
| | - Elisa Wilson
- 2 Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute , Toronto, Ontario, Canada
| | - Alexis F Turgeon
- 9 CHU de Québec - Université Laval Research Center , Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Québec City, Québec, Canada .,13 Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval , Québec City, Québec, Canada
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33
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Narad ME, Treble-Barna A, Zang H, Zhang N, Smith-Paine J, Yeates KO, Taylor HG, Stancin T, Wade SL. Parenting Behaviors after Moderate - Severe Traumatic Injury in Early Childhood. Dev Neurorehabil 2019; 22:437-444. [PMID: 30235048 PMCID: PMC6426679 DOI: 10.1080/17518423.2018.1518350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose: Examine the impact of traumatic brain injury (TBI) on parenting behavior over time. Method: Included 206 children (3-7 years old) with moderate to severe TBI or orthopedic injury, using a prospective longitudinal cohort study design. Assessments completed at baseline, 6-months, 12-months, 18-months, 3.5 years, and 6.8 years after injury. Dependent variables included authoritative, permissive, and authoritarian parenting. Results: Injury characteristics had limited impact on parenting behaviors over time. Levels of authoritative parenting remained stable over time; however, levels of warmth and involvement declined over time for those with TBI. Levels of permissive and authoritarian parenting declined for all participants by 3.5 years post injury. SES and stressors impacted parenting behaviors. Conclusions: While there was limited effect of TBI on parenting behavior over time, it remains unclear how individuals respond to these parenting behaviors years after injury. Clinicians should monitor family and parenting behaviors to foster an environment to promote positive recovery.
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Affiliation(s)
- Megan E. Narad
- Division of Physical Medicine & Rehabilitation, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Amery Treble-Barna
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Huaiyu Zang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Julia Smith-Paine
- Division of Physical Medicine & Rehabilitation, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, Department of Psychology, University of Cincinnati, Cincinnati, OH
| | - Keith O. Yeates
- Department of Psychology, Alberta Children’s Hospital Research Institute Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - H. Gerry Taylor
- Division of Developmental & Behavioral Pediatrics and Psychology, Department of Pediatrics, Case Western Reserve University, Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Cleveland, OH
| | - Terry Stancin
- Division of Pediatric Psychology, Department of Pediatrics, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Shari L. Wade
- Division of Physical Medicine & Rehabilitation, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and The University of Cincinnati College of Medicine, Cincinnati, OH
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34
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Yehene E, Brezner A, Ben-Valid S, Golan S, Bar-Nadav O, Landa J. Factors associated with parental grief reaction following pediatric acquired brain injury. Neuropsychol Rehabil 2019; 31:105-128. [PMID: 31556807 DOI: 10.1080/09602011.2019.1668280] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The present study investigated factors associated with parental grief reaction (PGR) following pediatric acquired brain injury (ABI), and compared PGR to the one exhibited following child death. Fifty-seven parents of 51 children (aged 3-18) whose ABI occurred 1-14 years before participation, completed the multi-scale Two-Track Bereavement Questionnaire; a socio-demographic questionnaire; and a scale assessing perceived behavioural changes in the child. Results from regression analysis indicated that time since injury had no impact on parents' grief other than having an adverse impact on their overall coping and functioning; A higher amount of weekly caring hours predicted only a greater traumatic perception of the loss; Older children's ages but mostly greater parental-perceived behavioural changes, predicted greater PGR on most scales. PGR was compared with the pre-existing data of bereaved parents who completed the same grief questionnaire. Although grief response patterns and intensity were similar in both groups, significant differences were found on scales assessing the continuing bond with the child: relational active grief, close and positive relationship, and conflictual relationship. Our findings indicate that parental grief is multi-dimensional following pediatric ABI and illuminate the interplay between elements characterizing parents' nonfinite vs. finite loss experience.
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Affiliation(s)
- Einat Yehene
- School of Behavioral Sciences, The Academic College of Tel-Aviv Yafo, Tel-Aviv, Israel.,Pediatric Rehabilitation Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel HaShomer, Israel
| | - Amichai Brezner
- Pediatric Rehabilitation Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel HaShomer, Israel
| | - Shani Ben-Valid
- School of Behavioral Sciences, The Academic College of Tel-Aviv Yafo, Tel-Aviv, Israel
| | - Sapir Golan
- School of Behavioral Sciences, The Academic College of Tel-Aviv Yafo, Tel-Aviv, Israel
| | - Ofri Bar-Nadav
- International Center for the Study of Loss, Bereavement and Human Resilience, Department of Psychology, University of Haifa, Haifa, Israel
| | - Janna Landa
- Pediatric Rehabilitation Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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35
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Investigating the Connection Between Traumatic Brain Injury and Posttraumatic Stress Symptoms in Adolescents. J Head Trauma Rehabil 2019; 33:210-218. [PMID: 28520669 DOI: 10.1097/htr.0000000000000319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify potentially modifiable individual and social-environmental correlates of posttraumatic stress symptoms (PTSS) among adolescents hospitalized for traumatic brain injury (TBI). SETTING Four pediatric hospitals and 1 general hospital in the United States. PARTICIPANTS Children ages 11 to 18 years, hospitalized for moderate-severe TBI within the past 18 months. DESIGN Retrospective cross-sectional analysis. MAIN MEASURES The University of California at Los Angeles (UCLA) Post-traumatic Stress Disorder (PTSD) Reaction Index and the Youth Self-Report (YSR) PTSD subscale. RESULTS Of 147 adolescents enrolled, 65 (44%) had severe TBI, with an average time since injury of 5.8 ± 4 months. Of the 104 who completed the UCLA-PTSD Reaction Index, 22 (21%) reported PTSS and 9 (8%) met clinical criteria for PTSD. Of the 143 who completed the YSR-PTSD subscale, 23 (16%) reported PTSS and 6 (4%) met clinical criteria for PTSD. In multivariable analyses, having a negative approach to problem solving and depressive symptoms were both associated (P < .001) with higher levels of PTSS based on the UCLA-PTSD Reaction Index (β = 0.41 and β = 0.33, respectively) and the YSR-PTSD subscale (β = 0.33 and β = 0.40, respectively). CONCLUSION Targeting negative aspects of problem solving in youths after brain injury may mitigate PTSS.
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36
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Foster K, Mitchell R, Young A, Van C, Curtis K. Resilience-promoting factors for parents of severely injured children during the acute hospitalisation period: A qualitative inquiry. Injury 2019; 50:1075-1081. [PMID: 30573290 DOI: 10.1016/j.injury.2018.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/22/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Paediatric injury impacts the entire family. Many parents experience stress and anxiety following paediatric injury, but little is known about factors that support parents' wellbeing and how they successfully manage the adversity of child injury during acute hospitalisation. AIM To explore parent experiences and resilience-promoting factors that facilitate the wellbeing of parents with severely injured children during the acute hospitalisation period. METHODS A qualitative inquiry conducted across four major Australian paediatric trauma services. Semi-structured interviews were conducted with a purposive sample of 40 parents of 30 severely injured children aged 0-12 years during the acute post-injury hospitalisation period. Interviews explored parents' experiences and how parents had managed the stress of their child's injury during the acute hospitalisation period. Data were analysed using directed content analysis. RESULTS Parents identified a range of individual characteristics and resources, and those of their children and families, communities, and the hospital environment, which facilitated their wellbeing during the initial post-injury period. Three themes were derived from analysis: Drawing on inner strengths; Having positive and supportive relationships; Being in a safe place with the right help. CONCLUSION Resilience-promoting factors for parents of injured children can be used to inform development of brief online intervention modules to enhance parent resilience. Routine screening and targeted psychological first aid for parental distress are recommended.
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Affiliation(s)
- Kim Foster
- Australian Catholic University, School of Nursing, Midwifery & Paramedicine, 115 Victoria Parade, Fitzroy, Victoria, 3065, Australia; Northwestern Mental Health, Melbourne Health, Grattan Street, Parkville, Victoria, 3050, Australia.
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University NSW 2109, Australia
| | - Alexandra Young
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown NSW 2006, Australia
| | - Connie Van
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown NSW 2006, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown NSW 2006, Australia; Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University NSW 2109, Australia; Illawarra Shoalhaven Local Health District, Wollongong Hospital, Loftus Street, Wollongong NSW 2500, Australia; Illawarra Health and Medical Research Institute, Building 32, University of Wollongong, Northfields Avenue, Wollongong NSW 2522, Australia; The George Institute for Global Health, Level 5, 1 King Street, Newtown NSW 2042, Australia
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Foster K, Mitchell R, Young A, Van C, Curtis K. Parent experiences and psychosocial support needs 6 months following paediatric critical injury: A qualitative study. Injury 2019; 50:1082-1088. [PMID: 30655002 DOI: 10.1016/j.injury.2019.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/23/2018] [Accepted: 01/07/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Parents of critically injured children can experience high levels of psychological distress post-injury, however little is known about their experiences and needs following injury. This study aimed to explore parent experiences and psychosocial support needs in the six months following child critical injury. METHODS An interpretive qualitative design was used. Semi-structured interviews were conducted with 30 parents of 23 critically injured children. Interviews explored parent experiences and psychosocial support needs. Qualitative data were managed using NVIVO 10 and analysed thematically. RESULTS Four themes were identified: integrating back into home life; adjusting mentally and emotionally to injury; coping with injury as a family; and navigating resources to meet family needs. Parents and families experienced substantial ongoing emotional impacts at 6 months following child injury. Parents were unprepared for the negative changes in their child's psychological wellbeing and behaviour post injury, and parents' mental health was negatively impacted, with mothers more likely to seek emotional support than fathers. Parents reported receiving no psychosocial follow-up from the hospital and limited information about community services and accessing local community resources on returning home. CONCLUSIONS There is a need to include all family members in discharge planning, and to use a family-centred continuity-of-care approach from the time of child injury through to post-discharge recovery. To strengthen parent and family wellbeing, a biopsychosocial holistic approach is recommended, including cognitive-behavioural and other psychological strategies to help reduce distress for parents and all family members and strengthen their coping capacity. A dedicated family support coordinator role to facilitate care over the child recovery trajectory, and development of accessible online and e-psychosocial support resources for parents and families are recommended.
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Affiliation(s)
- Kim Foster
- Australian Catholic University, School of Nursing, Midwifery & Paramedicine, 115 Victoria Parade, Fitzroy, Victoria, 3065, Australia; Northwestern Mental Health, Melbourne Health, Grattan Street, Parkville, Victoria, 3050, Australia; Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown NSW 2006, Australia.
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University NSW 2109, Australia
| | - Alexandra Young
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown NSW 2006, Australia
| | - Connie Van
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown NSW 2006, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown NSW 2006, Australia; Illawarra Shoalhaven Local Health District, Wollongong Hospital, Loftus Street, Wollongong NSW 2500, Australia; Illawarra Health and Medical Research Institute, Building 32, University of Wollongong, Northfields Avenue, Wollongong NSW 2522, Australia; The George Institute for Global Health, Level 5, 1 King Street, Newtown NSW 2042, Australia
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Hill K, Brenner M. Well siblings' experiences of living with a child following a traumatic brain injury: a systematic review protocol. Syst Rev 2019; 8:81. [PMID: 30940180 PMCID: PMC6446255 DOI: 10.1186/s13643-019-1005-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this systematic review is to synthesize the available evidence identified through a systematic search on well siblings' experiences of living with a child following a traumatic brain injury (TBI). Brain injuries in children have been referred to as the "silent epidemic" of current times. Brain injuries in children are also recognized as a global public health concern, with the impact on children, effects on family life, and caregiving markedly misunderstood and underestimated. It is widely recognized that a serious brain injury impacts on the whole family, both immediate and extended regardless of the age of the individual who experiences the brain injury. While some research refers to parental experiences of children with TBIs and caregivers experiences, there is a dearth of literature relating to the impact on well siblings and their perspectives. Well siblings' experiences regarding the impact of living with a child post-TBI are not well understood. In order to advance the delivery of family nursing care in the home, an understanding of the well siblings' experiences is fundamental. METHODS The search will be conducted using seven medical and healthcare databases for articles published up until February 2019. Two reviewers will independently screen the articles for inclusion and assess for study quality using the standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Two reviewers will extract data from each study and carry out data analysis to uncover themes within the literature. Data synthesis of findings will be carried out using JBI-QARI. DISCUSSION It is anticipated that the findings of the proposed review will be of interest to health and social care professionals, particularly those working in units where children have suffered TBIs, their well siblings, and families. The aim is to identify well siblings' experiences which can inform enhanced care delivery to the families of children following a TBI. The findings of this review will provide evidence to aid professionals with the assessment of siblings' needs to enhance their sense of self within the family unit. Future directions, in addition to potential limitations of the approach, will be discussed. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2018 CRD42018111036.
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Affiliation(s)
- Katie Hill
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Gan C, Wright FV. Development of the family needs questionnaire - pediatric version [FNQ-P] - phase I. Brain Inj 2019; 33:623-632. [PMID: 30676093 DOI: 10.1080/02699052.2019.1566836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To adapt the well-validated 37-item adult Family Needs Questionnaire to make it suitable for families of children and youth with acquired brain injury (ABI). METHODS Measurement construction employed a modified Delphi technique to identify the most relevant content items for the pediatric Family Needs Questionnaire (FNQ-P). The Delphi process involved a panel of 11 ABI-team clinicians and seven family caregivers of children/youth with an ABI and four rounds of anonymous voting on each item's importance. Qualitative responses related to each item's review were incorporated into item content and wording decisions. Cognitive interviews were conducted with three parents after the Delphi to evaluate face and content validity. RESULTS The outcome of the final Delphi round was a set of 40 items within the original FNQ's original six categories: Health Information (n = 10), Emotional Support (n = 6), Instrumental Support (n = 4), Professional Support (n = 6), Community Support (n = 6), and Involvement with Care (n = 8). Cognitive interviews resulted in changes to formatting, rating scale, and item wording, and culminated in overall consensus about the FNQ-P's face/content validity. CONCLUSIONS Use of the Delphi process with family and clinical partners resulted in content-endorsed pediatric FNQ that is ready for validation work prior to transfer to clinical practice.
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Affiliation(s)
- Caron Gan
- a Bloorview Research Institute , Toronto , Ontario , Canada.,b Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada
| | - F Virginia Wright
- a Bloorview Research Institute , Toronto , Ontario , Canada.,c Department of Physical Therapy , University of Toronto , Toronto , Ontario , Canada
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Zhang N, Kaizar EE, Narad ME, Kurowski BG, Yeates KO, Taylor HG, Wade SL. Examination of Injury, Host, and Social-Environmental Moderators of Online Family Problem Solving Treatment Efficacy for Pediatric Traumatic Brain Injury Using an Individual Participant Data Meta-Analytic Approach. J Neurotrauma 2018; 36:1147-1155. [PMID: 30328749 DOI: 10.1089/neu.2018.5885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A series of five randomized controlled clinical trials (RCTs) conducted between 2002 and 2015 support the potential efficacy of online family problem-solving treatment (OFPST) in improving both child and parent/family outcomes after pediatric traumatic brain injury (TBI). However, small sample sizes and heterogeneity across individual studies have precluded examination of potentially important moderators. We jointly analyzed individual participant data (IPD) from these five RCTs, involving 359 children and adolescents between the ages of 5 and 18 years, to confirm the role of previously identified moderators (child's age and pre-treatment symptom levels, parental education) and to examine other potential moderators (race, sex, IQ), using IPD meta-analysis. This reanalysis revealed statistically strong evidence that parental education, child age at baseline, IQ, sex, and parental depression level pre-treatment moderated the effect of OFPST on various outcomes. In particular, children of parents with a less than high school education exhibited fewer internalizing problems and better social competence. Children injured at an older age exhibited fewer externalizing behaviors and less executive dysfunction following OFPST. Child IQ moderated the effect of OFPST on social competence, with significantly better competence for children with lower IQ who received OFPST. Lower levels of parental depression followed OFPST among subgroups with lower IQ, boys, and higher parental depression scores at baseline. Our findings indicate that the optimal application of OFPST is likely to involve older children, those with lower IQ scores, or those from families with lower socioeconomic status (SES).
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Affiliation(s)
- Nanhua Zhang
- 1 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Eloise E Kaizar
- 2 Department of Statistics, Nationwide Children's Hospital Research Institute, Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Megan E Narad
- 3 Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brad G Kurowski
- 3 Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Keith Owen Yeates
- 4 Department of Psychology, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - H Gerry Taylor
- 5 Center for Biobehavioral Health, Nationwide Children's Hospital Research Institute, Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Shari L Wade
- 3 Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
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‘It's turned our world upside down’: Support needs of parents of critically injured children during Emergency Department admission – A qualitative inquiry. Australas Emerg Care 2018; 21:137-142. [DOI: 10.1016/j.auec.2018.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 11/23/2022]
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Golos A, Bedell G. Responsiveness and discriminant validity of the Child and Adolescent Scale of Participation across three years for children and youth with traumatic brain injury. Dev Neurorehabil 2018; 21:431-438. [PMID: 28692352 DOI: 10.1080/17518423.2017.1342711] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To examine responsiveness and discriminant validity of the Child and Adolescent Scale of Participation (CASP) across three years. METHODS Examined longitudinal data on 515 children and youth with TBI and arm injuries. Repeated measures analyses of variance were used to examine CASP scores (pre-injury; 3, 12, 24, 36 months post-injury). RESULTS Scores decreased from pre-injury to 3 months, but significantly only for moderate and severe TBI groups. Scores gradually increased post-injury for all groups except severe TBI. Scores were consistently lowest for severe TBI, followed by moderate TBI, mild TBI, and arm injury across time. Severe TBI scores were significantly lower than scores for mild TBI and arm injury, but not moderate TBI. CONCLUSIONS CASP scores were responsive to change over time at most measurements and differentiated between groups, particularly severe TBI. Further research is needed with a larger sample of children with moderate/severe TBI as they were underrepresented in this study.
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Affiliation(s)
- Anat Golos
- a School of Occupational Therapy of Hadassah and the Hebrew University , Jerusalem , Israel
| | - Gary Bedell
- b Department of Occupational Therapy , Tufts University , Medford , MA , USA
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Kurowski BG, Stancin T, Taylor HG, McNally KA, Kirkwood MW, Cassedy A, King E, Sklut M, Narad ME, Wade SL. Comparative effectiveness of family problem-solving therapy (F-PST) for adolescents after traumatic brain injury: Protocol for a randomized, multicenter, clinical trial. Contemp Clin Trials Commun 2018; 10:111-120. [PMID: 30023445 PMCID: PMC6046511 DOI: 10.1016/j.conctc.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction The objective of this manuscript is to describe the methodology that will be used to test the comparative effectiveness, feasibility, and acceptability of three formats of family problem solving therapy (F-PST) for improving functional outcomes of complicated mild to severe adolescent TBI. Methods Three-arm comparative effectiveness, randomized clinical trial (RCT) design. We describe the protocol of a three-arm RCT comparing the effectiveness of three modalities of F-PST to reduce executive dysfunction and behavior problems following TBI in adolescence. The RCT will compare the relative effectiveness among face-to-face; online and self-directed; and therapist-supported online modes of treatment. Ethics and dissemination It is anticipated that findings from this work will inform future clinical care practices, with implications for treatment of other patient populations of youth with psychological symptoms arising from neurological conditions. Institutional review board approval will be obtained from all sites prior to commencement of the study.
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Affiliation(s)
- Brad G. Kurowski
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Corresponding author. Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 4009, Cincinnati, OH, 45229-3039, USA.
| | - Terry Stancin
- Case Western Reserve University and MetroHealth Medical Center, Cleveland Medical Center, Cleveland, OH, USA
| | - H. Gerry Taylor
- Biobehavioral Health Center, Nationwide Children's Hospital Research Institute, The Ohio State University, Columbus, OH, USA
- Case Western Reserve University, Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kelly A. McNally
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Michael W. Kirkwood
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy Cassedy
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eileen King
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - McKenna Sklut
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Megan E. Narad
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shari L. Wade
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Williams TS, McDonald KP, Roberts SD, Westmacott R, Ahola Kohut S, Dlamini N, Miller SP. In their own words: developing the Parent Experiences Questionnaire following neonatal brain injury using participatory design. Brain Inj 2018; 32:1386-1396. [DOI: 10.1080/02699052.2018.1495844] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Tricia S Williams
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Kyla P McDonald
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- York University, Toronto, Ontario, Canada
| | - Samantha D Roberts
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robyn Westmacott
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Sara Ahola Kohut
- Medical Psychiatry Alliance, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, The University of Toronto, Toronto, Ontario, Canada
| | - Nomazulu Dlamini
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Steven P Miller
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
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Tyerman E, Eccles FJR, Gray V, Murray CD. Siblings' experiences of their relationship with a brother or sister with a pediatric acquired brain injury. Disabil Rehabil 2018; 41:2940-2948. [PMID: 29987955 DOI: 10.1080/09638288.2018.1482506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Primary purpose: Child acquired brain injury has significant impact on the family, including siblings. This study aimed to explore siblings' experiences of their relationship with their brother or sister with acquired brain injury in order to make recommendations for health professionals working with this population.Research design: Semi-structured interviews were conducted with five siblings of children with acquired brain injury aged between 9 and 12 years and analyzed using interpretative phenomenological analysis.Results: The analysis resulted in four themes: (i) Coping with "a nightmare that you live"; (ii) Disconnection from family relationships; (iii) My sibling is different but "still the same underneath all this thing"; and (iv) Changing togetherness.Conclusions: The siblings in this study experienced a high level of distress with the near loss of their brother or sister. This was followed by difficulty in adjusting to the physical and psychological changes in their injured sibling and the impact on their sibling role and relationship. The changes were experienced alongside disruption to family relationships. Important clinical implications include the inclusion of siblings in their injured sibling's care and the provision of information and support for this group.Implications for RehabilitationSiblings of children with an acquired brain injury experience significant challenges while trying to adapt to their changing sibling relationship and feelings of disconnection with their family.This study highlights a need to work systemically with families of childhood brain injury and recognize siblings' important role in their family unit and therefore involve them in their brother/sister's care and rehabilitation.This study also highlights a need to support siblings to cope with the trauma and provide information to validate and understand their experience.
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Affiliation(s)
- Emma Tyerman
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Victoria Gray
- Psychological Services (Paediatrics), Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Craig D Murray
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Hickey L, Anderson V, Hearps S, Jordan B. Family Forward: a social work clinical trial promoting family adaptation following paediatric acquired brain injury. Brain Inj 2018; 32:867-878. [DOI: 10.1080/02699052.2018.1466195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Lyndal Hickey
- The Royal Children’s Hospital, University of Melbourne, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Vicki Anderson
- The Royal Children’s Hospital, University of Melbourne, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Stephen Hearps
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Brigid Jordan
- The Royal Children’s Hospital, University of Melbourne, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
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Meert K, Slomine BS, Christensen JR, Telford R, Holubkov R, Dean JM, Moler FW. Burden of caregiving after a child's in-hospital cardiac arrest. Resuscitation 2018; 127:44-50. [PMID: 29601846 DOI: 10.1016/j.resuscitation.2018.03.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/14/2018] [Accepted: 03/26/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe caregiver burden among those whose children survive in-hospital cardiac arrest and have high risk of neurologic disability, and explore factors associated with burden during the first year post-arrest. METHODS The study is a secondary analysis of the Therapeutic Hypothermia after Paediatric Cardiac Arrest In-Hospital (THAPCA-IH) trial. 329 children who had an in-hospital cardiac arrest, chest compressions for >2 min, and mechanical ventilation after return of circulation were recruited to THAPCA-IH. Of these, 155 survived to one year, and caregivers of 138 were assessed for burden. Caregiver burden was assessed at baseline, and 3 and 12 months post-arrest using the Infant Toddler Quality of Life Questionnaire for children <5 years old and the Child Health Questionnaire for children >5 years. Child functioning was assessed using the Vineland Adaptive Behaviour Scales Second Edition (VABS-II), the Paediatric Overall Performance Category (POPC) and Paediatric Cerebral Performance Category (PCPC) scales, and caregiver perception of global functioning. RESULTS Of 138 children, 77 (55.8%) were male, 77 (55.8%) were white, and 109 (79.0%) were <5 years old at the time of arrest. Caregiver burden was greater than reference norms at all time points. Worse POPC, PCPC and VABS-II scores at 3 months post-arrest were associated with greater caregiver burden at 12 months. Worse global functioning at 3 months was associated with greater burden at 12 months for children <5 years. CONCLUSIONS Caregiver burden is substantial during the first year after paediatric in-hospital cardiac arrest, and associated with the extent of the child's neurobehavioural dysfunction.
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Affiliation(s)
- Kathleen Meert
- Children's Hospital of Michigan, Wayne State University, 3901 Beaubien Boulevard, Detroit, MI 48201, USA.
| | - Beth S Slomine
- Kennedy Krieger Institute, Johns Hopkins University, 707 North Broadway, Baltimore, MD 21205, USA
| | - James R Christensen
- Kennedy Krieger Institute, Johns Hopkins University, 707 North Broadway, Baltimore, MD 21205, USA
| | - Russell Telford
- University of Utah, 295 Chipeta Way, P. O. Box 581289, Salt Lake City, UT 84158, USA
| | - Richard Holubkov
- University of Utah, 295 Chipeta Way, P. O. Box 581289, Salt Lake City, UT 84158, USA
| | - J Michael Dean
- University of Utah, 295 Chipeta Way, P. O. Box 581289, Salt Lake City, UT 84158, USA
| | - Frank W Moler
- University of Michigan, CS Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA
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Stakeholders’ Perspectives on Communication and Collaboration Following School Reintegration of a Seriously Ill Child: A Literature Review. CHILD & YOUTH CARE FORUM 2018. [DOI: 10.1007/s10566-018-9443-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Juste-Lorente O, Maza M, Lorente AI, Lopez-Valdes FJ. Differences in the kinematics of booster-seated pediatric occupants using two different car seats. TRAFFIC INJURY PREVENTION 2018; 19:18-22. [PMID: 28594247 DOI: 10.1080/15389588.2017.1334119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 05/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objective of this article is to compare the performance of forward-facing child restraint systems (CRS) mounted on 2 different seats. METHODS Two different anthropomorphic test device (ATD) sizes (P3 and P6), using the same child restraint system (a non-ISOFIX high-back booster seat), were exposed to the ECE R44 regulatory deceleration pulse in a deceleration sled. Two different seats (seat A, seat B) were used. Three repetitions per ATD and mounting seat were done, resulting in a total of 12 sled crashes. Dummy sensors measured the head tri-axial acceleration and angular rate and the thorax tri-axial acceleration, all acquired at 10,000 Hz. A high-speed video camera recorded the impact at 1,000 frames per second. The 3D kinematics of the head and torso of the ATDs were captured using a high-speed motion capture system (1,000 Hz). A pair-matched statistical analysis compared the outcomes of the tests using the 2 different seats. RESULTS Statistically significant differences in the kinematic response of the ATDs associated with the type of seat were observed. The maximum 3 ms peak of the resultant head acceleration was higher on seat A for the P3 dummy (54.5 ± 1.9 g vs. 44.2 ± 0.5 g; P =.012) and for the P6 dummy (56.0 ± 0.8 g vs. 51.7 ± 1.2 g; P =.015). The peak belt force was higher on seat A than on seat B for the P3 dummy (5,488.0 ± 198.0 N vs. 4,160.6 ± 63.6 N; P =.008) and for the P6 dummy (7,014.0 ± 271.0 N vs. 5,719.3 ± 37.4 N; P =.015). The trajectory of the ATD head was different between the 2 seats in the sagittal, transverse, and frontal planes. CONCLUSION The results suggest that the overall response of the booster-seated occupant exposed to the same impact conditions was different depending on the seat used regardless of the size of the ATD. The differences observed in the response of the occupants between the 2 seats can be attributed to the differences in cushion stiffness, seat pan geometry, and belt geometry. However, these results were obtained for 2 particular seat models and a specific CRS and therefore cannot be directly extrapolated to the generality of vehicle seats and CRS.
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Affiliation(s)
- O Juste-Lorente
- a Impact Laboratory-Aragon Institute for Engineering Research (I3A) , University of Zaragoza , Alcañiz, Teruel , Spain
| | - M Maza
- a Impact Laboratory-Aragon Institute for Engineering Research (I3A) , University of Zaragoza , Alcañiz, Teruel , Spain
| | - A I Lorente
- a Impact Laboratory-Aragon Institute for Engineering Research (I3A) , University of Zaragoza , Alcañiz, Teruel , Spain
| | - F J Lopez-Valdes
- a Impact Laboratory-Aragon Institute for Engineering Research (I3A) , University of Zaragoza , Alcañiz, Teruel , Spain
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Rolland JS. Neurocognitive Impairment: Addressing Couple and Family Challenges. FAMILY PROCESS 2017; 56:799-818. [PMID: 28887888 DOI: 10.1111/famp.12316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Conditions involving neurocognitive impairment pose enormous challenges to couples and families. However, research and practice tend to focus narrowly on immediate issues for individual caregivers and their dyadic relationship with the affected member. A broad family systems approach with attention to family processes over time is needed in training, practice, and research. In this paper, Rolland's Family Systems Illness model provides a guiding framework to consider the interaction of different psychosocial types of neurocognitive conditions and their evolution over time with individual, couple, and family life-course development. Discussion addresses key family and couple issues with mild-to-severe cognitive impairment and progressive dementias, including: communication, multigenerational legacies, threatened future neurocognitive disability, ambiguous loss, decisional capacity, reaching limits, placement decisions, issues for adult children and spousal caregivers, and the transformation of intimate bonds. Principles and guidelines are offered to help couples and families master complex challenges, deepen bonds, and forge positive pathways ahead.
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Affiliation(s)
- John S Rolland
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, and Chicago Center for Family Health, Chicago, IL
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