1
|
Kyösti E, Mikkonen E, Raj R, Ohtonen P, Peltoniemi O, Skrifvars MB, Ala-Kokko T. Long-Term Quality of Life After Pediatric Traumatic Brain Injury Treated in the Intensive Care Unit. Pediatr Neurol 2024; 157:50-56. [PMID: 38865950 DOI: 10.1016/j.pediatrneurol.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/02/2024] [Accepted: 04/29/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND To examine the long-term health-related quality of life (HRQL) after pediatric traumatic brain injury (TBI) treated in the intensive care unit (ICU). METHODS This retrospective cohort study was conducted using data from four university hospital ICUs in Finland. Children aged < 18 years with TBI treated in the ICU during 2003 to 2013 were included. Patients alive at the end of 2020 were sent two different HRQL questionnaires 15/16-dimensional (15D/16D) and RAND-36 and questions regarding chronic diseases, socioeconomical status, and the need for health care support. HRQL was defined as poor when the 15D/16D score total score was below the age- and sex-matched mean population score in Finland minus the minimal clinically important difference. RESULTS A total of 150 of 337 (44%) patients responded (n = 144 15D/16D responses). Median follow-up time was 11 years. Seventy patients (49%) had a poor HRQL according to 15D/16D score. Patients with TBI had significantly poorer 15D scores in every dimension when compared with the matched population mean values. A higher Helsinki CT score, mechanical ventilation, and female sex were associated with poor long-term HRQL according to the 15D/16D. Patients with poor 15D/16D scores also needed significantly more health care services and medications and had more comorbidities than patients with normal scores. A poor 15D/16D score was associated with lower socioeconomic status. CONCLUSIONS Half of long-term pediatric ICU-treated TBI survivors had poor HRQL 11 years after injury. More severe head computed tomographic findings at admission and female sex associated with poor HRQL.
Collapse
Affiliation(s)
- Elina Kyösti
- Research Group of Surgery, Anaesthesiology and Intensive Care Medicine, Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland; Medical Research Center of Oulu University and Oulu University Hospital, Critical Care Center, Oulu, Finland.
| | - Era Mikkonen
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Emergency Care and Services, Helsinki University Hospital & University of Helsinki, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pasi Ohtonen
- Research Group of Surgery, Anaesthesiology and Intensive Care Medicine, Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland; Medical Research Center of Oulu University and Oulu University Hospital, Critical Care Center, Oulu, Finland; Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Outi Peltoniemi
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland; Division of Intensive Care Medicine, Department of Paediatrics, Oulu University Hospital, Oulu, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, Helsinki University Hospital & University of Helsinki, Helsinki, Finland
| | - Tero Ala-Kokko
- Research Group of Surgery, Anaesthesiology and Intensive Care Medicine, Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland; Medical Research Center of Oulu University and Oulu University Hospital, Critical Care Center, Oulu, Finland
| |
Collapse
|
2
|
Linden MA, McKinlay A, Hawley C, Aaro-Jonsson C, Kristiansen I, Meyer-Heim A, Ewing-Cobbs L, Wicks B, Beauchamp MH, Prasad R. Further recommendations of the International Paediatric Brain Injury Society (IPBIS) for the post-acute rehabilitation of children with acquired brain injury. Brain Inj 2024; 38:151-159. [PMID: 38329039 DOI: 10.1080/02699052.2024.2309252] [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: 08/11/2022] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Paediatric acquired brain injury is a life-long condition which impacts on all facets of the individual's lived experience. The existing evidence base continues to expand and new fields of enquiry are established as clinicians and researchers uncover the extent of these impacts. PRIMARY OBJECTIVE To add to recommendations described in the International Paediatric Brain Injury Society's 2016 paper on post-acute care for children with acquired brain injury and highlight new areas of enquiry. REVIEW OF INFORMATION Recommendations were made based on the opinions of a group of experienced international clinicians and researchers who are current or past members of the board of directors of the International Paediatric Brain Injury Society. The importance of each recommendation was agreed upon by means of group consensus. OUTCOMES This update gives new consideration to areas of study including injuries which occur in pre-school children, young people in the military, medical referral, young offenders and the use of technology in rehabilitation.
Collapse
Affiliation(s)
- Mark A Linden
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Carol Hawley
- Warwick Medical School - Mental Health and Wellbeing, University of Warwick, UK
| | | | - Ingela Kristiansen
- Department of Pediatric Neurology, Uppsala University Hospital, Uppsala, Sweden
| | - Andreas Meyer-Heim
- Rehabilitation Centre, University Children's Hospital Zürich, Zurich, Switzerland
| | - Linda Ewing-Cobbs
- Department of Pediatrics, UTHealth Houston, McGovern Medical School, USA
| | | | - Miriam H Beauchamp
- Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Rajendra Prasad
- Department of Neurosurgery, Indraprastha Apollo Hospitals, New Delhi, India
| |
Collapse
|
3
|
Sargénius HL, Andersson S, Haugen I, Hypher R, Brandt AE, Finnanger TG, Rø TB, Risnes K, Stubberud J. Cognitive rehabilitation in paediatric acquired brain injury-A 2-year follow-up of a randomised controlled trial. Front Neurol 2023; 14:1173480. [PMID: 37325227 PMCID: PMC10267836 DOI: 10.3389/fneur.2023.1173480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/26/2023] [Indexed: 06/17/2023] Open
Abstract
Background Goal management training (GMT), a metacognitive rehabilitation method that has been demonstrated to improve executive function (EF) in adults with acquired brain injury (ABI), could potentially be effective for children in the chronic phase of ABI. In a previously published randomised controlled trial (RCT), the efficacy of a paediatric adaptation of GMT (pGMT) compared to a psychoeducative control intervention (paediatric Brain Health Workshop, pBHW) was investigated. Comparable improvements in EF in both groups were found at 6-month follow-up. However, a specific effect of pGMT could not be conclusively proven. The present study reports 2-year follow-up data (T4; T1: baseline, T2: post-intervention, T3: 6-month follow-up, and T4: 2-year follow-up) from this original RCT. Methods A total of 38 children and adolescents and also their parents completed questionnaires tapping into daily life EF. Explorative analyses were conducted comparing the 2-year follow-up data (T4) with the baseline (T1) and 6-month follow-up data (T3) for T4-participants in the two intervention groups (pGMT; n = 21, pBHW; n = 17), and we also assessed T4-participants vs. non-responders (n = 38) in the RCT. Primary outcome measures were the Behavioural Regulation Index (BRI) and the Metacognition Index (MI) derived from the Behaviour Rating Inventory of Executive Function (BRIEF) parent report. Results No difference between intervention groups was found (BRI, F = 2.25, p = 0.143, MI, F = 1.6, p = 0.213), and no time*group interaction (BRI, F = 0.07, p = 0.976, MI, F = 0.137, p = 0.937) could be seen at the 2-year follow-up. Nevertheless, both pGMT and the pBHW groups improved daily EF as measured by parental reports over time from the baseline to T4 (p = 0.034). T4 participants and non-responders shared similar baseline characteristics. Conclusion Our results extend the findings from the 6-month follow-up previously published. Both pGMT and pBHW groups sustained their improvements in daily life EFs from the baseline, but additional effectiveness of pGMT relative to pBHW was not found.
Collapse
Affiliation(s)
| | - Stein Andersson
- Department of Psychology, University of Oslo, Oslo, Norway
- Psychosomatic Medicine and Clinical Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Ingvild Haugen
- Division of Mental Health Care, Innlandet Hospital Trust, Brumunddal, Norway
| | - Ruth Hypher
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Anne Elisabeth Brandt
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
- Children's Clinic, St. Olav University Hospital, Trondheim, Norway
| | | | - Torstein B. Rø
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
- Children's Clinic, St. Olav University Hospital, Trondheim, Norway
| | - Kari Risnes
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
- Children's Clinic, St. Olav University Hospital, Trondheim, Norway
| | - Jan Stubberud
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| |
Collapse
|
4
|
Self- and Parent-Reported Fatigue 7 Years After Severe Childhood Traumatic Brain Injury: Results of the Traumatisme Grave de l'Enfant Prospective Longitudinal Study. J Head Trauma Rehabil 2021; 35:104-116. [PMID: 31246880 DOI: 10.1097/htr.0000000000000502] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate presence of and factors associated with self- and parent-reported fatigue 7 years after severe childhood traumatic brain injury (TBI) in the prospective longitudinal study TGE (Traumatisme Grave de l'Enfant-severe childhood trauma). METHODS Self-reports and/or parent reports on the Multidimensional Fatigue Scale were collected for 38 participants (aged 7-22 years) 7 years after severe childhood TBI, and 33 controls matched for age, gender, and parental educational level. The data collected included sociodemographic characteristics, age at injury and injury severity scores, overall disability (Glasgow Outcome Scale Extended), intellectual outcome (Wechsler scales), and questionnaires assessing executive functions, health-related quality of life, behavior, and participation. RESULTS Fatigue levels were significantly worse in the TBI than in the control group, especially for cognitive fatigue. Correlations of reported fatigue with age at injury, gender, TBI severity, and intellectual ability were moderate and often not significant. Fatigue was significantly associated with overall level of disability (Glasgow Outcome Scale Extended) and with all questionnaires completed by the same informant. CONCLUSION High levels of fatigue were reported by 30% to 50% of patients 7 years after a severe childhood TBI. Reported fatigue explained more than 60% of the variance of reported health-related quality of life by the same informant (patient or parent).
Collapse
|
5
|
Crichton A, Ignjatovic V, Babl FE, Oakley E, Greenham M, Hearps S, Delzoppo C, Beauchamp MH, Guerguerian AM, Boutis K, Hubara E, Hutchison J, Anderson V. Interleukin-8 Predicts Fatigue at 12 Months Post-Injury in Children with Traumatic Brain Injury. J Neurotrauma 2021; 38:1151-1163. [PMID: 31880977 DOI: 10.1089/neu.2018.6083] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Despite many children experiencing fatigue after childhood brain injury, little is known about the predictors of this complaint. To date, traditional indices of traumatic brain injury (TBI) severity have not predicted reliably persisting fatigue (up to three years post-injury). This study aimed to establish whether persisting fatigue is predicted by serum biomarker concentrations in child TBI. We examined whether acute serum biomarker expression would improve prediction models of 12-month fatigue based on injury severity. Blood samples were collected from 87 children (1-17 years at injury) sustaining mild to severe TBI (Glasgow Coma Scale [GCS] range 3-15; mean 12.43; classified as mild TBI [n = 50, 57%] vs. moderate/severe TBI [n = 37, 43%]), and presenting to the emergency departments (ED) and pediatric intensive care units (PICU) at one of three tertiary pediatric hospitals (Royal Children's Hospital (RCH); Hospital for Sick Children (HSC), Toronto; St Justine Children's Hospital (SJH), Montreal). Six serum biomarker concentrations were measured within 24 h of injury (interleukin-6, interleukin-8 [IL-8], soluble vascular cell adhesion molecule [SVCAM], S100 calcium binding protein B [S100B], neuron specific enolase [NSE], and soluble neural cell adhesion molecule [sNCAM]). Fatigue at 12 months post-injury was measured using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (parent report), classified as present/absent using previously derived cut-points. At 12 months post-injury, 22% of participants experienced fatigue. A model including IL-8 was the best serum biomarker for estimating the probability of children experiencing fatigue at 12 months post-injury. The IL-8 also significantly improved predictive models of fatigue based on severity.
Collapse
Affiliation(s)
- Alison Crichton
- Murdoch Children's Research Institute, Melbourne, Australia.,Monash University Faculty of Medicine Nursing and Health Sciences, School of Clinical Sciences, The Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Ed Oakley
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Mardee Greenham
- Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Stephen Hearps
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Carmel Delzoppo
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Canada.,Research Center, Ste-Justine Hospital, Montreal, Canada
| | - Anne-Marie Guerguerian
- Critical Care Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada.,Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute, Toronto, Canada.,The Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | - Kathy Boutis
- Paediatric Emergency Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Evyatar Hubara
- Critical Care Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Jamie Hutchison
- Critical Care Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada.,Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute, Toronto, Canada.,The Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| |
Collapse
|
6
|
Luther M, Poppert Cordts KM, Williams CN. Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery. Sleep 2021; 43:5824413. [PMID: 32328648 DOI: 10.1093/sleep/zsaa083] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Sleep is vital for brain development and healing after injury, placing children with sleep-wake disturbances (SWD) after traumatic brain injury (TBI) at risk for worse outcomes. We conducted a systematic review to quantify SWD after pediatric TBI including prevalence, phenotypes, and risk factors. We also evaluated interventions for SWD and the association between SWD and other posttraumatic outcomes. METHODS Systematic searches were conducted in MEDLINE, PsychINFO, and reference lists for English language articles published from 1999 to 2019 evaluating sleep or fatigue in children hospitalized for mild complicated, moderate, or severe TBI. Two independent reviewers assessed eligibility, extracted data, and assessed risk of bias using the Newcastle-Ottowa Score for observational studies. RESULTS Among 966 articles identified in the search, 126 full-text articles were reviewed, and 24 studies were included (11 prospective, 9 cross-sectional, and 4 case studies). Marked heterogeneity was found in study populations, measures defining SWD, and time from injury to evaluation. Studies showed at least 20% of children with TBI had trouble falling or staying asleep, fatigue, daytime sleepiness, and nightmares. SWD are negatively correlated with posttraumatic cognitive, behavioral, and quality of life outcomes. No comparative intervention studies were identified. The risk of bias was moderate-high for all studies often related to lack of validated or objective SWD measures and small sample size. Heterogeneity precluded meta-analyses. CONCLUSIONS SWD are important morbidities after pediatric TBI, though current data are limited. SWD have implications for TBI recovery and may represent a modifiable target for improving outcomes after pediatric TBI.
Collapse
Affiliation(s)
- Madison Luther
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR
| | - Katrina M Poppert Cordts
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE
| | - Cydni N Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR.,Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR
| |
Collapse
|
7
|
Botchway EN, Godfrey C, Ryan NP, Hearps S, Nicholas CL, Anderson VA, Catroppa C. Sleep Disturbances in Young Adults with Childhood Traumatic Brain Injury: Relationship with Fatigue, Depression, and Quality of Life. Brain Inj 2020; 34:1579-1589. [PMID: 33054410 DOI: 10.1080/02699052.2020.1832704] [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 This study assessed the consequences of childhood traumatic brain injury (TBI) on sleep, fatigue, depression, and quality of life (QoL) outcomes and explored the relationships between these variables at 20 years following childhood TBI. PARTICIPANTS We followed up 54 young adults with mild, moderate, and severe TBI, and 13 typically developing control (TDC) participants, recruited at the time of TBI. METHODS Sleep was assessed with the Pittsburgh Sleep Quality Index and actigraphy. RESULTS At 20 years postinjury, results showed no significant difference between whole TBI group and TDC participants on subjective sleep quality; however, the moderate TBI group reported significantly poorer subjective sleep quality compared to those with severe TBI. Poorer subjective sleep was associated with increased symptoms of fatigue, depression, and poorer perceptions of General Health in the TBI group. Actigraphic sleep efficiency, fatigue, depression, and QoL outcomes were not significantly different between TBI and TDC or among TBI severity groups. CONCLUSIONS These preliminary findings underscore associations between subjective sleep disturbance, fatigue, depression, and QoL in this TBI sample, and mostly comparable outcomes in sleep, fatigue, depression, and QoL between the TBI and TDC groups. Further research is required to clarify these findings.
Collapse
Affiliation(s)
- Edith N Botchway
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne , Melbourne, Australia
| | - Celia Godfrey
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne , Melbourne, Australia
| | - Nicholas P Ryan
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne , Melbourne, Australia.,Cognitive Neuroscience Unit, Deakin University , Geelong, Victoria, Australia
| | - Stephen Hearps
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia
| | - Christian L Nicholas
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Melbourne School of Psychological Sciences, University of Melbourne , Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health , Heidelberg, Victoria, Australia
| | - Vicki A Anderson
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne , Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne , Melbourne, Australia
| | - Cathy Catroppa
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne , Melbourne, Australia
| |
Collapse
|
8
|
van Markus-Doornbosch F, van der Holst M, de Kloet AJ, Vliet Vlieland TPM, Meesters JJL. Fatigue, Participation and Quality of Life in Adolescents and Young Adults with Acquired Brain Injury in an Outpatient Rehabilitation Cohort. Dev Neurorehabil 2020; 23:328-335. [PMID: 31746261 DOI: 10.1080/17518423.2019.1692948] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To study the association between fatigue and participation and QoL after acquired brain injury (ABI) in adolescents and young adults (AYAs). MATERIALS & METHODS Cross-sectional study with AYAs aged 14-25 years, diagnosed with ABI. The PedsQL™ Multidimensional Fatigue Scale, Child & Adolescent Scale of Participation, and PedsQL™4.0 Generic Core Scales were administered. RESULTS Sixty-four AYAs participated in the study, 47 with traumatic brain injury (TBI). Median age at admission was 17.6 yrs, 0.8 yrs since injury. High levels of fatigue (median 44.4 (IQR 34.7, 59.7)), limited participation (median 82.5 (IQR 68.8, 92.3)), and diminished QoL (median 63.0 (IQR 47.8, 78.3)) were reported. More fatigue was significantly associated with more participation restrictions (β 0.64, 95%CI 0.44, 0.85) and diminished QoL (β 0.87, 95%CI 0.72, 1.02). CONCLUSIONS AYAs with ABI reported high levels of fatigue, limited participation and diminished quality of life with a significant association between fatigue and both participation and QoL. Targeting fatigue in rehabilitation treatment could potentially improve participation and QoL.
Collapse
Affiliation(s)
| | - Menno van der Holst
- Basalt Rehabilitation , The Hague, The Netherlands.,Leiden University Medical Center , Leiden, The Netherlands
| | - Arend J de Kloet
- Basalt Rehabilitation , The Hague, The Netherlands.,The Hague University of Applied Sciences , The Hague, The Netherlands
| | - Thea P M Vliet Vlieland
- Basalt Rehabilitation , The Hague, The Netherlands.,Leiden University Medical Center , Leiden, The Netherlands
| | - Jorit J L Meesters
- Basalt Rehabilitation , The Hague, The Netherlands.,Leiden University Medical Center , Leiden, The Netherlands.,The Hague University of Applied Sciences , The Hague, The Netherlands
| |
Collapse
|
9
|
Williams CN, Eriksson CO, Kirby A, Piantino JA, Hall TA, Luther M, McEvoy CT. Hospital Mortality and Functional Outcomes in Pediatric Neurocritical Care. Hosp Pediatr 2020; 9:958-966. [PMID: 31776167 DOI: 10.1542/hpeds.2019-0173] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Pediatric neurocritical care (PNCC) outcomes research is scarce. We aimed to expand knowledge about outcomes in PNCC by evaluating death and changes in Functional Status Scale (FSS) from baseline among PNCC diagnoses. METHODS We conducted a 2-year observational study of children aged 0 to 18 years admitted to the ICU with a primary neurologic diagnosis (N = 325). Primary outcomes were death and change in FSS from preadmission baseline to discharge. New disability was defined as an FSS change of ≥1 from baseline, and severe disability was defined as an FSS change of ≥3. Categorical results are reported as relative risk (RR) with 95% confidence interval (CI). RESULTS Thirty (9%) patients died. New disability (n = 103; 35%) and severe disability (n = 37; 13%) were common in PNCC survivors. New disability (range 14%-54%) and severe disability (range 3%-33%) outcomes varied significantly among primary diagnoses (lowest in status epilepticus; highest in infectious and/or inflammatory and stroke cohorts). Disability occurred in all FSS domains: mental status (15%), sensory (52%), communication (38%), motor (48%), feeding (40%), and respiratory (12%). Most (64%) patients with severe disability had changes in ≥3 domains. Requiring critical care interventions (RR 2.1; 95% CI 1.5-3.1) and having seizures (RR 1.5; 95% CI 1.1-2.0) during hospitalization were associated with new disability. CONCLUSIONS PNCC patients have high rates of death and new disability at discharge, varying significantly between PNCC diagnoses. Multiple domains of disability are affected, underscoring the ongoing multidisciplinary health care needs of survivors. Our study quantified hospital outcomes of PNCC patients that can be used to advance future research in this vulnerable population.
Collapse
Affiliation(s)
- Cydni N Williams
- Pediatric Critical Care and Neurotrauma Recovery Program and .,Divisions of Pediatric Critical Care
| | | | | | - Juan A Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program and.,Pediatric Neurology
| | - Trevor A Hall
- Pediatric Critical Care and Neurotrauma Recovery Program and.,Pediatric Psychology, and
| | | | - Cindy T McEvoy
- Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
10
|
Williams CN, Hartman ME, McEvoy CT, Hall TA, Lim MM, Shea SA, Luther M, Guilliams KP, Guerriero RM, Bosworth CC, Piantino JA. Sleep-Wake Disturbances After Acquired Brain Injury in Children Surviving Critical Care. Pediatr Neurol 2020; 103:43-51. [PMID: 31735567 PMCID: PMC7042044 DOI: 10.1016/j.pediatrneurol.2019.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/12/2019] [Accepted: 08/18/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sleep-wake disturbances are underevaluated among children with acquired brain injury surviving critical care. We aimed to quantify severity, phenotypes, and risk factors for sleep-wake disturbances. METHODS We performed a prospective cohort study of 78 children aged ≥3 years with acquired brain injury within three months of critical care hospitalization. Diagnoses included traumatic brain injury (n = 40), stroke (n = 11), infectious or inflammatory disease (n = 10), hypoxic-ischemic injury (n = 9), and other (n = 8). Sleep Disturbances Scale for Children standardized T scores measured sleep-wake disturbances. Overall sleep-wake disturbances were dichotomized as any total or subscale T score ≥60. Any T score ≥70 defined severe sleep-wake disturbances. Subscale T scores ≥60 identified sleep-wake disturbance phenotypes. RESULTS Sleep-wake disturbances were identified in 44 (56%) children and were classified as severe in 36 (46%). Sleep-wake disturbances affected ≥33% of patients within each diagnosis and were not associated with severity of illness measures. The most common phenotype was disturbance in initiation and maintenance of sleep (47%), although 68% had multiple concurrent sleep-wake disturbance phenotypes. One third of all patients had preadmission chronic conditions, and this increased risk for sleep-wake disturbances overall (43% vs 21%, P = 0.04) and in the traumatic brain injury subgroup (52% vs 5%, P = 0.001). CONCLUSIONS Over half of children surviving critical care with acquired brain injury have sleep-wake disturbances. Most of these children have severe sleep-wake disturbances independent of severity of illness measures. Many sleep-wake disturbances phenotypes were identified, but most children had disturbance in initiation and maintenance of sleep. Our study underscores the importance of evaluating sleep-wake disturbances after acquired brain injury.
Collapse
Affiliation(s)
- Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University,,Department of Pediatrics, Division of Pediatric Critical Care, Oregon Health and Science University
| | - Mary E. Hartman
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St Louis Children’s Hospital
| | - Cindy T. McEvoy
- Department of Pediatrics, Division of Neonatology, Oregon Health and Science University
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University,,Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University
| | - Miranda M. Lim
- Department of Neurology, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Department of Behavioral Neuroscience, Oregon Health and Science University;,Oregon Institute of Occupational Health Sciences, Oregon Health and Science University;,VA Portland Health Care System, Portland, OR
| | - Steven A. Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University
| | - Madison Luther
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University
| | - Kristin P. Guilliams
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St Louis Children’s Hospital;,Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St Louis Children’s Hospital
| | - Rejean M. Guerriero
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St Louis Children’s Hospital
| | - Christopher C. Bosworth
- Department of Psychology, Washington University School of Medicine, St Louis Children’s Hospital
| | - Juan A. Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University,,Department of Pediatrics, Division of Pediatric Neurology, Oregon Health and Science University
| |
Collapse
|
11
|
Williams CN, Hartman ME, Guilliams KP, Guerriero RM, Piantino JA, Bosworth CC, Leonard SS, Bradbury K, Wagner A, Hall TA. Postintensive Care Syndrome in Pediatric Critical Care Survivors: Therapeutic Options to Improve Outcomes After Acquired Brain Injury. Curr Treat Options Neurol 2019; 21:49. [PMID: 31559490 DOI: 10.1007/s11940-019-0586-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Children surviving the pediatric intensive care unit (PICU) with neurologic illness or injury have long-term morbidities in physical, cognitive, emotional, and social functioning termed postintensive care syndrome (PICS). In this article, we review acute and longitudinal management strategies available to combat PICS in children with acquired brain injury. RECENT FINDINGS Few intervention studies in this vulnerable population target PICS morbidities. Small studies show promise for both inpatient- and outpatient-initiated therapies, mainly focusing on a single domain of PICS and evaluating heterogeneous populations. While evaluating the effects of interventions on longitudinal PICS outcomes is in its infancy, longitudinal clinical programs targeting PICS are increasing. A multidisciplinary team with inpatient and outpatient presence is necessary to deliver the holistic integrated care required to address all domains of PICS in patients and families. While PICS is increasingly recognized as a chronic problem in PICU survivors with acquired brain injury, few interventions have targeted PICS morbidities. Research is needed to improve physical, cognitive, emotional, and social outcomes in survivors and their families.
Collapse
Affiliation(s)
- Cydni N Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA.
- Department of Pediatrics, Division of Pediatric Critical Care, Oregon Health and Science University, Portland, OR, USA.
| | - Mary E Hartman
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Kristin P Guilliams
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Rejean M Guerriero
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Juan A Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA
- Department of Pediatrics, Division of Pediatric Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Christopher C Bosworth
- Department of Psychology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Skyler S Leonard
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Kathryn Bradbury
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Amanda Wagner
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Trevor A Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
12
|
A Systematic Review of Sleep-Wake Disturbances in Childhood Traumatic Brain Injury: Relationship with Fatigue, Depression, and Quality of Life. J Head Trauma Rehabil 2019; 34:241-256. [DOI: 10.1097/htr.0000000000000446] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Câmara-Costa H, Francillette L, Opatowski M, Toure H, Brugel D, Laurent-Vannier A, Meyer P, Dellatolas G, Watier L, Chevignard M. Participation seven years after severe childhood traumatic brain injury . Disabil Rehabil 2019; 42:2402-2411. [PMID: 30950661 DOI: 10.1080/09638288.2019.1594398] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Participation in home, school and community activities is considered as the ultimate aim of rehabilitation. The aims of this study were to examine participation seven years post-severe childhood traumatic brain injury and factors associated with participation.Materials and methods: Participants were enrolled in the Traumatisme Grave de l'Enfant (Severe Childhood Injury) cohort study following severe accidental childhood traumatic brain injury. Participation seven years post-injury, was examined using parent- and self-report forms of the Child and Adolescent Scale of Participation among 37 patients [62% males, mean age 15.4 years (SD = 4.4), mean length of coma 6.68 days (SD = 4.96)] and 33 matched controls.Results: Parent reports indicated significantly lower participation among patients compared to controls, but the self-reports did not. In the traumatic brain injury group, parent-reported participation was variable, with 22% of the patients clearly showing greater restrictions than controls. Participation restrictions were significantly associated with injury severity, poor functional outcome one-year post-injury, executive and behavioral difficulties and higher fatigue levels seven years post-injury, but not with pre-injury nor family factors.Conclusions: Several years after severe childhood traumatic brain injury, participation appears to depend more on injury-related factors than on environmental factors. In self-reports assessments of participation, it could be difficult for children and adolescents to distinguish capacity from performance.Implications for rehabilitationParticipation outcomes were highly variable in a sample of patients who sustained severe childhood traumatic brain injury.Participation should be assessed systematically following severe traumatic brain injury, both initially but also in the long-term, ideally using a combination of self- and proxy-report measures.Among patients with severe injuries, the influence of initial brain injury severity markers on participation seems much stronger than that of social/family environment factors.Children's and adolescents' self-reported participation assessed with the Child and Adolescent Scale of Participation may be difficult to interpret.
Collapse
Affiliation(s)
- Hugo Câmara-Costa
- Paris-Saclay University, Paris-Sud University, UVSQ, CESP, INSERM, Paris, France.,Sorbonne University, Laboratory of Biomedical Imaging (LIB), Paris, France
| | - Leila Francillette
- Sorbonne University, Laboratory of Biomedical Imaging (LIB), Paris, France
| | - Marion Opatowski
- Department of Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Hanna Toure
- Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Dominique Brugel
- Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France.,Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Anne Laurent-Vannier
- Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France.,Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Philippe Meyer
- Department of Paediatric Anesthesiology, Hôpital Necker Enfants Malades, Paris, France.,Faculty of Medicine René Descartes, Paris 5 University, Paris, France
| | - Georges Dellatolas
- Paris-Saclay University, Paris-Sud University, UVSQ, CESP, INSERM, Paris, France
| | - Laurence Watier
- Department of Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Mathilde Chevignard
- Sorbonne University, Laboratory of Biomedical Imaging (LIB), Paris, France.,Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France.,Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France.,Clinical Research Group of Cognitive Handicap and Rehabilitation (HanCRe), Sorbonne University, Paris, France
| |
Collapse
|
14
|
Botchway EN, Godfrey C, Nicholas CL, Hearps S, Anderson V, Catroppa C. Objective sleep outcomes 20 years after traumatic brain injury in childhood. Disabil Rehabil 2019; 42:2393-2401. [PMID: 30945574 DOI: 10.1080/09638288.2019.1578422] [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: 10/27/2022]
Abstract
Purpose: To assess objective sleep outcomes and correlates in young adults with a history of childhood traumatic brain injury.Materials and methods: Participants included 45 young adults who sustained brain injury in childhood (mild = 12, moderate = 22, and severe = 11) and 13 typically developing control participants. Sleep was assessed with actigraphy and sleep diaries recorded over 14 consecutive days. Rates of good sleep (sleep efficiency ≥ 85%) and poor sleep (sleep efficiency < 85%) were also evaluated.Results: At 20-years postinjury, participants with traumatic brain injury and controls presented with similar outcomes across the objective sleep parameters (all p > 0.050) and rates of poor sleepers were also similar between these groups (p = 0.735): 67% and 77%, respectively. However, moderate and severe traumatic brain injury and female sex were associated with longer sleep duration.Conclusions: These findings provide preliminary insights into objective sleep outcome and associated factors in the very-long-term after childhood brain injuries. They also indicate the need to monitor sleep outcomes in young adults with and without traumatic brain injury.Implication for rehabilitationSustaining traumatic brain injury in childhood can impact on several functional domains including sleep.Sleep disturbances, particularly insomnia-related symptoms, are common in this population, with evidence of poor outcomes reported until adolescence postinjury, while outcomes beyond adolescence remain unexplored.In this first investigation of objective sleep outcomes in young adults with a history of childhood traumatic brain injury, we showed that insomnia-related symptoms are highly prevalent in both young adults with traumatic brain injury (67%) and healthy controls (77%).These findings suggest the need to routinely evaluate and treat sleep problem in young adults in general, irrespective of history of childhood traumatic brain injury.
Collapse
Affiliation(s)
- Edith N Botchway
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Celia Godfrey
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Christian L Nicholas
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Stephen Hearps
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| |
Collapse
|
15
|
Fatigue Following Traumatic Brain Injury in Children and Adolescents: A Longitudinal Follow-Up 6 to 12 Months After Injury. J Head Trauma Rehabil 2018; 33:200-209. [DOI: 10.1097/htr.0000000000000330] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
16
|
Fatigue following Paediatric Acquired Brain Injury and its Impact on Functional Outcomes: A Systematic Review. Neuropsychol Rev 2018; 28:73-87. [PMID: 29552735 DOI: 10.1007/s11065-018-9370-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 02/15/2018] [Indexed: 10/17/2022]
Abstract
Fatigue is a commonly reported sequela following an acquired brain injury (ABI), and can have a negative impact on many areas of a child's life. However, there is minimal research that focuses on fatigue specifically, and so factors such as its occurrence, duration, and impact on functioning remain uncertain. This systematic review aims to provide a comprehensive summary of the research to date, bringing together a number of studies with a focus on paediatric ABI and fatigue. Terms were searched in relevant databases (PsycInfo, Medline, CINAHL), and articles were included or excluded based on specified criteria. Of the 1177 papers identified in the original search, a total of 9 papers met inclusion criteria, and were categorised as traumatic brain injury (TBI; n = 4), meningitis and meningococcal disease (n = 2), brain tumours (n = 2), and mixed ABI group (n = 1). Key findings suggest that fatigue is a problem encountered by a significant proportion of patients in all the studies reviewed, and often occurred regardless of the cause; fatigue was also associated with poor academic achievement, limited physical activity, and social and emotional problems. Injuries of greater severity were associated with higher levels of fatigue and worse outcomes. Several management options were suggested, though their efficacy was not reported. Future research is required with a suggested focus on using multiple time points to better understand the trajectories of fatigue following childhood ABI, and to build an evidence base to determine which management options are most suitable.
Collapse
|
17
|
Williams CN, Lim MM, Shea SA. Sleep disturbance after pediatric traumatic brain injury: critical knowledge gaps remain for the critically injured. Nat Sci Sleep 2018; 10:225-228. [PMID: 30123016 PMCID: PMC6087029 DOI: 10.2147/nss.s174608] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Miranda M Lim
- Department of Neurology.,Department of Medicine.,Department of Behavioral Neurosciences.,Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA,
| | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA,
| |
Collapse
|
18
|
Norup A, Svendsen SW, Doser K, Ryttersgaard TO, Frandsen N, Gade L, Forchhammer HB. Prevalence and severity of fatigue in adolescents and young adults with acquired brain injury: A nationwide study. Neuropsychol Rehabil 2017; 29:1113-1128. [PMID: 28895796 DOI: 10.1080/09602011.2017.1371045] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: To investigate the prevalence and severity of fatigue in adolescents and young adults with acquired brain injury (ABI) compared with healthy controls (HCs) and to examine associations between fatigue and gender, age and level of education. Methods: This cross-sectional study included 15-30 year old patients with ABI and a convenience sample of 15-30 year old HCs. All participants completed the 20-item Multidimensional Fatigue Inventory (MFI-20). Pathological fatigue was defined as "General Fatigue" ≥12. Adjusted mean differences between groups were calculated using multivariate analysis of covariance (MANCOVA). The adjusted prevalence proportion ratio (PPRadj) of pathological fatigue was calculated using Poisson regression. Results: The patients (n = 334) had higher scores than the HCs (n = 168) on all MFI-20 subscales with adjusted mean differences ranging from 1.7 to 4.7 and a higher prevalence of pathological fatigue (73% versus 29%), PPRadj 2.7 (95% confidence interval 2.1-3.5). Female patients experienced more fatigue than males on the "General Fatigue" and "Reduced Activity" subscales, while no gender differences were found in the HC group. Patients and HCs with elementary education had elevated scores on the "Reduced Activity" and "Mental Fatigue" subscales. Age was not associated with any of the subscale scores. Conclusion: Young patients with ABI had markedly higher prevalence and severity of fatigue than HCs. Age (15-30 years) was not associated with fatigue. No clear patterns of associations were evident with gender and level of education. Abbreviations: ABI: acquired brain injury; CI: confidence interval; GF: general fatigue; GOSE: Glasgow Outcome Scale Extended; HC: healthy control; MANCOVA: multivariate analysis of covariance; MF: mental fatigue; MFI-20: Multidimensional Fatigue Inventory-20; PF: physical fatigue; RA: reduced activity; RM: reduced motivation; TBI: traumatic brain injury.
Collapse
Affiliation(s)
- Anne Norup
- a National study of young brain injury survivors, Department of Neurology , Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - Susanne Wulff Svendsen
- b National study of young brain injury survivors, Hammel Neurorehabilitation Centre and University Research Clinic , Aarhus University , Hammel , Denmark
| | - Karoline Doser
- c Survivorship Unit , Danish Cancer Society Research Center , Copenhagen , Denmark
| | - Trine Okkerstrøm Ryttersgaard
- d National study of young brain injury survivors, Department of Neurology , Aalborg University Hospital , Aalborg , Denmark
| | - Nicole Frandsen
- e National study of young brain injury survivors, Department of Neurology , Odense University Hospital , Odense , Denmark
| | - Louise Gade
- f National study of young brain injury survivors, Department of Neurology , Slagelse Hospital , Slagelse , Denmark
| | - Hysse Birgitte Forchhammer
- a National study of young brain injury survivors, Department of Neurology , Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| |
Collapse
|
19
|
Lindsay S, Stoica A. A systematic review of factors affecting driving and public transportation among youth and young adults with acquired brain injury. Brain Inj 2017. [DOI: 10.1080/02699052.2017.1321140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sally Lindsay
- Department of Occupational Science and Occupational Therapy, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada
| | - Andrei Stoica
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| |
Collapse
|
20
|
|
21
|
Sakzewski L, Lewis MJ, McKinlay L, Ziviani J, Boyd RN. Impact of multi-modal web-based rehabilitation on occupational performance and upper limb outcomes: pilot randomized trial in children with acquired brain injuries. Dev Med Child Neurol 2016; 58:1257-1264. [PMID: 27230022 DOI: 10.1111/dmcn.13157] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 12/01/2022]
Abstract
AIMS To determine whether the multi-modal web-based rehabilitation 'Move it to improve it' (Mitii) is more effective than wait list control (usual care) to improve occupational performance, upper limb function, and visual perception in children with acquired brain injury (ABI). METHOD Fifty-eight randomly allocated children (53% males; mean age 11y 11mo, SD 2y 6mo; Manual Abilities Classification Scale equivalent I=32, II=24, III=2; mean Full-scale IQ 75.8, SD 16.2) received either 20 weeks of Mitii (n=29) or usual care (n=29). Mitii comprised upper limb, cognitive, visual perception, and gross motor tasks, recommended for 30 minutes per day, 6 days per week, over 20 weeks. Outcomes were the Assessment of Motor and Process Skills (AMPS), Melbourne Assessment of Unilateral Upper Limb Function, Jebsen-Taylor Test of Hand Function, Test of Visual Perceptual Skills, Assisting Hand Assessment (AHA), and Canadian Occupational Performance Measure. The primary comparison at 20 weeks between groups on the AMPS process and motor measures used generalized estimating equations. RESULTS Groups were equivalent at baseline. Participants completed on average 17.6 hours (range 0-46h) of Mitii. There were no differences between groups on the primary outcome (AMPS process: estimated mean difference -0.1, 95% CI -0.3 to 0.2, p=0.589; and AMPS motor: estimated mean difference 0.2, 95% CI -0.1 to 0.5, p=0.192). There were no differences between groups on overall visual perception, upper limb, and occupational performance outcomes. INTERPRETATION Mitii led to negligible changes on all primary and secondary outcomes compared with usual care. This likely reflects the small dose achieved and poses questions around the acceptability and feasibility of home-delivered Mitii in this population of children with ABI.
Collapse
Affiliation(s)
- Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia
| | - Melinda J Lewis
- Lady Cilento Children's Hospital, Queensland Health, Brisbane, Qld, Australia
| | - Lynne McKinlay
- Lady Cilento Children's Hospital, Queensland Health, Brisbane, Qld, Australia
| | - Jenny Ziviani
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia
| |
Collapse
|
22
|
Cognitive reserve and preinjury educational attainment: effects on outcome of community-based rehabilitation for longer-term individuals with acquired brain injury. Int J Rehabil Res 2016; 39:234-9. [DOI: 10.1097/mrr.0000000000000175] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
23
|
van Markus-Doornbosch F, de Kloet AJ, Berger MAM, Lambregts SAM, Wolterbeek R, Vliet Vlieland TPM. Factors related to fatigue after paediatric acquired brain injury (ABI). Brain Inj 2016; 30:1533-1541. [DOI: 10.1080/02699052.2016.1197968] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - A. J. de Kloet
- Sophia Rehabilitation, The Hague, The Netherlands
- The Hague University of Applied Sciences, The Hague, The Netherlands
| | - M. A. M. Berger
- The Hague University of Applied Sciences, The Hague, The Netherlands
| | - S. A. M. Lambregts
- Revant Rehabilitation Centre, Breda, The Netherlands
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - R. Wolterbeek
- Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands
| | - T. P. M. Vliet Vlieland
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Orthopaedics, Leiden University Medical Centre, Rehabilitation and Physical Therapy, Leiden, The Netherlands
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
| |
Collapse
|
24
|
Ryan NP, Beauchamp MH, Beare R, Coleman L, Ditchfield M, Kean M, Silk TJ, Genc S, Catroppa C, Anderson VA. Uncovering cortico-striatal correlates of cognitive fatigue in pediatric acquired brain disorder: Evidence from traumatic brain injury. Cortex 2016; 83:222-30. [PMID: 27603573 DOI: 10.1016/j.cortex.2016.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/04/2016] [Accepted: 07/22/2016] [Indexed: 11/29/2022]
Abstract
Cognitive fatigue is among the most profound and disabling sequelae of pediatric acquired brain disorders, however the neural correlates of these symptoms in children remains unexplored. One hypothesis suggests that cognitive fatigue may arise from dysfunction of cortico-striatal networks (CSNs) implicated in effort output and outcome valuation. Using pediatric traumatic brain injury (TBI) as a model, this study investigated (i) the sub-acute effect of brain injury on CSN volume; and (ii) potential relationships between cognitive fatigue and sub-acute volumetric abnormalities of the CSN. 3D T1 weighted magnetic resonance imaging sequences were acquired sub-acutely in 137 children (TBI: n = 103; typically developing - TD children: n = 34). 67 of the original 137 participants (49%) completed measures of cognitive fatigue and psychological functioning at 24-months post-injury. Results showed that compared to TD controls and children with milder injuries, children with severe TBI showed volumetric reductions in the overall CSN package, as well as regional gray matter volumetric change in cortical and subcortical regions of the CSN. Significantly greater cognitive fatigue in the TBI patients was associated with volumetric reductions in the CSN and its putative hub regions, even after adjusting for injury severity, socioeconomic status (SES) and depression. In the first study to evaluate prospective neuroanatomical correlates of cognitive fatigue in pediatric acquired brain disorder, these findings suggest that post-injury cognitive fatigue is related to structural abnormalities of cortico-striatal brain networks implicated in effort output and outcome valuation. Morphometric magnetic resonance imaging (MRI) may have potential to unlock early prognostic markers that may assist to identify children at elevated risk for cognitive fatigue post-TBI.
Collapse
Affiliation(s)
- Nicholas P Ryan
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia; Department of Psychology, Royal Children's Hospital, Melbourne, Australia.
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Canada; Ste-Justine Research Center, Montreal, Canada
| | - Richard Beare
- Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Lee Coleman
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Michael Ditchfield
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Michael Kean
- Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Timothy J Silk
- Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sila Genc
- Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Cathy Catroppa
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Vicki A Anderson
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia; Department of Psychology, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| |
Collapse
|
25
|
Ongoing daytime behavioural problems in university students following childhood mild traumatic brain injury. Int J Rehabil Res 2015; 39:77-83. [PMID: 26704343 DOI: 10.1097/mrr.0000000000000149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sleep is often disrupted in traumatic brain injury (TBI) and may be related to persistent behaviour problems; however, little is known about this relationship in young adults. This study explored associations between TBI, behavioural problems and sleep disturbances in 247 university students (197 non-TBI, 47 mild TBI, two moderate TBI, one severe TBI) aged 18-25 years, who completed validated measures for behaviour, sleep quality and history of TBI. Because of small group numbers, participants reporting moderate to severe TBI were excluded from the analyses. Results indicated that students with mild TBI reported higher levels of daytime dysfunction, somatic complaints, withdrawal, other behavioural complaints and internalizing behaviours compared with students with no TBI history. A correlational analysis indicated a moderate relationship between the above significant variables. Our results suggest that university students with a history of mild TBI are more likely to experience certain ongoing daytime behavioural problems, which are likely to negatively influence their academic functioning in tertiary education. This study highlights the importance of research on long-term problems following mild TBI in young adults aged 18-25 years--an age group often overlooked within the literature.
Collapse
|
26
|
Gagner C, Landry-Roy C, Lainé F, Beauchamp MH. Sleep-Wake Disturbances and Fatigue after Pediatric Traumatic Brain Injury: A Systematic Review of the Literature. J Neurotrauma 2015; 32:1539-52. [DOI: 10.1089/neu.2014.3753] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlotte Gagner
- Department of Psychology, University of Montreal, Quebec, Canada
- Ste-Justine Hospital Research Center, Montreal, Quebec, Canada
| | | | - France Lainé
- Institut Universitaire de Gériatrie de Montréal Research Center, Montreal, Quebec, Canada
| | - Miriam H. Beauchamp
- Department of Psychology, University of Montreal, Quebec, Canada
- Ste-Justine Hospital Research Center, Montreal, Quebec, Canada
| |
Collapse
|