Examining the Use of a Rest-Activity Ratio in a Pediatric Rehabilitation Setting

OBJECTIVE

To examine the relationship between an estimate of sleep/wake regulation derived from actigraphy would be sensitive to neurocognitive dysfunction associated with acquired brain injury (ABI) in a pediatric rehabilitation sample.

DESIGN

cross-sectional design SETTING: Inpatient pediatric rehabilitation facility PARTICIPANTS: A sample of 31 males (72.1%) and 12 females (27.9%) admitted to a pediatric rehabilitation hospital wore an actigraph (wrist accelerometer) for one week. Ages ranged from 8 to 17 years (M=13.1, SD=2.7).

INTERVENTIONS

not applicable MAIN OUTCOME MEASURE(S): Raw actigraphy activity counts in 1-minute epochs were used to derive a rest-activity ratio over each 24-hour period and a 5-day average value was calculated covering Monday through Friday. Brain injury status was derived through medical record review and three groups were formed: traumatic brain injury (n=14), non-traumatic brain injury (n=16), and a non-ABI control group (n=13). Functional status was measured using WeeFIM Cognitive and Motor scores extracted from the medical records.

RESULTS

Unadjusted models showed a significant main group effect for brain injury status (p=0.012). Compared with controls, the rest-activity ratio was significantly lower in both the traumatic brain injury (p = 0.005), and non-traumatic brain injury (p = 0.023) groups. However, the main group effect was no longer significant in an adjusted model controlling for WeeFIM Cognitive and WeeFIM Motor scores at admission. In the context of the adjusted model, there was a significant relationship between the rest-activity ratio and WeeFIM Cognitive scores at admission.

CONCLUSIONS

Individuals with lower functional status at admission, especially in the cognitive domain, had lower rest-activity ratios, suggesting poorer sleep/wake regulation. Similar to findings in adults with acquired brain injury, this ratio may have utility in tracking sleep/wake regulation in the pediatric rehabilitation setting. Future studies should investigate sensitivity to change over the course of recovery and responsiveness to clinical interventions to improve sleep.

Inpatient length of stay moderates the relationship between payer source and functional outcomes in pediatric brain injury

OBJECTIVE

To examine the extent to which race/ethnicity, length of rehabilitation hospital stay (LOS), and payer source contribute to functional status following inpatient rehabilitation in children with acquired brain injury (ABI).

DESIGN

Retrospective cohort study from a pediatric rehabilitation hospital including 485 individuals with ABI.

METHODS

Functional Independence Measure for Children (WeeFIM) scores were transformed into age-corrected Developmental Functional Quotients (DFQ) to examine the effects of race/ethnicity, LOS, and payer source (public insurance vs. private) on functional outcomes while controlling for year of admission, admission DFQ, time to rehabilitation, age, and brain injury aetiology.

RESULTS

Discharge DFQ scores tended to be lower for children with public insurance as well as those with longer LOS. There was no main effect of race/ethnicity, but a significant interaction effect for payer source×LOS (p < .001) was found. Further breakdown of the interaction showed lower discharge DFQ scores for children with public insurance primarily when LOS exceeded 28 days (p = .001).

CONCLUSION

Children with ABI who have both public insurance and LOS beyond 4 weeks tend to have poorer functional outcomes after inpatient rehabilitation. Because all children were receiving services at the same facility, payer source may be functioning as a proxy for other sociodemographic factors.

0985 Utility Of A Rest-activity Ratio In A Pediatric Brain Injury Rehabilitation Sample: A Pilot Study

Introduction

Sleep is an important element of health that can impact daytime performance in brain injury rehabilitation. Actigraphy in a pediatric inpatient setting can pose challenges when there are increased amounts of time spent in a hospital bed. A rest-activity ratio (Duclos et al., 2013) has demonstrated utility in adult brain injury populations, showing sensitivity to improved regulation of the sleep-wake cycle as individuals recover during their hospitalization. The present study sought to examine the utility of this ratio in differentiating children with and without acquired brain injury (ABI).

Methods

Sixteen individuals, ages 8-16 (M=12.6, SD=2.4) admitted to an inpatient pediatric rehabilitation hospital wore an actigraph over a 7-day period. Eight inpatients were being treated for ABI whereas another 8 inpatients treated for other, non-neurological conditions served as a control. Raw activity counts across the 24-hour period were analyzed to derive a rest-activity ratio.

Results

Those with ABI had lower average ratios (0.73) compared with patients without ABI (0.84), F(1,14)=4.3, p=0.058. Individuals with ratios of 0.85 or higher were rated by their physical therapists as being more alert during therapy using a 5-point Likert scale, F(1,14)=4.1, p=0.061. While these results were marginally significant, this pilot sample was small, and the effect sizes were large (eta squared = 0.234 and 0.229 respectively).

Conclusion

The rest-activity ratio successfully distinguished those with ABI from a non-ABI sample. This preliminary evidence in a pediatric sample suggests that this ratio, shown to be sensitive to the effects of brain injury on sleep-wake regulation, may be a useful metric in the inpatient pediatric rehabilitation setting when sleep diaries may be difficult to obtain and patients may be spending more time in bed while awake. Future studies with larger sample sizes are needed to explore the correlates of this ratio with other aspects of rehabilitation after pediatric brain injury.

Support

This study was funded in part through a generous grant from the Church & Dwight Employee Giving Fund

THE EFFECT OF LOW TO MODERATE PRENATAL ALCOHOL EXPOSURE AND BINGE DRINKING EPISODES ON DRAW-A-PERSON AT AGE 5 YEARS

This study examined the effects of maternal alcohol consumption and binge drinking during pregnancy on children's Draw-A-Person (DAP) scores. Participants were 1,533 5-year-olds from the Danish National Birth Cohort. Regression analyses revealed an adverse effect of nine or more drinks per week. A drop in mean DAP score of 6.26 (95 % CI: -12.24; -0.39) was observed in the fully adjusted model. A significant interaction between average weekly consumption and binge episodes also was observed. Findings suggest that prenatal exposure to moderate weekly doses of alcohol and binge drinking episodes are associated with lowered scores on the DAP.

New insights into the brain involvement in patients with Crohn's disease: a voxel-based morphometry study

BACKGROUND

Crohn's disease (CD) is a chronic intestinal disorder characterized by overproduction of inflammatory cytokines and recurrent abdominal pain. Recently, brain morphological abnormalities in the pain matrix were found in patients with chronic pain disorders including irritable bowel syndrome. To investigate potential structural brain changes associated with CD, we used magnetic resonance imaging (MRI). Furthermore, we tested whether in patients gray matter (GM) volumes correlated with disease duration.

METHODS

Eighteen CD patients in remission and 18 healthy controls underwent structural MRI. Voxel-based morphometry (VBM) is a fully automated technique allowing identification of regional differences in the amount of GM enabling an objective analysis of the whole brain between groups of subjects. VBM was used for comparisons and correlation analysis.

KEY RESULTS

With respect to controls, CD patients exhibited decreased GM volumes in portion of the frontal cortex and in the anterior midcingulate cortex. Disease duration was negatively correlated with GM volumes of several brain regions including neocortical and limbic areas.

CONCLUSIONS & INFERENCES

Crohn's disease is associated with brain morphological changes in cortical and subcortical structures involved in nociception, emotional, and cognitive processes. Our findings provide new insight into the brain involvement in chronic inflammatory bowel disorders.