La Crosse Virus Neuroinvasive Disease in Children: A Contemporary Analysis of Clinical/Neurobehavioral Outcomes and Predictors of Disease Severity.

BACKGROUND: La Crosse virus (LACV) is the most common neuroinvasive arboviral infection in children in the United States. However, data regarding predictors of disease severity and neurologic outcome are limited. Additionally, long-term neurologic and neurobehavioral outcomes remain relatively sparse. METHODS: This was a single-center, retrospective cohort study, followed by recruitment for a cross-sectional analysis of long-term neurobehavioral outcomes, among children aged 0-18 years with proven or probable LACV neuroinvasive disease (LACV-ND) between January 2009 and December 2018. Case ascertainment was assured by International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes cross-referenced with laboratory results detecting LACV. Demographics, diagnostics, radiographs, and outcomes were evaluated. Recruitment of patients with prior diagnosis of LACV-ND occurred from January 2020 to March 2020, with assessment performed by validated pediatric questionnaires. RESULTS: One-hundred fifty-two children (83 males; median age, 8 years [interquartile range, 5-11.5 years]) were diagnosed with proven (n = 61 [47%]) and probable (n = 91 [60%]) LACV-ND. Sixty-five patients (43%) had severe disease. Altered mental status (AMS) (odds ratio [OR], 6.36 [95% confidence interval {CI}, 2.03-19.95]; P = .0002) and seizures at presentation (OR, 10.31 [95% CI, 3.45-30.86]; P = .0001) were independent predictors of severe disease. Epileptiform discharges on electroencephalogram (EEG) were independently associated with epilepsy diagnosis at follow-up (OR, 13.45 [95% CI, 1.4-128.77]; P = .024). Fifty-four patients were recruited for long-term neurobehavioral follow-up, with frequent abnormal assessments identified (19%-54%) irrespective of disease severity. CONCLUSIONS: Severe disease was observed frequently among children with LACV-ND. Seizures and AMS at presentation were independent predictors of severe disease. EEG may help determine long-term epilepsy risk. Long-term neurobehavioral issues are frequent and likely underrecognized among children with LACV-ND.

COVID-19 issues related to pediatric neuropsychology and inpatient rehabilitation - challenges to usual care and solutions during the pandemic.

Objective: To describe the challenges related to COVID-19 affecting pediatric neuropsychologists practicing in inpatient brain injury rehabilitation settings, and offer solutions focused on face-to-face care and telehealth.Methods: A group of pediatric neuropsychologists from 12 pediatric rehabilitation units in North America and 2 in South America have met regularly since COVID-19 stay-at-home orders were initiated in many parts of the world. This group discussed challenges to clinical care and collaboratively problem-solvedsolutions.Results: Three primary challenges to usual care were identified, these include difficulty providing 1) neurobehavioral and cognitive assessments; 2) psychoeducation for caregivers and rapport building; and 3) return to academic instruction and home. Solutions during the pandemic for the first two areas focus on the varying service provision models that include 1) face-to-face care with personal protective equipment (PPE) and social distancing and 2) provision of care via remote methods, with a focus on telehealth. During the pandemic,neuropsychologists generally combine components of both the face-to-face and remote care models. Solutions to the final challenge focus on issues specific to returning to academic instruction and home after an inpatient stay.Conclusions: By considering components of in-person and telehealth models of patient care during the pandemic, neuropsychologists successfully serve patients within the rehabilitation setting, as well as the patient's family who may be limited in their ability to be physically present due to childcare, illness, work-related demands, or hospital restrictions.

A randomized trial of teen online problem solving: efficacy in improving caregiver outcomes after brain injury.

OBJECTIVE: To examine the results of a randomized clinical trial (RCT) of Teen Online Problem Solving (TOPS), an online problem solving therapy model, in increasing problem-solving skills and decreasing depressive symptoms and global distress for caregivers of adolescents with traumatic brain injury (TBI). METHOD: Families of adolescents aged 11-18 who sustained a moderate to severe TBI between 3 and 19 months earlier were recruited from hospital trauma registries. Participants were assigned to receive a web-based, problem-solving intervention (TOPS, n = 20), or access to online resources pertaining to TBI (Internet Resource Comparison; IRC; n = 21). Parent report of problem solving skills, depressive symptoms, global distress, utilization, and satisfaction were assessed pre- and posttreatment. Groups were compared on follow-up scores after controlling for pretreatment levels. Family income was examined as a potential moderator of treatment efficacy. Improvement in problem solving was examined as a mediator of reductions in depression and distress. RESULTS: Forty-one participants provided consent and completed baseline assessments, with follow-up assessments completed on 35 participants (16 TOPS and 19 IRC). Parents in both groups reported a high level of satisfaction with both interventions. Improvements in problem solving skills and depression were moderated by family income, with caregivers of lower income in TOPS reporting greater improvements. Increases in problem solving partially mediated reductions in global distress. CONCLUSIONS: Findings suggest that TOPS may be effective in improving problem solving skills and reducing depressive symptoms for certain subsets of caregivers in families of adolescents with TBI.

Effect on behavior problems of teen online problem-solving for adolescent traumatic brain injury.

PURPOSE: To report the results of a randomized clinical trial of teen online problem-solving (TOPS) meant to improve behavioral outcomes of adolescents with traumatic brain injury (TBI). METHODS: A randomized clinical trial was conducted to compare the efficacy of TOPS with access to Internet resources in teenagers with TBI in improving parent and self-reported behavior problems and parent-teen conflicts. Participants included 41 adolescents aged 11 to 18 years (range: 11.47-17.90 years) who had sustained a moderate-to-severe TBI between 3 and 19 months earlier. Teens in the TOPS group received 10 to 14 online sessions that provided training in problem-solving, communication skills, and self-regulation. Outcomes were assessed before treatment and at a follow-up assessment an average of 8 months later. Groups were compared on follow-up scores after we controlled for pretreatment levels. Injury severity and socioeconomic status were examined as potential moderators of treatment efficacy. RESULTS: Forty-one participants provided consent and completed baseline assessments, and follow-up assessments were completed for 35 participants (16 TOPS, 19 Internet resource comparison). The TOPS group reported significantly less parent-teen conflict at follow-up than did the Internet-resource-comparison group. Improvements in teen behavior after TOPS were moderated by injury severity; there were greater improvements in the teens' internalizing symptoms after TOPS among adolescents with severe TBI. Family socioeconomic status also moderated the efficacy of TOPS in improving behavior problems reported by both parents and teens, although the nature of the moderation effects varied. CONCLUSION: Our findings suggest that TOPS contributes to improvements in parent-teen conflict generally and parent and self-reported teen behavior problems for certain subsets of participants.

A randomized trial of teen online problem solving for improving executive function deficits following pediatric traumatic brain injury.

OBJECTIVE: To examine the efficacy of teen online problem solving (TOPS) in improving executive function (EF) deficits following traumatic brain injury (TBI) in adolescence. METHODS: Families of adolescents (aged 11-18 years) with moderate to severe TBI were recruited from the trauma registry of 2 tertiary-care children's hospitals and then randomly assigned to receive TOPS (n = 20), a cognitive-behavioral, skill-building intervention, or access to online resources regarding TBI (Internet resource comparison; n = 21). Parent and teen reports of EF were assessed at baseline and a posttreatment follow-up (mean = 7.88 months later). RESULTS: Improvements in self-reported EF skills were moderated by TBI severity, with teens with severe TBI in the TOPS treatment reporting significantly greater improvements than did those with severe TBI in the Internet resource comparison. The treatment groups did not differ on parent ratings of EF at the follow up. CONCLUSIONS: Findings suggest that TOPS may be effective in improving EF skills among teens with severe TBI.