Parental distress, parenting practices, and child adaptive outcomes following traumatic brain injury.

Moderate and severe pediatric traumatic brain injuries (TBI) are associated with significant familial distress and child adaptive sequelae. Our aim was to examine the relationship between parental psychological distress, parenting practices (authoritarian, permissive, authoritative), and child adaptive functioning 12-36 months following TBI or orthopedic injury (OI). Injury type was hypothesized to moderate the relationship between parental distress and child adaptive functioning, demonstrating a significantly stronger relationship in the TBI relative to OI group. Authoritarian parenting practices were hypothesized to mediate relationship between parental distress and child adaptive functioning across groups. Groups (TBI n = 21, OI n = 23) did not differ significantly on age at injury, time since injury, sex, race, or SES. Parents completed the Brief Symptom Inventory, Parenting Practices Questionnaire, and Vineland-II. Moderation and mediation hypotheses were tested using hierarchical multiple regression and a bootstrapping approach, respectively. Results supported moderation and revealed that higher parental psychological distress was associated with lower child adaptive functioning in the TBI group only. Mediation results indicated that higher parental distress was associated with authoritarian parenting practices and lower adaptive functioning across groups. Results suggest that parenting practices are an important area of focus for studies attempting to elucidate the relationship between parent and child functioning following TBI.

Achievement of client-centred goals by persons with acquired brain injury in comprehensive day treatment is associated with improved functional outcomes.

OBJECTIVES: To study the relationship between goal achievement and vocational and independent living at discharge and 1-year follow-up in persons with acquired brain injury (ABI) participating in a Comprehensive Day Treatment (CDT) programme. DESIGN: A retrospective review of longitudinal data. METHODS: One hundred and fifty-four participants with ABI were included in the analyses. Personal, short-term and graduation goals were generated for each participant. A graduation goal was generated in each of four primary domains of the intervention (Orientation, Cognitive, Social Awareness and Communication). Participants who achieved all graduation goals at discharge were classified as 'goals met', while those who did not meet all goals were classified as 'goals unmet'. RESULTS: Forty-eight percent of participants were classified into the goals met group and 52% were classified into the goals unmet group. There were no group differences at programme admission. A significantly greater percentage of individuals in the goals met group were both living independently and engaging in community-based employment at programme discharge than individuals in the goals unmet group. These group differences were maintained or exceeded at 1-year follow-up. CONCLUSIONS: The results demonstrate that achievement of individualized CDT graduation goals is associated with greater levels of vocational and residential independence following acquired brain injury.

Point of entry and functional outcomes after comprehensive day treatment participation.

OBJECTIVES: To explore the relationship between point of entry into a comprehensive day treatment (CDT) program and outcomes after acquired brain injury (ABI). We hypothesized that participants entering our program 0 to 6 months postinjury would demonstrate greater declines in neurobehavioral sequelae and improvements in residential/vocational independence than those entering >6 to 12 and >12 to 24 months postinjury. DESIGN: Retrospective examination of admission, discharge, and 1-year follow-up data from a CDT program. SETTING: A large Midwestern academic medical center. PARTICIPANTS: Adult CDT participants with traumatic brain injuries (TBI) (n=54) or cerebrovascular accidents (CVAs) (n=29). INTERVENTIONS: A CDT rehabilitation program. MAIN OUTCOME MEASURES: Portland Adaptability Inventory/Mayo-Portland Adaptability Inventory (percent change scores between admission and discharge) and the Independent Living and Vocational Independence Scales. RESULTS: Time since injury was categorically coded into the 3 aforementioned point of entry groups. A 2 (injury type) × 3 (point of entry) between subjects analysis of covariance revealed a significant main effect for the point of entry (P<.001). Post hoc tests indicated that individuals entering the program 0 to 6 months postinjury demonstrated significantly greater treatment gains than those entering 6 to 12 or 12 to 24 months postinjury. Within group chi-square analyses revealed that a significantly higher percentage of the early entry participants were living and working independently at discharge and 1-year follow-up. CONCLUSIONS: Entry into a CDT program (0-6mo postinjury) is associated with significantly greater declines in neurobehavioral sequelae and improvements in residential and vocational independence in participants with TBI or CVA. Sustainable modest treatment gains were also observed in the late entry groups, suggesting that these individuals also benefit significantly from CDT program participation.

Quantifying pediatric neuro-oncology risk factors: development of the neurological predictor scale.

Pediatric neuro-oncology researchers face methodological challenges associated with quantifying the influence of tumor and treatment-related risk factors on child outcomes. The Neurological Predictor Scale was developed to serve as a cumulative index of a child's exposure to risk factors. The clinical utility of the Neurological Predictor Scale was explored in a sample of 25 children with heterogeneous brain tumors. Consistent with expectation, a series of regression analyses demonstrated that the Neurological Predictor Scale significantly predicted composite intellectual functioning (r(2) = 0.21, p < .05), short-term memory (r(2) = 0.16, p = .05), and abstract visual reasoning abilities (r(2) = 0.28, p < .05). With the exception of chemotherapy, the Neurological Predictor Scale accounted for a significant amount of the variance in child intellectual functioning above and beyond individually examined variables. The Neurological Predictor Scale can be used to quickly quantify the cumulative risk factors associated with pediatric brain tumor diagnoses.

Attention and memory in children with brain tumors.

The Rey Auditory Verbal Learning Test was utilized to examine attention, learning, and memory abilities in 42 children with cerebellar (N = 18) and third ventricle tumors (N = 24). Children with cerebellar tumors exhibited significant auditory attentional impairments and displayed adequate encoding and retrieval across subsequent learning and memory trials. In contrast, children with third ventricle tumors exhibited average auditory attentional abilities, but they displayed mild encoding deficits across trials 2-5. Furthermore, the third ventricle group's compromised performance on the delayed recall trial and average performance on the delayed recognition trial is suggestive of underlying retrieval deficits.