Cognitive function and participation in children and youth with mild traumatic brain injury two years after injury.

BACKGROUND: 10-20% of children and youth with mild traumatic brain injury (mTBI) suffer from long-term cognitive impairments with, supposedly, a negative impact on most domains of functioning. OBJECTIVES: To describe cognitive functioning and participation in children and youth two-years post-mTBI and to determine associated risk factors. METHODS: Cross-sectional study among 73 patients (aged 6-22 years), hospital diagnosed with mTBI. Linear regression modelling was used to investigate the effect of potential predictors on cognitive functioning as measured with a neuropsychological assessment (NPA), two-years post-injury. Extent of participation was assessed using the Child and Adolescent Scale of Participation and correlation analysis was conducted to examine its association with level of cognitive functioning. RESULTS: 7-15% of all participants had impaired cognitive functions, especially in the domains of processing speed, inhibitory control, cognitive flexibility, visuospatial constructional ability and visuospatial memory. Lower level of education and pre-injury cognitive problems were predictive for a lower level of long-term cognitive functioning. Slower inhibition speed, impaired visuospatial and verbal working memory were associated with reduced participation. DISCUSSION AND CONCLUSIONS: Persisting cognitive problems two years after mTBI were mostly related to the lower level of education and to pre-injury cognitive problems. Although participation of the patients was reported by parents to be relatively high, slower inhibition speed, impaired visuospatial and verbal working memory were associated with reduced participation.

Factors related to fatigue after paediatric acquired brain injury (ABI).

OBJECTIVE: To assess the degree of fatigue in children and youth after traumatic and non-traumatic brain injury (TBI and NTBI) and related factors. METHOD: Follow-up study including patients with a hospital-based diagnosis of acquired brain injury (ABI), aged 4-20 years at onset and their parents. Parents and children (dependent on age) completed the Paediatric Quality of Life Inventory™ Multidimensional Fatigue Scale (PedsQL™ MFS), which measures general fatigue (GF), sleep/rest fatigue (SRF) and cognitive fatigue (CF). Additional assessments included the Child & Family Follow-up Survey (CFFS) and PedsQL™ 4.0 General Core Scales and sociodemographic and disease characteristics. RESULTS: Eighty-eight parents completed the PedsQL™ MFS 24-30 months after diagnosis, with 49/88 patients (56%) completing the child version. The median age of the patients was 11 years (interquartile range [IQR] = 7). There were 69 patients with TBI (16% moderate/severe TBI) and 19 patients with NTBI (16% moderate/severe NTBI). The median parent-reported and child-reported PedsQL™ MFS Total Scale Scores were 76.5 (SD = 16.4) and 78.5 (12.9), respectively (Spearman r = 0.450, p = 0.001). Apart from NTBI, increasing age and a single-parent household were significantly associated with more fatigue according to the parent-reported PedsQL™ MFS Total Score (and/or one or more sub-scale scores). CONCLUSION: Two years after onset, in particular, the parent-reported fatigue after NTBI was considerable. Moreover, older children and children from a single-parent household were found to have higher fatigue levels.

Youth with acquired brain injury in The Netherlands: a multi-centre study.

UNLABELLED: Abstract Aim: To describe the occurrence and causes of acquired brain injury (ABI), including traumatic brain injury (TBI) and non-traumatic brain injury (NTBI), among Dutch youth and estimate incidence rates from the data. PATIENTS: Aged 1 month-24 years, hospital diagnosed with ABI in 2008 or 2009. METHODS: In three major hospitals in the southwest region of the Netherlands patients with ABI were retrospectively identified by means of diagnosis codes and specific search terms. RESULTS: One thousand eight hundred and ninety-two patients were included: 1476 with TBI and 416 with NTBI. Causes of TBI and NTBI varied among the age groups 0-4, 5-14 and 15-24 years, with accidents (in traffic or at home) being the most common cause of TBI and hypoxic-ischemic events for NTBI, in all groups. The estimated yearly incidence rates per 100 000 for mild-moderate-severe TBI were 271.2-15.4-2.3 (0-14 years) and 261.6-27.0-7.9 (15-24 years), for mild-moderate-severe NTBI they were 95.7-11.8-1.3 (0-14 years) and 73.8-6.1-1.6 (15-24 years), respectively. CONCLUSION: More than 15% of TBI and NTBI in children and youth is classified as moderate or severe, with causes of TBI and NTBI varying among age groups. Based on the occurrence of ABI in three hospitals, the estimated incidence of ABI in children and youth in the southwest region of the Netherlands is substantial.

Knee disarticulation after total-knee replacement.

An 89-year-old woman who had a total-knee replacement in the past, underwent a knee disarticulation of the same leg because of an ischaemic foot. Eight (8) months postoperatively the stump is fully weight-bearing and the patient is able to walk safely, using a prosthesis and a walking frame.