Effects of Pediatric Traumatic Brain Injury on Verbal IQ: A Systematic Review and Meta-Analysis.

OBJECTIVES: To examine the effects of pediatric traumatic brain injury (TBI) on verbal IQ by severity and over time. METHODS: A systematic review and subsequent meta-analysis of verbal IQ by TBI severity were conducted using a random effects model. Subgroup analysis included two epochs of time (e.g., <12 months postinjury and ≥12 months postinjury). RESULTS: Nineteen articles met inclusion criteria after an extensive literature search in MEDLINE, PsycInfo, Embase, and CINAHL. Meta-analysis revealed negative effects of injury across severities for verbal IQ and at both time epochs except for mild TBI < 12 months postinjury. Statistical heterogeneity (i.e., between-study variability) stemmed from studies with inconsistent classification of mild TBI, small sample sizes, and in studies of mixed TBI severities, although not significant. Risk of bias on estimated effects was generally low (k = 15) except for studies with confounding bias (e.g., lack of group matching by socio-demographics; k = 2) and measurement bias (e.g., outdated measure at time of original study, translated measure; k = 2). CONCLUSIONS: Children with TBI demonstrate long-term impairment in verbal IQ, regardless of severity. Future studies are encouraged to include scores from subtests within verbal IQ (e.g., vocabulary, similarities, comprehension) in addition to functional language measures (e.g., narrative discourse, reading comprehension, verbal reasoning) to elucidate higher-level language difficulties experienced in this population.

Language performance within three months of early childhood traumatic brain injury.

PURPOSE: To examine language outcomes in the short-term stage (i.e., within three months) of early childhood traumatic brain injury (TBI). METHODS: A retrospective chart review over a 10-year period (January 1, 2007 to December 31, 2016) was completed at a single-site inpatient rehabilitation hospital. Inclusion criteria were children aged 15 months to five years 11 months with a diagnosis of closed TBI. RESULTS: Twenty-four charts were included in the descriptive analysis of language; there were fewer children with expressive language scores (n = 18) than receptive language scores (n = 24), likely due to word retrieval difficulties as per clinical documentation. Effects of TBI on language performance were more pronounced in receptive than expressive language. For children with scores in both receptive and expressive language areas (n = 18), five children had below average scores. These children were described as having language delays pre-injury (n = 2), lower exposure to English (n = 1), information processing difficulties (n = 1), and difficulties with formulation and organization of language (n = 1). CONCLUSION: This study represents an initial step in understanding expressive and receptive language performance shortly after early childhood TBI. Challenges with assessment as well as directions for future research are discussed.

Cognitive Communication Impairments in Children With Traumatic Brain Injury: A Scoping Review.

OBJECTIVE: This scoping review synthesizes the scholarly literature on cognitive communication impairments in traumatic brain injury (TBI) sustained during childhood to identify gaps in research, and make recommendations that will further the field of cognitive communication in pediatric TBI. METHODS: MEDLINE, PsycINFO, CINAHL, and EMBASE were searched to identify peer-reviewed studies that examined cognitive communication impairments in children who sustained a TBI between 3 months to 18 years of age. RESULTS: Twenty-eight studies met inclusion criteria with 3 main categories identified in relation to cognitive communication: (1) impairments according to TBI severity, (2) impairments according to age at injury, and (3) trends in recovery according to TBI severity. CONCLUSIONS: The results of this scoping review suggest that (1) TBI severity is not the sole predictor of performance; other factors contribute to cognitive communication outcome and recovery; (2) developing skills at time of injury are most susceptible to impairment; and (3) standard, norm-referenced language assessments are not sensitive in detecting language impairments that are secondary to cognitive impairments found in TBI. Directions for future research and suggestions for clinical practice are proposed.

Dove and hawk profiles in youth concussion: Rethinking occupational performance.

BACKGROUND: Youth concussion and its subsequent recovery have been described as heterogeneous; no one injury is the same, and each youth is different in how he or she recovers. PURPOSE: This paper proposes a theoretical perspective on the management of youth with persistent concussion symptoms. KEY ISSUES: When managing concussion within youth, further consideration of person, occupation, and environment factors may provide insight on (a) the differential spectrum of profiles that exist among youth who have experienced a concussion and (b) how these profiles can support client-centred rehabilitation. Passive-dove and active-hawk stress profiles from evolutionary literature will be used to contextualize return to occupational performance. An innovative, novel model-the Dove-Hawk Model of Allostatic Load for Youth With Persistent Concussion Symptoms-is proposed to illustrate these concepts, and approaches to rehabilitation across the spectrum of profiles are offered. IMPLICATIONS: Viewing persistent youth concussion recovery in this way may elucidate different approaches to client-centred rehabilitation.