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OBJECTIVE: To investigate reported burden by the Primary Family Caregiver (PFC) 7-years after severe pediatric traumatic brain injury in the TGE (Traumatisme Grave de l'Enfant) longitudinal study. METHODS: Subjective burden was estimated with the Zarit Burden Inventory (ZBI) in 36 PFC (parents), who rated their own health status (Medical Outcome Study Short Form-12), family functioning and their child's level of care and needs (Pediatric/Adult Care And Needs Scale [PCANS/CANS]). Data collection included: child and PFC sociodemographic characteristics, injury-related factors, 'objective' (e.g. overall level of disability: Glasgow Outcome Scale - Extended, GOS-E/GOS-E-Peds) and 'subjective' outcomes (e.g. participation, behavior, executive functions, quality of life and fatigue). RESULTS: 25% of PFC reported mild-moderate burden, and 19% moderate-severe burden. Higher burden correlated with worse outcomes in all 'subjective' PFC-rated outcomes, and with self-reported participation. The ZBI correlated strongly with CANS/PCANS and GOS-E/GOS-E-Peds. Overall level of disability and PFC-reported executive functioning explained 62% of the ZBI variance. For equal levels of disability, burden was higher when PFC reported a 'negative' picture of their child. CONCLUSION: Significant PFC-reported burden 7-years post-injury was associated with overall disability and 'subjective' PFC-rated outcomes. Factors influencing parental burden in the long term should be identified and psychological support implemented over time.
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Lesões Encefálicas Traumáticas , Lesões Encefálicas , Adulto , Humanos , Criança , Estudos Longitudinais , Qualidade de Vida/psicologia , Cuidadores/psicologia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas/complicaçõesRESUMO
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01437683..
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PURPOSE: To investigate self- and parent-reported Health-Related Quality-of-Life (HRQoL) and their associations after severe childhood traumatic brain injury (TBI) in the Traumatisme Grave de l'Enfant (TGE) cohort. METHODS: Self- (n = 34) and/or parent-reports (n = 25) of HRQoL were collected for 38 participants (age 7-22 years) 7 years after severe childhood TBI. The collected data included sociodemographic characteristics, injury severity indices, and overall disability and functional outcome at 3-months, 1- and 2-years post-injury. At 7-years post-injury, data were collected in the TBI group and in a control group (n = 33): overall disability (Glasgow Outcome Scale Extended), intellectual ability (IQ), and questionnaires assessing HRQoL (Pediatric Quality of Life Inventory), executive functions (Behavior Rating Inventory of Executive Functions), behavior (Child Behavior Checklist), fatigue (Multidimensional Fatigue Scale) and participation (Child and Adolescent Scale of Participation). RESULTS: Parent- and self-reports of HRQoL were significantly lower in the TBI group than in the control group. Parent-rated HRQoL was not associated with objectively assessed factors, whereas self-reported HRQoL was associated with gender (worse in females) and initial functional outcome. All questionnaire scores completed by the same informant (self or parent) were strongly inter-correlated. CONCLUSIONS: Reported HRQoL 7-years after severe childhood TBI is low compared to controls, weakly or not-related to objective factors, such as injury severity indices, clinically assessed functional outcomes, or IQ, but strongly related to reports by the same informant of executive deficits, behavior problems, fatigue, and participation.
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Lesões Encefálicas Traumáticas/psicologia , Qualidade de Vida/psicologia , Autorrelato , Adolescente , Adulto , Criança , Estudos de Coortes , Pessoas com Deficiência , Função Executiva/fisiologia , Família , Fadiga/psicologia , Feminino , Humanos , Masculino , Pais/psicologia , Estudos Prospectivos , Inquéritos e Questionários , Índices de Gravidade do Trauma , Adulto JovemRESUMO
OBJECTIVE: To investigate presence of and factors associated with self- and parent-reported fatigue 7 years after severe childhood traumatic brain injury (TBI) in the prospective longitudinal study TGE (Traumatisme Grave de l'Enfant-severe childhood trauma). METHODS: Self-reports and/or parent reports on the Multidimensional Fatigue Scale were collected for 38 participants (aged 7-22 years) 7 years after severe childhood TBI, and 33 controls matched for age, gender, and parental educational level. The data collected included sociodemographic characteristics, age at injury and injury severity scores, overall disability (Glasgow Outcome Scale Extended), intellectual outcome (Wechsler scales), and questionnaires assessing executive functions, health-related quality of life, behavior, and participation. RESULTS: Fatigue levels were significantly worse in the TBI than in the control group, especially for cognitive fatigue. Correlations of reported fatigue with age at injury, gender, TBI severity, and intellectual ability were moderate and often not significant. Fatigue was significantly associated with overall level of disability (Glasgow Outcome Scale Extended) and with all questionnaires completed by the same informant. CONCLUSION: High levels of fatigue were reported by 30% to 50% of patients 7 years after a severe childhood TBI. Reported fatigue explained more than 60% of the variance of reported health-related quality of life by the same informant (patient or parent).
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Lesões Encefálicas Traumáticas , Fadiga , Adolescente , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/epidemiologia , Criança , Fadiga/epidemiologia , Fadiga/etiologia , Humanos , Escala de Gravidade do Ferimento , Estudos Longitudinais , Pais , Estudos Prospectivos , Qualidade de Vida , Autorrelato , Adulto JovemRESUMO
The aims of this study were (1) to prospectively measure memory functioning following severe childhood Traumatic Brain Injury (TBI), and its evolution over 2 years; (2) to assess demographic and medical factors associated with memory function and recovery; (3) to explore relations between memory and other TBI outcomes. Methods: Children (aged 0-15 years; n= 65) consecutively admitted in a single trauma center over a 3-year period, who survived severe non-inflicted TBI, were included in a prospective longitudinal study. Memory was assessed in 38 children aged 5-15 years at injury, using the Children's Memory Scale at 3, 12, and 24 months post-injury. Results: Mean general memory score was low at 3 months (M = 90.2, SD = 20.3) but within the normal range at 12 and 24 months (M = 100.6, SD = 23.1 and M = 108.6, SD = 24.1, respectively), with high variability. Improvement was stronger for immediate visual memory than for other memory indices. Lower general memory score was associated with higher injury severity, lower intellectual ability and functional status, higher overall disability, and ongoing education. Conclusion: Memory functioning is highly variable following severe childhood TBI, related to injury severity and functional, cognitive and educational outcomes; improvement is significant during the first-year post-injury, but varies according to the type of memory.
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Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/psicologia , Transtornos da Memória/etiologia , Transtornos da Memória/psicologia , Memória , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Avaliação da Deficiência , Avaliação Educacional , Feminino , Escala de Coma de Glasgow , Humanos , Lactente , Testes de Inteligência , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Estudos Prospectivos , Recuperação de Função Fisiológica , Resultado do Tratamento , Percepção VisualRESUMO
BACKGROUND AND PURPOSE: The cerebellum has a pivotal role in regulating human behavior; yet whether this function is mediated only through contralateral cerebro-cerebellar pathways is under-investigated. Thus, we examined feed-backward and feed-forward ipsilateral and contralateral cerebro-cerebellar connections using a detereministic diffusion tensor imaging (DTI) algorithm, the robustness of which was also estimated using phantom DTI data. MATERIALS AND METHODS: Fifty-one healthy controls (22-60 years old; 15 males/36 females) were scanned in a 3T MRI scanner with a 30-direction DTI sequence. Multiple region-of-interest (ROI) method was applied for the reconstruction of the ipsilateral and contralateral (based on cerebellar seed ROI) fronto-ponto-cerebellar (FPC), parieto-ponto-cerebellar (PPC), temporo-ponto-cerebellar (TPC), occipito-ponto-cerebellar (OPC) and dentate-rubro-thalamo-cortical (DRTC) tract bilaterally using the Brainance DTI Suite. A realistic diffusion MR phantom was used to evaluate the fiber tracking methodology for 16 fibers containing crossing, kissing, splitting and bending configurations. RESULTS: Both contralateral and ipsilateral FPC, PPC, OPC and ipsilateral DRTC tracts were successfully reconstructed; the contralateral DRTC tract was not reconstructed in all subjects. Also, the TPC tract was not reproduced in several subjects mostly regarding the contralateral connection. Descriptive DTI measures (number of fibers, fractional anisotropy, radial and axial diffusivity) are presented for each tract. Regarding phantom data, Brainance DTI Suite returned a dataset of 16 fibers that almost perfectly matched the 16 ground truth fibers. CONCLUSIONS: We identified ipsilateral and contralateral connections using a clinically applicable DTI sequence, a robust deterministic algorithm and an unbiased methodology, which can be applied in daily practice in different brain pathologies.
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Cerebelo/anatomia & histologia , Imagem de Tensor de Difusão/métodos , Vias Neurais/anatomia & histologia , Substância Branca/anatomia & histologia , Adulto , Algoritmos , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Imagens de Fantasmas , Valores de ReferênciaRESUMO
PURPOSE: The purpose of this study was to evaluate the long-term cognitive sequelae and to describe the neuropsychological profile of patients with intracranial germ cell tumors according to tumor location (pineal or suprasellar site). PATIENTS AND METHODS: Forty-five children treated at Gustave Roussy between 1991 and 2010 were assessed with neuropsychological tests to measure IQ, memory, visuospatial, motor, and executive skills at a mean delay of 4.2 years after diagnosis. All patients have received chemotherapy associated with surgery in 17 cases. Thirty-nine patients received, radiotherapy (focal 27, focal plus ventricles 8, craniospinal 4). Twenty-three patients had 2 IQ assessments with a mean delay of 4.1 years between the first and second. RESULTS: Full scale IQ was preserved, with higher verbal IQ than other IQ indexes. Visuospatial, fine-motor, and executive difficulties were present in a significant proportion of patients. Visuospatial and fine-motor deficits were significantly associated with oculomotor difficulties, more present in the pineal than in the suprasellar group. No cognitive decline was observed between the first and the second IQ assessment. CONCLUSIONS: Overall cognitive abilities were preserved in children treated for central nervous system germ cell tumor.
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Neoplasias Encefálicas/psicologia , Sistema Nervoso Central/patologia , Cognição , Neoplasias Embrionárias de Células Germinativas/psicologia , Glândula Pineal/patologia , Adolescente , Neoplasias Encefálicas/terapia , Criança , Pré-Escolar , Terapia Combinada , Humanos , Testes de Inteligência , Masculino , Neoplasias Embrionárias de Células Germinativas/terapia , Testes NeuropsicológicosRESUMO
OBJECTIVE: Studies on parental stress following childhood acquired brain injury (ABI-including brain tumours (BT) and other brain injuries) are scarce. The aim of this study was to assess maternal stress in a sample of children and adolescents diagnosed with severe paediatric ABI. METHODS: Seventy-eight French-speaking mothers of 37 with BT and 41 with other ABIs completed the Paediatric Inventory for Parents (PIP), the State-Trait Anxiety Inventory (STAI) and the Family Assessment Device (FAD) at a mean time since diagnosis of 1.5 years. RESULTS: The PIP correlated significantly with the STAI and the FAD. Socio-demographic factors, such as the age of mother and child, and the mother's educational level, were correlated with both maternal stress and anxiety. Maternal stress scores were comparable between groups. Emotional functioning was the most markedly affected domain, followed by parental role. CONCLUSIONS: Emotional stress as assessed by the PIP in mothers of children with ABI is significant and should motivate specific psychosocial interventions.
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Lesões Encefálicas/epidemiologia , Relações Mãe-Filho/psicologia , Mães/psicologia , Estresse Psicológico/etiologia , Adolescente , Adulto , Lesões Encefálicas/psicologia , Lesões Encefálicas/reabilitação , Criança , Correlação de Dados , Família , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fatores Socioeconômicos , Estresse Psicológico/epidemiologia , Inquéritos e QuestionáriosRESUMO
Acquisition of time knowledge (TK; the correct representation and use of time units) is linked to the development of numerical abilities, but this relationship has not been investigated in children. The current study examined the acquisition of TK and its association with numerical skills. A total of 105 children aged 6 to 11 years were interviewed with our Time Knowledge Questionnaire (TKQ), developed for purposes of this study, and the Zareki-R, a battery for the evaluation of number processing and mental calculation. The TKQ assessed conventional time knowledge (temporal orientation, temporal sequences, relationships between time units, and telling the time on a clock), estimation of longer durations related to birthday and life span, and estimation of the duration of the interview. Time knowledge increased with age, especially from 6 to 8 years, and was strongly linked to numerical skills. Regression analyses showed that four numerical components were implicated in TK: academic knowledge of numbers and number facts (e.g., reading Arabic numerals, mental calculation), number line estimation (e.g., correspondence between a number and a distance), contextual estimation (e.g., many/few leaves on a tree, children in a family), and numerical tasks involving verbal working memory (e.g., comparison of numbers presented orally). Numerical correlations with TK varied according to children's age; subtests based on academic knowledge of numbers, working memory, and number line estimation were linked with TK in the younger children, but only contextual estimation was associated with TK in the older children.
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Desenvolvimento Infantil/fisiologia , Matemática , Percepção do Tempo/fisiologia , Fatores Etários , Criança , Feminino , Humanos , Masculino , Memória de Curto Prazo , Análise de RegressãoRESUMO
PRIMARY OBJECTIVE: Conceptions of time in children having survived malignant cerebellar tumours (CT) and healthy children matched for chronological age (HCCA) were compared, knowing that the cerebellum has been involved in time perception. METHODS AND PROCEDURE: Study participants included 20 children with CT (13 boys) and 20 HCCA (10 boys) aged 6-12 years. All children with CT were at least 1 year after the end of treatment without relapse. A time questionnaire (TQ) exploring duration of daily activities, time units, planning and diachronic thinking was used, as well as a video animation (VA) displaying cyclic and linear time. MAIN OUTCOMES AND RESULTS: Children with CT obtained similar results as HCCA for time units, planning and diachronic thinking, but showed more difficulties than controls in estimating the duration of daily activities and understanding linear and cyclic time concepts (VA). CONCLUSIONS: These findings are not in favour of impaired time conceptions in children with CT and are probably linked to the specific life experience among children treated for a malignant pathology, rather than to the role of the cerebellum in time processing.
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Neoplasias Cerebelares/fisiopatologia , Formação de Conceito , Percepção , Sobreviventes , Neoplasias Cerebelares/complicações , Neoplasias Cerebelares/psicologia , Criança , Feminino , Humanos , Masculino , Inquéritos e Questionários , Sobreviventes/psicologia , Fatores de TempoRESUMO
INTRODUCTION: Severe pediatric traumatic brain injury (spTBI), including abusive head trauma (AHT) in young children, is a major public health problem. Long-term consequences of spTBI include a large variety of physical, neurological, biological, cognitive, behavioral and social deficits and impairments. AREAS COVERED: The present narrative review summarizes studies and reviews published from January 2019 to February 2024 on spTBI. Significant papers published before 2019 were also included. The article gives coverage to the causes of spTBI, its epidemiology and fatality rates; disparities, inequalities, and socioeconomic factors; critical care; outcomes; and interventions. EXPERT OPINION: There are disparities between countries and according to socio-economic factors regarding causes, treatments and outcomes of spTBI. AHT has an overall poor outcome. Adherence to critical care guidelines is imperfect and the evidence-base of guidelines needs further investigations. Neuroimaging and biomarker predictors of outcomes is a rapidly evolving domain. Long-term cognitive, behavioral and psychosocial difficulties are the most prevalent and disabling. Their investigation should make a clear distinction between objective (clinical examination, cognitive tests, facts) and subjective measures (estimations using patient- and proxy-reported questionnaires), considering possible common source bias in reported difficulties. Family/caregiver-focused interventions, ecological approaches, and use of technology in delivery of interventions are recommended to improve long-term difficulties after spTBI.
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PURPOSE/OBJECTIVE: To investigate the occurrence of behavioral problems 7 years after severe pediatric traumatic brain injury (TBI), and their evolution from 3 months to 7 years postinjury. METHOD/DESIGN: Thirty-four participants, 38% girls, M (SD) age at injury 7.6 (4.7) years, age at assessment 15 (4.6) years, underwent comprehensive assessments 7 years after severe TBI from March 2014 to March 2016 and were matched to a control group by age, gender, and parental education. A subgroup of 20 participants had available behavioral assessments at 3, 12, and 24 months postinjury. Internalizing, externalizing, and total behavioral problems were assessed with self- and parent reports of the Achenbach's Behavioral Checklist. Additional data included sociodemographic background, initial injury severity, and specific outcomes assessed concurrently 7 years postinjury. RESULTS: Compared to controls: (a) a significant proportion of participants with severe TBI fell above the clinical cutoff for self- (42%) and parent-reported (36%) externalizing problems, but not for self- (33%) or parent-reported (45%) internalizing problems; (b) withdrawn/depressed, intrusive behavior, and somatic complaints were significantly higher in self-reports; and (c) rule-breaking behavior, attention, and social problems were significantly higher in parent reports. Parent-reported internalizing problems were associated with older age at injury, whereas externalizing problems correlated with greater injury severity and concurrent levels of greater overall disability, lower intellectual ability, and poorer family functioning. In multiple hierarchical regression analyses, overall disability and worse family functioning significantly predicted externalizing problems. Parent-reported internalizing and externalizing problems persisted over time. CONCLUSIONS/IMPLICATIONS: These results highlight the importance of long-term follow-up and individualized behavioral interventions for children who sustained severe TBI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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PURPOSE: To determine what epilepsy types occur after herpetic encephalitis and what are the determinant factors for subsequent infantile spasms. METHODS: We analyzed retrospectively the clinical history of 22 patients, referred to Necker and Saint Vincent de Paul Hospitals (Paris) through the French pediatric epilepsy network from March 1986 to April 2010 and who developed epilepsy some months after herpetic encephalitis. We focused on seizure semiology with video-electroencephalography (EEG) recording, and on neuroradiology and epilepsy follow-up. KEY FINDINGS: Fourteen patients developed pharmacoresistant spasms, and eight developed focal epilepsy, but none had both. The patients who developed spasms were more frequently younger than 30 months at age of onset of epilepsy and had herpetic encephalitis earlier (mean 10.6 months of age) than those who developed focal epilepsy (mean 59.7 and 39.6 months, respectively). Epilepsy follow-up was similar in both groups (8.5 and 11 years, respectively). We found 26 affected cerebral areas; none alone was related to the development of epileptic spasms. SIGNIFICANCE: Risk factors to develop epileptic spasms were to have had herpetic encephalitis early (mean 10 months); to be significantly younger at onset of epilepsy (mean 22.1 months); and to have cerebral lesions involving the insula, the hippocampus, and the temporal pole.
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Encefalite por Herpes Simples/metabolismo , Espasmos Infantis/metabolismo , Fatores Etários , Córtex Cerebral/metabolismo , Criança , Pré-Escolar , Encefalite por Herpes Simples/complicações , Humanos , Lactente , Recém-Nascido , Estudos Retrospectivos , Espasmos Infantis/etiologiaRESUMO
AIM: Having previously shown that comorbidity is a major determinant of neurological sequelae in hypoglycaemia, our aim was to describe the neuroimaging patterns of brain damage in different hypoglycaemic situations and to elucidate the factors that determine lesion topography. METHOD: We reviewed 50 patients (31 females, 19 males) with symptomatic hypoglycaemia (<2.8 mmol/L) occurring between 1 day and 5 years of age (median 4 d) who had undergone magnetic resonance imaging (MRI; at least axial T2-weighted, sagittal T1-weighted, and coronal fluid-attenuated inversion recovery [FLAIR]-weighted imaging). MRI was performed during the follow-up examination at least 1 month after the occurrence of symptomatic hypoglycaemia, i.e. between 1 month and 5 years of age (median 3 mo). Hypoglycaemia resulted from three inborn errors of metabolism: congenital hyperinsulinism (33 patients), fatty acid ß-oxidation disorders (13 patients), or glycogen storage disease type I (four patients). We selected the patients with clear MRI abnormalities and analysed their topography according to aetiology and age at occurrence of the lesion. RESULTS: The topography of the brain lesions depended on age: from the neonatal period to 6 months of age, lesions predominantly involved the posterior white matter; between 6 and 22 months the basal ganglia, and after 22 months the parietotemporal cortex (p=0.04). INTERPRETATION: The relationship between brain lesions and age could reflect the maturation sequence of the brain.
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Encéfalo/patologia , Hipoglicemia/patologia , Fatores Etários , Encéfalo/metabolismo , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , NeuroimagemRESUMO
AIM: To determine risk factors for neurological sequelae following hypoglycemia. METHOD: We analysed the neurological outcome in 164 patients (mean age 10y 10mo, SD 5.9) following hypoglycemia due to three diseases with various metabolic contexts, different ages at onset, and combinations with comorbidity (fever/infection, hypoxia/ischemia): glycogen storage disease type I (GSDI) (21 patients, mean age at first hypoglycemic episode 3.8mo, SD 3.5); fatty acid ß-oxidation defects (FAOD) (29 patients, mean age at first hypoglycemic episode 14.8mo, SD 12.6); and hyperinsulinism (HIns) (114 patients, mean age at first hypoglycemic episode 2.3mo, SD 4.7). RESULTS: Risk factors of poor neurological outcome were aetiology (p<0.006), comorbidity (p<0.001), and prolonged convulsions (p<0.001). Ordinal logistic regression showed that comorbidity (p<0.001) and status epilepticus (p=0.002) were the main determinants of sequelae. Asymptomatic hypoglycemia did not lead to sequelae, whatever the aetiology. Age was not correlated to sequelae, whatever the aetiology. The highest prevalence of hypoglycemic sequelae was found in FAOD and HIns combined with comorbidity, the lowest in GSDI (p<0.001) in which hypoglycemia is often asymptomatic, associated with increased plasma lactate, and rarely combined with comorbidity. INTERPRETATION: Hypoglycemia is severely deleterious for the brain in the context of fever/infection and/or hypoxia/ischemia, and status epilepticus. The metabolic context providing alternative fuels may improve neurological outcome.
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Hipoglicemia/complicações , Doenças do Sistema Nervoso/etiologia , Criança , Pré-Escolar , Comorbidade , Doença de Depósito de Glicogênio Tipo I/complicações , Humanos , Hiperinsulinismo/complicações , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Lactente , Modelos Logísticos , Doenças do Sistema Nervoso/epidemiologia , Fatores de Risco , ConvulsõesAssuntos
Alexia Pura/etiologia , Esclerose Múltipla Recidivante-Remitente/complicações , Adulto , Alexia Pura/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Esclerose Múltipla Recidivante-Remitente/psicologiaRESUMO
PRIMARY OBJECTIVE: The aim of the study was the validation of the Deasy-Spinetta Questionnaire (DSQ) in 6-11 year olds with attention to the verification of three factors (learning difficulties, socialization and emotionality) and its application in children treated for cerebellar tumour. METHODS AND PROCEDURES: Twenty-nine children aged between 6-11 years were compared with 609 classmates. Teachers completed the DSQ. Patients were evaluated according to Wechsler Scales, the Purdue Pegboard and the International Cooperative Ataxia Rating scale. MAIN OUTCOMES AND RESULTS: In classmates, the DSQ factorial analysis showed three factors: learning, socialization difficulties and disturbing behaviour. Teachers reported more learning difficulties in patients than in classmates. Learning difficulties in patients were greater for mathematics and reasoning than for reading. Patients were described as less active, without evidence of autistic-like behaviour or irritability. The teachers' report of learning difficulties was significantly correlated with IQ scores, but not with neurological deficits. CONCLUSIONS: The proposed DSQ scores are interesting for the assessment of learning and behavioural difficulties in children treated for cerebellar tumours, as they provide complementary ecological information to that given by clinical and neuropsychological testing.
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Neoplasias Cerebelares/complicações , Neoplasias Cerebelares/terapia , Transtornos do Comportamento Infantil/diagnóstico , Função Executiva , Docentes , Deficiências da Aprendizagem/diagnóstico , Logro , Neoplasias Cerebelares/epidemiologia , Neoplasias Cerebelares/psicologia , Criança , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/etiologia , Feminino , Humanos , Deficiências da Aprendizagem/epidemiologia , Deficiências da Aprendizagem/etiologia , Masculino , Testes Neuropsicológicos , Inquéritos e Questionários , Análise e Desempenho de TarefasRESUMO
Numerical cognition is based on two components - number processing and calculation. Its development is influenced by biological, cognitive, educational, and cultural factors. The objectives of the present study were to: i) assess number processing and calculation in Brazilian children aged 7-12 years from public schools using the Zareki-R (Battery of neuropsychological tests for number processing and calculation in children, Revised; von Aster & Dellatolas, 2006) in order to obtain normative data for Portuguese speakers; ii) identify how environment, age, and gender influences the development of these mathematical skills; iii) investigate the construct validity of the Zareki-R by the contrast with the Arithmetic subtest of WISC-III. The sample included 172 children, both genders, divided in two groups: urban (N = 119) and rural (N = 53) assessed by the Zareki-R. Rural children presented lower scores in one aspect of number processing; children aged 7-8 years demonstrated an inferior global score than older; boys presented a superior performance in both number processing and calculation. Construct validity of Zareki-R was demonstrated by high to moderate correlations with Arithmetic subtest of WISC-III. The Zareki-R therefore is a suitable instrument to assess the development of mathematical skills, which is influenced by factors such as environment, age, and gender.
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Cognição , Matemática , Fatores Etários , Brasil , Criança , Desenvolvimento Infantil , Feminino , Humanos , Testes de Inteligência , Masculino , Testes Neuropsicológicos , População Rural , Fatores Sexuais , População UrbanaRESUMO
BACKGROUND: Childhood severe traumatic brain injury (TBI) is a leading cause of long-lasting acquired disability, but predicting long-term functional outcome remains difficult. OBJECTIVES: This study aimed to 1) describe the functional outcome at 1 and 7 years post-TBI; 2) determine the initial and concurrent factors associated with long-term outcome; and 3) evaluate the predictive value of functional status, overall disability level and intellectual ability measured at 1 year post-injury to determine 7-year clinically meaningful outcomes. METHODS: Among the children (<16 years) consecutively included over 3 years in the Traumatisme Grave de l'Enfant (TGE) prospective longitudinal cohort study after accidental severe TBI, we studied the outcomes of 39 survivors at 1 and 7 years post-injury. Overall outcome included disability level (Glasgow Outcome Scale), functional status (Pediatric Injury Functional Outcome Scale), intellectual ability (Wechsler scales), executive functions (Behavior Rating Inventory of Executive Functions), behavior (Child Behavior Checklist) as well as neurological impairments and academic status. RESULTS: Mean (SD) age of the 39 survivors at injury was 7.6 (4.6) years, and long-term evaluation was conducted at a mean of 7.8 years post-injury (range 5.9-9.3); 36% of participants were adults (≥18 years old). Most of the neurological impairments remained stable beyond 1 year after TBI, whereas overall disability level improved significantly from 1 to 7 years but remained highly variable, with almost half of participants presenting significant disability levels (moderate: 26%, or severe: 21%). Almost half of participants had significant cognitive, behavior and/or academic difficulties at 7 years post-TBI. On multivariate regression analysis, functional impairment at 1 year was the best predictor of severe disability at 7 years (F(3,31)=13.18, p < 0.001, sensitivity=100%, specificity=78%). CONCLUSIONS: Our results confirm the significant long-term impact of childhood severe TBI. All children with TBI should benefit from systematic follow-up, especially those with persistent functional deficits at 1 year post-injury, because the severity of functional impairment at 1 year seems the best predictor of long-term significant disability up to 7 years post-TBI.
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Lesões Encefálicas Traumáticas , Estado Funcional , Adolescente , Adulto , Criança , Estudos de Coortes , Humanos , Estudos Longitudinais , Estudos ProspectivosRESUMO
This study investigated parental reports of the level of care and needs 7-years following severe childhood traumatic brain injury (TBI), and the factors associated with this outcome. From the 65 children (0-15 years) consecutively admitted to the Parisian regional TBI reference intensive care unit following severe TBI, included in this prospective longitudinal study, 39 patients [M(SD) age at injury = 7.5 years (4.6) and assessment 15.3(4.4)] were followed 7-years post-injury and matched with a control group composed of typically developing participants (n = 34) matched by age, sex and parental education level. We used the Care and Need Scale (CANS) and its Pediatric version (PCANS) to assess the primary outcome 7-years post-injury. Concurrent measures included overall level of disability, and parent- and/or self-reported questionnaires assessing executive functioning, behavior, quality of life, fatigue, participation and caregivers' burden. The level of care and needs was significantly higher in the TBI group than in the control group, the difference being significant with the CANS only. PCANS scores were extremely variable in the control group. High level of dependency was associated with initial TBI severity (higher coma duration and initial Injury Severity Score), higher levels of behavioral problems, executive function deficits, fatigue, and lower participation levels. Caregivers' burden was strongly associated with the CANS. The CANS provides a simple and reliable measure of the support needed long-term after childhood TBI, in accordance with previous studies. The PCANS scores were not significantly different between the TBI and the control groups, which seems to illustrate the difficulty to assess accurately mild-to-moderate deficits of functional independence/adaptive behavior in children based exclusively on parental reports.