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1.
Brain Inj ; 38(2): 142-149, 2024 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-38328966

RESUMO

OBJECTIVE: The aim of this scoping review was to identify behavioral disturbances exhibited by patients in post-traumatic amnesia (PTA). While behavioral disturbances are common in PTA, research into their presentation and standardized measures for their assessment are limited. DESIGN: The study protocol was registered with PROSPERO (CRD42021268275). A scoping review of databases was performed according to pre-determined criteria on 29 July 2021 and updated on 13 July 2022. A conventional content analysis was used to examine and categorize behavioral disturbances. RESULTS: Thirty papers met the inclusion criteria, of which 27 reported observations and/or scores obtained on behavioral scales, and 3 on clinician interviews and surveys. None focused exclusively on children. Agitation was the most frequently assessed behavior, and Agitated Behavior Scale was the most used instrument. Content analysis, however, bore eight broad behavioral categories: disinhibition, agitation, aggression, lability, lethargy/low mood, perceptual disturbances/psychotic symptoms, personality change and sleep disturbances. CONCLUSION: Our study revealed that while standardized assessments of behavior of patients in PTA are often limited to agitation, clinical descriptions include a range of behavioral disturbances. Our study highlights a significant gap in the systematic assessment of a wide range of behavioral disturbances observed in PTA.


Assuntos
Lesões Encefálicas Traumáticas , Comportamento Problema , Criança , Humanos , Amnésia/etiologia , Amnésia/diagnóstico , Amnésia Retrógrada , Ansiedade , Agressão
2.
Brain Inj ; 36(6): 750-758, 2022 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-35622928

RESUMO

AIM: The Child Behavior Checklist (CBCL) includes several sleep items. We aimed to examine the convergent validity of CBCL sleep scores with validated sleep measures, and to explore their functional correlates. METHODS: This cross-sectional study included 44 children with moderate to severe TBI, aged 6-15 years. Parents completed the CBCL and Sleep Disturbance Scale for Children (SDSC), and children wore actigraphy watches. RESULTS: We found significant, albeit differential, associations between CBCL and SDSC sleep scores. Specifically: (i) "trouble sleeping" with SDSC total score, (ii) "trouble sleeping" and "nightmares" with SDSC initiating and maintaining sleep, (iii) "talks/walks in sleep" with SDSC arousal, and (iv) "overtired," "sleeps more" and CBCL sleep composite with SDSC excessive somnolence. The CBCL item "sleeps less" was the only significant predictor of functioning; children who slept less had lower social competence. No associations were found between CBCL sleep scores and actigraphy. CONCLUSIONS: The CBCL does not provide a comprehensive assessment of sleep disturbances in children with moderate to severe TBI. Nevertheless, certain CBCL sleep items demonstrate initial convergent validity with subscales of the SDSC assessing select types of sleep disturbances. The CBCL may be useful in research and clinical situations when administration of more comprehensive assessment sleep tools is not viable.


Assuntos
Lesões Encefálicas Traumáticas , Transtornos do Sono-Vigília , Lesões Encefálicas Traumáticas/complicações , Lista de Checagem , Criança , Comportamento Infantil , Estudos Transversais , Humanos , Sono , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários
3.
Chem Senses ; 462021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33893484

RESUMO

Currently, no method has been developed for rehabilitating olfaction in anosmic patients following a traumatic brain injury (TBI). Here a method for rehabilitation is described which is based on a recent finding that the human posterior pyriform cortex (PPC) generates predictive odor "search images" in advance of an encounter with an olfactory stimulus. The search image enhances perceptual sensitivity and allows the odor it represents to be identified without input occurring from the olfactory receptors or bulbs. Furthermore, based on the finding here that anosmics with a TBI often have normal trigeminal and gustatory function, it is proposed that normality in these chemosensory systems may indicate that key cortical regions including the PPC are intact in anosmics and capable of processing olfactory information. In addition, the results of chemosensory tests of the olfactory, gustatory, and intranasal trigeminal systems of 18 patients with a TBI are given that identify which patients would most likely benefit from the rehabilitation procedure.


Assuntos
Anosmia/fisiopatologia , Lesões Encefálicas Traumáticas/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Pessoa de Meia-Idade
4.
J Head Trauma Rehabil ; 36(2): E108-E117, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32769830

RESUMO

OBJECTIVE: To characterize fatigue in children with moderate or severe traumatic brain injury (TBI) and to identify associated factors. SETTING: Urban tertiary pediatric healthcare facility. PARTICIPANTS: Children aged 5 to 15 years with a moderate TBI (n = 21), severe TBI (n = 23), or an orthopedic injury (OI; n = 38). DESIGN: Case-control study. MAIN MEASURES: (i) Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS), completed by parents and children; (ii) Sleep Disturbance Scale for Children, completed by parents. Data on injury-specific factors and other factors of interest were also collected. RESULTS: The 2 TBI groups did not differ on any of the fatigue outcomes (child or parent ratings). Relative to the OI group, parents rated children in both TBI groups as experiencing greater fatigue. However, on self-ratings, only children with moderate TBI endorsed greater fatigue. Sleep was commonly associated with fatigue, with child sleep disturbance and child sleep hygiene associated with parent-rated and self-rated child fatigue, respectively. Individually, there were no cases of "normal" fatigue coinciding with severe sleep disturbance. However, there were several cases of severe fatigue coinciding with normal sleep. Additional factors associated with fatigue were older age at injury, longer time since injury, and/or greater internalizing difficulties. CONCLUSION: Children with moderate and severe TBI experience greater fatigue than OI controls. Parent and child ratings of fatigue appear to be associated with different factors, indicating that fatigue management may require a broad range of treatments.


Assuntos
Lesões Encefálicas Traumáticas , Transtornos do Sono-Vigília , Idoso , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/epidemiologia , Estudos de Casos e Controles , Criança , Fadiga/epidemiologia , Fadiga/etiologia , Humanos , Qualidade de Vida , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia
5.
Brain Inj ; 35(6): 682-689, 2021 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-33689527

RESUMO

Objective:Primary: to examine objective sleep outcomes in children who sustained moderate to severe traumatic brain injury (TBI). Secondary: to examine the relation of objective sleep with subjective sleep, fatigue, and injury variables.Setting: A single tertiary brain injury unit.Participants: Children (5-15 years) with moderate to severe TBI (n = 23) or orthopedic injury (OI; n = 13).Design: Cohort study.Measures: Primary: objective sleep measure (actigraphy watch). Secondary: subjective sleep measure (questionnaire), fatigue questionnaire, and injury variables.Results: On actigraphy, children with TBI had longer sleep onset latency compared to children with OI. On the sleep questionnaire, children with TBI obtained higher scores for total sleep disturbance, initiating and maintaining sleep, and excessive somnolence. On the fatigue questionnaire, greater difficulties were found for total, sleep/rest, and cognitive fatigue for the TBI group. In the TBI group, actigraphy data did not correlate with sleep questionnaire, fatigue, or injury variables.Conclusion: Our study showed evidence of objective and subjective sleep disturbance in children with moderate to severe TBI, but these two types of sleep measures were not related. It is possible that distinct mechanisms underpin objective and subjective sleep disturbance, which may require different interventions.


Assuntos
Lesões Encefálicas Traumáticas , Transtornos do Sono-Vigília , Actigrafia , Lesões Encefálicas Traumáticas/complicações , Criança , Estudos de Coortes , Humanos , Sono , Transtornos do Sono-Vigília/etiologia
6.
Neuropsychol Rehabil ; 31(3): 345-368, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31752595

RESUMO

Difficulties falling asleep or staying asleep (symptoms of insomnia) are common following paediatric traumatic brain injury (TBI). Yet, interventions to treat insomnia in this population have not yet been reported. This single-case series examined the feasibility and acceptability of cognitive behavioral treatment for insomnia (CBT-I) for adolescents (n = 5, aged 11-13 years) with TBI, and explored changes in sleep and fatigue post-treatment. Adolescents were randomly assigned to two conditions: a 7- or 14-days baseline, followed by 4 weeks of manualised CBT-I delivered individually. To assess feasibility and acceptability we compared recruitment and retention rates, and questionnaire scores to a-priori set criteria. We explored treatment efficacy and functional gains in sleep and fatigue from baseline to follow-up using structured visual analysis of time-series graphs, and reliable change indices or changes in clinical classification. Feasibility and acceptability indicators met a-priori criteria, but therapists noticed limited adolescent engagement in sessions. Clinically significant improvements were found in sleep, in 3 out of 4 cases, and fatigue, in all cases. Our study provides preliminary evidence that CBT-I is feasible for insomnia treatment in adolescents with TBI and provides directions for development of future treatment studies.


Assuntos
Lesões Encefálicas Traumáticas , Distúrbios do Início e da Manutenção do Sono , Adolescente , Lesões Encefálicas Traumáticas/complicações , Criança , Cognição , Estudos de Viabilidade , Seguimentos , Humanos , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/terapia
7.
Brain Inj ; 34(7): 914-920, 2020 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-32497441

RESUMO

OBJECTIVE: To assess the validity of the Westmead PTA scale in school-aged children treated with opiate analgesics. METHOD: Twenty-eight hospitalized children without brain injury, aged between 8 and 16 years treated with opiate analgesics for pain relief following surgery were tested on the Westmead PTA scale. Pain and stress levels were also self-reported each day. RESULTS: Only 29% (n = 7) of children assessed over four days obtained a maximum score of 12/12 on three consecutive days, thus 71% would have been deemed to have been in PTA when they were not. The percentage of children who obtained a maximum score significantly decreased over consecutive days of assessment, due to an increase in error rate on picture memory items. Self-reported pain and stress ratings were not correlated with PTA scores. CONCLUSIONS: Opiate analgesia can disrupt performance on the Westmead PTA scale in school-aged children resulting in a high false-positive error rate. It is therefore important to record pain medication schedules and interpret results cautiously when opiate analgesia is used following a TBI. Alteration of the method of administration of the memory items should be researched as this may increase the validity of the scale for children with TBI treated with opiate analgesics.


Assuntos
Alcaloides Opiáceos , Adolescente , Amnésia/diagnóstico , Amnésia/etiologia , Amnésia Retrógrada , Analgésicos Opioides/uso terapêutico , Criança , Humanos , Instituições Acadêmicas
8.
J Head Trauma Rehabil ; 34(2): 122-131, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30045218

RESUMO

OBJECTIVES: To characterize the sleep disturbance in children with moderate or severe traumatic brain injury (TBI), and to identify associated factors. SETTING: An urban tertiary pediatric healthcare facility. PARTICIPANTS: Children aged 5 to 15 years with a moderate TBI (n = 21), severe TBI (n = 23), or an orthopedic injury (OI; n =38) comparable in age, gender, and socioeconomic status. DESIGN: Cohort study. MEASURES: Primary: Sleep Disturbance Scale for Children (SDSC). Secondary: Injury-specific factors (TBI severity, age at injury, and time since injury), and other factors of interest (sleep hygiene; pain intensity; difficulties with internalizing, externalizing, or attention/hyperactivity; parental distress; and parental knowledge of TBI). RESULTS: On the SDSC, parents rated children with moderate TBI (but not severe TBI) as experiencing greater overall sleep disturbance, as well as excessive somnolence and sleep breathing disturbance, relative to OI controls. Children with severe TBI (but not moderate TBI) were rated as experiencing greater disturbance with initiating and maintaining sleep. The moderate and severe TBI groups did not differ on any of the sleep outcomes. Only 3 factors were associated with sleep disturbance in the combined TBI group: (1) lower TBI severity with greater excessive somnolence; (2) greater internalizing difficulties with greater overall sleep disturbance, and disturbance with initiating and maintaining sleep specifically; and (3) younger age at injury with greater overall sleep disturbance, and sleep breathing disturbance specifically. CONCLUSION: Children with moderate or severe TBI experience greater overall and/or specific forms of sleep disturbance. Different forms of sleep disturbance may be associated with different factors.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Índices de Gravidade do Trauma , Ferimentos e Lesões/epidemiologia
9.
J Neuropsychol ; 2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38628148

RESUMO

Behavioural disturbances are often observed, but (to our knowledge) not systematically assessed, in children who are in post-traumatic amnesia (PTA) following traumatic brain injury (TBI). Therefore, we aimed to develop a prototype scale that measures the full range of behavioural disturbances exhibited by school-aged children in PTA. Quantitative and qualitative feedback was collected via online surveys. First, experts (n = 7) evaluated the relevance and developmental appropriateness of 37 behavioural items, extracted from the scoping literature review. Second, clinicians (n = 20) evaluated the preliminary scale for its suitability (acceptability, feasibility and usability). Analyses included descriptive statistics and qualitative analyses. First, experts eliminated nine items, adjusted the wording of three retained items and categorised 18 of the remaining 28 items into one of eight categories. Ten items were not consistently categorised. All experts highlighted that the scale needed to be short and easy to administer. Hence, categorised items were bundled, arriving at an 18-item preliminary scale. Second, clinicians deemed the preliminary scale highly suitable, easy to implement and addressing a gap in current clinical practice. The layout of the scale and wording of three items was modified according to qualitative feedback, arriving at an 18-item prototype. To our knowledge, this is the first scale designed to assess the full range of behavioural disturbances in children in PTA. The scale has the potential to systematically assess behaviour and streamline documentation of behavioural recovery in this population, inform management and rehabilitation, track responses to interventions and facilitate discussion with affected families.

10.
BMC Pediatr ; 13: 89, 2013 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-23710976

RESUMO

BACKGROUND: It is estimated that 22,800 children were living with an Acquired Brain Injury (ABI) (0.6% of children aged under 15 years) in Australia during 2003. Many children after a traumatic brain injury will experience difficulties with attention and concentration; a condition termed secondary Attention Deficit-Hyperactivity Disorder. There is conflicting evidence on whether treatment with stimulant therapy with medications such as methylphenidate or dexamphetamine will improve the attention and behavior of children with this condition. METHODS/DESIGN: Single patient trials (n-of-1s or SPTs) evaluate the effect of titrated doses of psychostimulants methylphenidate or dexamphetamine compared to placebo on attention and behavior, in children with TBI and secondary ADHD. The aggregation of multiple SPTs will produce a population estimate of the benefit. Forty-two children will be registered into the trial through rehabilitation services at three large children's hospitals in Australia. Patients will complete up to 3 cycles of treatment. Each cycle is 2 weeks long comprising seven days each of treatment and placebo, with the first two days of each cycle considered a washout period and the data not analysed. The order of treatment and placebo is randomly allocated for each cycle. The Conners' Parent Rating Scales long forms will be employed to measure change in attention-deficit/hyperactivity and related problems of the child, and the primary outcome measure is the Conners' Global Index Parent Version. Secondary outcomes include the teacher and child (if aged > 12 years) Conners' Rating Scales, the Behaviour Rating Inventory of Executive Function among other measures. This study will provide high-level evidence using a novel methodological approach to inform clinicians about the most appropriate treatment for individual children. Through aggregation of individual trials, a population estimate of treatment effect will be provided to guide clinical practice in the treatment of children with secondary ADHD after a traumatic brain injury. DISCUSSION: This study employs an innovative methodological approach on the effectiveness of CNS stimulants for secondary ADHD from a brain injury. The findings will both guide clinicians on treatment recommendations, and inform the concept and acceptance of SPTs in paediatric research. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry. ACTRN12609000873224.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Lesões Encefálicas/complicações , Estimulantes do Sistema Nervoso Central/uso terapêutico , Dextroanfetamina/uso terapêutico , Metilfenidato/uso terapêutico , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Teorema de Bayes , Criança , Protocolos Clínicos , Estudos Cross-Over , Método Duplo-Cego , Esquema de Medicação , Humanos , Modelos Estatísticos , Tamanho da Amostra , Resultado do Tratamento
11.
J Neuropsychol ; 17(1): 193-209, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36208456

RESUMO

The Westmead Post-Traumatic Amnesia Scale (WPTAS) is routinely used for the assessment of post-traumatic amnesia (PTA) in children who sustained traumatic brain injury (TBI). Yet, the WPTAS' predictive validity for functional outcomes is largely unknown. We aimed to determine whether PTA duration measured by the WPTAS (i) differentially predicts functional outcomes and (ii) contributes to predictions of outcomes beyond the Glasgow Coma Scale (GCS) in children who sustained TBI. Participants were children and adolescents with moderate-to-severe TBI (n = 55) aged 8-15 years. PTA duration was assessed with the WPTAS. Outcomes at the first outpatient follow-up were scored on the Kings Outcome Scale for Childhood Head Injury (KOSCHI) and the TBI Outcome Domain Scale-Extended (ODS-E). Longer PTA and lower GCS were both significantly correlated with worse (i) global outcomes: presence of disability on the KOSCHI and lower score on the ODS-E and (ii) select specific outcomes on the ODS-E: mobility, mood and cognition. PTA duration predicted cognitive outcome on the ODS-E independently, beyond GCS. Together, PTA duration and GCS, predicted the global KOSCHI outcome, as well as the ODS-E mobility and mood outcomes. Neither GCS nor PTA duration correlated with the ODS-E communication, impulsivity/disinhibition, headache, fatigue, sensory impairments or somatic complaints outcomes. PTA duration measured by the WPTAS is a significant unique predictor of functional cognitive outcomes in children who sustained moderate-to-severe TBI, and in combination with the GCS, a significant predictor of global, and several specific functional outcomes.


Assuntos
Amnésia , Lesões Encefálicas Traumáticas , Adolescente , Humanos , Criança , Amnésia/diagnóstico , Amnésia/etiologia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/psicologia , Escala de Coma de Glasgow , Cognição
12.
Disabil Rehabil ; 44(12): 2763-2773, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-33331793

RESUMO

PURPOSE: Longitudinal fibular deficiency (LFD) is the most common congenital long bone deficiency. This study aimed to objectively assess the physical performance of children and adolescents with LFD compared with unaffected peers, and to examine trends over age for subgroups of the LFD population. METHODS: Differences between children with LFD and unaffected peers were examined with hand-held dynamometry for lower-limb muscle strength, Six-Minute Walk Test, Timed up and down stairs test, Star Excursion Balance Test, and Standing long jump. RESULTS: Thirty-nine children with LFD and 284 unaffected peers participated. Children with LFD performed at a lower level than their unaffected peers, on all measures of physical performance (mean 2.1 z-scores lower, all p < 0.01), except in long jump (p = 0.27). When comparing the performance of children with LFD to their unaffected peers across four age groups, there was a significant between-groups difference on all strength measures, and on the Six-Minute Walk distance, between children with and without LFD. These differences were smallest in young children (3-6 years) and largest in the older children (15-18 years) (all p < 0.01). Children with no lengthening surgery performed better on the Six-Minute Walk Test, covering a greater distance during the test, than those who had surgery (mean difference 83 metres, p < 0.01). There were no significant differences between children who had or had not undergone an amputation. CONCLUSIONS: Children with LFD performed at a significantly lower level than unaffected peers on all measures of physical performance other than jumping. The largest differences were in older children. This paper provides baseline functional data for future interventions in LFD. LEVEL OF EVIDENCE: Cross-sectional study.Implications for RehabilitationThis paper provides the first baseline functional data using validated objective measures on a consecutive cohort of children and adolescents with longitudinal fibular deficiency.Children with LFD performed significantly worse than their unaffected peers on all measures of physical performance other than jumping, with children falling further behind their peers as they age.Children who undergo an amputation typically have the most severe anatomical presentation and yet perform at an equivalent functional level.This paper identifies multiple modifiable impairments that represent potential opportunities for rehabilitation professionals to target with conservative treatment options to improve functional performance.


Assuntos
Ectromelia , Adolescente , Amputação Cirúrgica , Criança , Pré-Escolar , Estudos Transversais , Ectromelia/cirurgia , Fíbula/anormalidades , Fíbula/cirurgia , Humanos , Desempenho Físico Funcional
13.
Brain Inj ; 25(1): 44-52, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21117914

RESUMO

PRIMARY OBJECTIVE: To examine implicit and explicit memory outcome in children who had sustained severe traumatic brain injury (TBI) through childhood. Opposite patterns of impairments were expected: (i) impaired implicit memory in children with early TBI (TBI-EC, < 6 years) and (ii) impaired explicit memory in children with late TBI (TBI-LC, ≥ 6 years). RESEARCH DESIGN: Children who had sustained severe TBI more then 1 year ago were assessed. METHODS AND PROCEDURE: Fourteen children who had sustained severe TBI (TBI-EC, n = 10 and TBI-LC, n = 4) between 8 months and 13 years 7 months of age and 13 non-injured control subjects (NC) participated. Implicit (repetition priming and skill learning) and explicit verbal memory were examined. RESULTS: The TBI group performed worse on implicit (repetition priming) and explicit memory tasks compared to the NC group. Moreover, impairments were found in implicit and explicit memory in the TBI-EC, but not in the TBI-LC group. CONCLUSIONS: This study has shown, for the first time, that severe childhood TBI may compromise not only explicit, but also implicit memory. Nevertheless, instead of a selective implicit memory impairment, it was found that children who sustained injuries in early childhood present with impairments in both memory systems.


Assuntos
Lesões Encefálicas/fisiopatologia , Transtornos da Memória/fisiopatologia , Rememoração Mental/fisiologia , Adolescente , Fatores Etários , Idade de Início , Análise de Variância , Lesões Encefálicas/complicações , Lesões Encefálicas/reabilitação , Criança , Pré-Escolar , Sinais (Psicologia) , Feminino , Humanos , Lactente , Masculino , Transtornos da Memória/etiologia , Transtornos da Memória/reabilitação , Testes Neuropsicológicos , Avaliação de Resultados em Cuidados de Saúde , Índice de Gravidade de Doença , Inquéritos e Questionários , Análise e Desempenho de Tarefas
14.
Neuropsychol Rehabil ; 21(2): 183-207, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21294049

RESUMO

Memory problems that interfere with everyday living are frequently reported in children who have sustained acquired brain injury (ABI), but their nature and rehabilitation is under-researched. This study aimed to (1) determine neuropsychological correlates of everyday memory deficits in children with ABI, and (2) investigate the effectiveness of a newly developed programme for their rehabilitation. We assessed everyday memory, verbal memory, attention and behaviour in 15 children with ABI. The children attended the everyday memory rehabilitation programme: six weekly sessions that involved diary training, self-instruction training and case examples. At the onset we found that everyday memory problems were related to impaired attention and behavioural difficulties. On completion of the programme there was a significant increase in children's abilities to perform daily routines that demanded recall of information and events. In addition, children used diaries more frequently. Moreover, significant secondary gains were found in attention and mood (anxiety and depression). In conclusion, the results provided preliminary evidence that our six week programme could be effective in reducing everyday memory difficulties and improving psychological well-being in children with ABI.


Assuntos
Lesões Encefálicas/reabilitação , Educação/métodos , Transtornos da Memória/reabilitação , Instruções Programadas como Assunto , Adolescente , Afeto , Atenção , Lesões Encefálicas/complicações , Criança , Feminino , Humanos , Masculino , Transtornos da Memória/complicações
15.
Sleep Med ; 81: 387-393, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33819841

RESUMO

OBJECTIVES: The primary aim was to examine whether sleep disturbances persist in children in the chronic stage of recovery from moderate or severe traumatic brain injury (TBI). The secondary aim was to examine whether memory difficulties and/or other previously identified factors relate to sleep disturbances in children with moderate to severe TBI. METHODS: This longitudinal study included 21 children with moderate to severe TBI, 8-18 years old, recruited from an urban tertiary paediatric specialised brain injury rehabilitation unit. Participants were seen 5 years and again 7 years post-injury, on average. Sleep disturbances were assessed with Sleep Disturbance Scale for Children (SDSC). Correlates that were considered included indicators of TBI severity, and questionnaires assessing everyday memory, fatigue, internalizing and externalizing behaviors and pain intensity. RESULTS: The SDSC scores of children with moderate to severe TBI indicated greater disturbances in initiating and maintaining sleep, arousal, sleep-wake transition, and excessive somnolence relative to the norms, at follow-up. The mean SDSC scores and the number of participants with subclinical to clinical sleep disturbances on the SDSC remained unchanged from baseline to follow-up. At follow-up, the SDSC initiating and maintaining sleep, and excessive somnolence scales were associated with poorer everyday memory and greater fatigue. CONCLUSIONS: Children with moderate to severe TBI experience ongoing sleep disturbances for years post-injury. Greater sleep disturbances are associated with worse functional outcomes. Further research into sleep disturbances and development of treatments is important, as it could improve the outcomes of children with TBI.


Assuntos
Lesões Encefálicas Traumáticas , Lesões Encefálicas , Transtornos do Sono-Vigília , Adolescente , Lesões Encefálicas Traumáticas/complicações , Criança , Humanos , Estudos Longitudinais , Sono , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia
16.
Appl Neuropsychol Child ; 8(1): 61-69, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29058469

RESUMO

The aim of this study was to assess the validity (developmental, concurrent, and predictive) of the Sydney Post-Traumatic Amnesia Scale (SYPTAS) for assessment of post-traumatic amnesia (PTA) in 4 to 7 year old children with traumatic brain injury (TBI). The design of this study is a retrospective cohort study. The SYPTAS was administered to 35 children (26 boys) aged 4.0 to 7.8 years who were consecutively admitted to a children's hospital with mild (n = 26), moderate (n = 3), or severe (n = 7) TBI. Concurrent validity of the SYPTAS was assessed against the Glasgow Coma Scale Scores (GCS). Predictive validity of the SYPTAS for functional outcomes was evaluated against the King's Outcome Scale for Childhood Head Injury (KOSCHI) at discharge and outpatient follow-ups. The length of PTA, measured by the SYPTAS, was invariant of children's chronological age, confirming the scale's developmental validity. Longer PTA was associated with lower GCS, endorsing concurrent validity of PTA duration measured by the SYPTAS, as a clinical indicator of TBI severity. PTA duration measured by the SYPTAS was a significant predictor of functional outcomes on the KOSCHI at discharge and follow-ups. This study provides evidence that the SYPTAS has good developmental, concurrent and predictive validity for assessment of PTA in children aged 4 to 7 years. PTA duration assessed by the SYPTAS is a clinical indicator of TBI severity and can aid rehabilitation planning post TBI.


Assuntos
Amnésia/diagnóstico , Lesões Encefálicas Traumáticas/reabilitação , Testes de Memória e Aprendizagem/normas , Avaliação de Resultados em Cuidados de Saúde/normas , Índice de Gravidade de Doença , Amnésia/etiologia , Lesões Encefálicas Traumáticas/complicações , Criança , Pré-Escolar , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos
17.
J Neuropsychol ; 13(2): 253-271, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-29265704

RESUMO

OBJECTIVES: Autobiographical memory (AM) is a complex function that involves re-experiencing of past personal events (episodic memory) scaffolded by personal facts (semantic memory). While AM is supported by a brain network and cognitive skills that are vulnerable to disruption by child traumatic brain injury (TBI), AM has not been examined in this patient population. DESIGN: Cross-sectional study. METHODS: Participants included children with severe closed TBI (n = 14) and healthy control (NC) children (n = 20) of comparable age, sex, and socioeconomic status. Participants completed (1) the Child Autobiographical Interview (Willoughby et al., 2012, Front. Psychol., 3, 53), which required recall of autobiographical events and distinguished episodic (internal) from non-episodic (external) details, and self-rating of event phenomenological qualities, and (2) a battery of neuropsychological tests. RESULTS: Children with TBI recalled significantly fewer internal details relative to NCs, but the between-group difference was eliminated when specific probes were provided. The groups did not differ in either recall of external details or in ratings of events' phenomenological qualities. The gap between the groups in recall of internal details increased with age, as the greater number of internal details was associated with older age in the NC group, but not in the TBI group. Poorer verbal memory and lower IQ were related to recall of fewer internal details in the TBI group. CONCLUSIONS: This study unveils, to our knowledge for the first time, that severe child TBI is associated with a selective deficit in autobiographical memory that involves episodic, but spares semantic details, and identifies the risk factors for this impairment.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/psicologia , Transtornos da Memória/etiologia , Transtornos da Memória/psicologia , Memória Episódica , Adolescente , Idade de Início , Envelhecimento/psicologia , Criança , Estudos Transversais , Função Executiva , Feminino , Humanos , Testes de Inteligência , Masculino , Rememoração Mental , Testes Neuropsicológicos , Classe Social
18.
Children (Basel) ; 6(3)2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30875935

RESUMO

Longitudinal fibular deficiency (LFD), or fibular hemimelia, is congenital partial or complete absence of the fibula. We aimed to compare the lower limb function of children and young people with LFD to that of unaffected peers. A cross-sectional study of Australian children and young people with LFD, and of unaffected peers, was undertaken. Twenty-three (12 males) children and young people with LFD (74% of those eligible) and 213 unaffected peers, all aged 7⁻21 years were subject to the Knee Osteoarthritis Outcome Score (KOOS/KOOS-Child) and the Cumberland Ankle Instability Tool (CAIT/CAIT-Youth). Linear regression models compared affected children and young people to unaffected peers. Participants with LFD scored lower in both outcomes (adjusted p < 0.05). The difference between participants with LFD and unaffected peers was significantly greater among younger participants than older participants for KOOS activities and sports domain scores (adjusted p ≤ 0.01). Differences in the other KOOS domains (pain/symptoms/quality of life) and ankle function (CAIT scores) were not affected by age (adjusted p ≥ 0.08). Children and young people with LFD on average report reduced lower limb function compared to unaffected peers. Knee-related activities and sports domains appear to be worse in younger children with LFD, and scores in these domains become closer to those of unaffected peers as they become older.

19.
J Neurotrauma ; 35(17): 2036-2043, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29566641

RESUMO

Imagining future events is thought to rely on recombination and integration of past episodic memory traces into future events. Future and past events contain episodic and nonepisodic details. Children with severe traumatic brain injury (TBI) were found to have impaired recall of past episodic (but not semantic) event details. Here, we examined whether severe TBI impairs construction of future events. Children with severe TBI (n = 15) and healthy controls (NC; n = 33) 1) completed tests of anterograde (narrative and relational) memory and executive skills, 2) recalled past events and generated future events, and 3) rated events' phenomenological qualities. Events were scored for episodic (internal) and semantic (external) details. The groups did not differ in generating details of future events, although children with TBI recalled significantly fewer past internal (but not external) events' details relative to NCs. Moreover, the number of past internal details relative to future internal details was significantly higher in the NC group, but not in the TBI groups. Significant correlations between past and future were found for 1) internal details in both groups and 2) external details in the NC group. The TBI group rated their events as being less significant than did the NC group. The groups did not differ on ratings of visual intensity and rehearsal. Our study has shown that children who have sustained severe TBI had impoverished recall of past, but not generation of future, events. This unexpected dissociation between past and future event construction requires further research.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico por imagem , Adolescente , Lesões Encefálicas Traumáticas/psicologia , Criança , Função Executiva , Feminino , Humanos , Testes de Inteligência , Masculino , Memória , Memória Episódica , Rememoração Mental , Testes Neuropsicológicos , Prognóstico
20.
Appl Neuropsychol Child ; 7(3): 257-267, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28388214

RESUMO

The aim of this study was to select developmentally valid and reliable items for inclusion in criterion-referenced (pass > 90%) posttraumatic amnesia (PTA) scale for children aged 4 to 7 years in a prospective cohort study. Fifty-two typically developing children (26 male/26 female) aged 4 to 7 years were administered a set of 10 items (5 orientation, 5 memory) over 3-4 days. The total score obtained on the set of 10 items had poor developmental validity and test-retest reliability. Nevertheless, individual item analysis identified five items (three orientation and two memory items) that were consistently passed by >90% of the children on each day of testing. For these five items the total scores did not differ significantly either between age groups or between days of testing. Test-retest was extremely high (close to 1). The five items had excellent developmental validity and test-retest reliability. This study identified 5 (3 orientation and 2 memory) items that met our selection criterion and form a new PTA scale, the Sydney PTA scale (SYPTAS), for children aged 4 to 7 years.


Assuntos
Lesões Encefálicas/fisiopatologia , Desenvolvimento Infantil/fisiologia , Memória/fisiologia , Orientação/fisiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Estudos Prospectivos , Reprodutibilidade dos Testes , Inquéritos e Questionários
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