Brain-damaged Children Research Articles

Retrospective Study on the Pathway and the Outcome of Children Victims of Acquired Brain Injury Accompanied By a Mobile Unit of School Reintegration

Objectives: to retrace the care pathways and the academic pathways of brain-damaged children supported a Mobile Unit of School Reintegration (MUSR) and to identify factors associated with their long-term outcome. Patients and methods: Retrospective study from the medical files of 53 children followed by the MUSR, conducted between November 2018 and April 2019. Results: The cerebro-lesions were mainly caused by a craniocerebral trauma (83% of cases), with an average age of onset of 9.8 years. The duration of the initial hospitalization was 39 days on average. The mean length of follow-up was 37 months. Long-term medical outcome was marked by 18.5% of medical complications, 29.6% of behavioral disorders and 9.2% of judiciary complications. The factors associated with long-term behavioral disorders were the age of onset (p = 0.015), the initial Glasgow score (p = 0.025), a head trauma related to a traffic accident (p = 0.046), a poor therapeutic alliance with the parents (p <0.001), the absence of psychological follow-up (p = 0.040) and the existence of legal complications (p = 0.001). The factor associated with long-term legal complications was a poor therapeutic alliance with the parents (p = 0.017). All the children followed were reintegrated into school, after an average of 6.4 months. A school reorientation was necessary in 49.9% of cases, associated with initial complications (p = 0.035), the existence of secondary brain aggressions of systemic origin (p <0.001), the existence of antecedents (p = 0.040), and the autonomy level (p = 0.023). Conclusion: The MUSR offers multidisciplinary, integrative and mobile cares, based on coordination of the care pathway and the academic pathway of children victims of acquired brain injuries.

Investigation of cognitive changes in cerebral palsy children employing different integrated sensing techniques

Background and purposeCognitive impairment is one of the biggest challenges for cerebral palsy (CP) survivors. Cognition is a mental process, of acquiring knowledge and understanding the thoughts, experiences, and senses. It encompasses processes such as attention, knowledge, working memory, judgment and logical reasoning. The purpose of this study was to determine the most effective therapy for understanding the cognitive changes in children with CP from different available rehabilitation therapies being employed. Materials and methodsA total of sixty participants divided into the four groups namely A, B, C and D (n = 15) were recruited for the study. Groups A, B, C, and D received usual standard therapy (ST), repetitive transcranial magnetic stimulation (r-TMS), neurofeedback (NFB) and cognitive brain training exercises respectively for 20 days. Outcome measures such as Vineland Social Maturity Scale (VSMS) and raw EEG data were recorded before and after the completion of 20 days (5 days a week for 4 weeks) therapy as pre and post assessment data of these different groups, for statistical data analysis. ResultsThe results suggested that r-TMS largely resulted in oriented therapy for cognitive enhancement in all selected therapy groups. Cognitive brain training exercises were found to be the second most effective as well as cost-effective therapy for cognitive enhancement in brain-damaged children. It showed 1.17% improvement in cognitive abilities as compared with r-TMS (1.28%) therapy. ConclusionAll therapies showed some degree of significant improvement in cognitive enhancement, however, r-TMS and cognitive exercises were found to be the best among the studied rehabilitation therapies in different groups for cognitive enhancement in CP children. This one of the first study to the best of our knowledge using different intervention techniques such as rTMS, NFB and CE for understanding the changes in the cognitive development in the CP children.

Pre-school language education for the brain-damaged child

No abstract available.

Food Habits, Dietary Intake, and Body Composition in Children with Cerebral Palsy.

This study aimed to determine meal-related factors affecting nutritional status, dietary intake, and body composition of children with cerebral palsy (CP). This study was conducted on 16 children with and 16 children without CP, aged 4 to 12 years, through a survey on general characteristics, body composition, eating habits, and nutrient intake. In the case of children with CP, comparisons were made according to classification into types of paralysis (hemiplegia, paraplegia, and quadriplegia). With respect to stature, the percentile of those surveyed was within normal range; however, children with CP were in a significantly lower percentile (p < 0.05) than healthy children. Regarding problems of dietary life, while usually brain-damaged children with CP have an overeating problem, seriously brain-damaged children with CP cannot have a meal by themselves; this was significantly different among the groups (p < 0.01). Regarding average intake of vitamin D and calcium, children with and without CP had a lower intake than required, with no significant difference between the groups. The evaluation of the nutrient status of children with and children without CP showed that children with CP were slow in stature development, and intake of vitamin D and calcium were less than required; therefore, it is necessary to provide education on adequate intake of nutrients. Since CP leads to frequent external intervention to having meals, it is required of parents and teachers to undergo training on adequate eating habits and attitudes.

Validation of upper limb motor assessment tasks using a rehabilitation robot in healthy children

To validate, establish norms and evaluate the reproducibility of upper limb motor assessment tasks using REAplan in healthy children. REAplan is a rehabilitation robotic device allowing upper limb mobilization in the horizontal plane. Forty-nine healthy children between six and twelve years participated in this study. Each child was assessed clinically and with REAplan, and twelve children were assessed twice. Elbow flexor and extensor muscles force were assessed with an isometric dynamometer Microfet II. REAplan allows assessing muscle force by an isometric and isokinetic evaluation (18 cm/s) in three directions. Finally, the kinematic was assessed by a pointing task to 30 targets evenly distribute in the REAplan working space. The isometric force assessed with REAplan is highly correlated with the one assessed with the dynamometer for flexor muscles ( r = 0.8 and P < 0.001) and is moderate for extensor muscles ( r = 0.61 and P < 0.001). The isokinetic force assessment showed that children developed a higher force when their upper limb was mobilized in a trajectory in front of them compared to trajectories angled 45°C in diagonal. This is true for elbow flexor and extensor muscles ( P < 0.001). For the kinematic assessment, straightness, averaged speed and speed metric improve when the distance to reach a target is longer ( P < 0.05). Finally, all assessment tasks showed a very good reproducibility (ICC > 0.82 and P < 0.001) and this study allowed to establish norms for each age group. This study allowed validating, establishing norms and evaluating the reproducibility of motor performance assessment tasks in healthy children using REAplan. This method can now be used to assess brain-damaged children. Some of these results will be illustrated during the congress.

Éveil visuel à l’image chez de jeunes enfants cérébrolésés : étude pilote d’un accompagnement pluridisciplinaire pour une intégration multimodale

To arouse the visual interest for image, the essential support for the prerequired school learnings, we proposed a work on shadows to five brain-damaged children presenting an important delay of psychomotor development and cerebral visual impairment. In a first part, the visual perceptions are stimulated by colors and elementary geometrical forms then by simple shadow figures thrown onto a screen. In a second part, the spatial and temporal structuralizations, the proprioception and the body image are worked by creating shadows with the body on the screen. We observed different types of visual and behavioral improvements: increase of the interest for image both by its creation and by its observation, increase of visual attention, more obvious social relationships. This therapeutic and educational experiment conducted over one year testifies of the importance of a multi-field coverage both by pooling the knowledge and by confronting objectives of the therapists and educator team for a holistic support of the young brain-damaged child in the understanding of image processing.

Body knowledge in brain-damaged children: A double-dissociation in self and other's body processing

Bodies are important element for self-recognition. In this respect, in adults it has been recently shown a self vs other advantage when small parts of the subjects’ body are visible. This advantage is lost following a right brain lesion underlying a role of the right hemisphere in self body-parts processing. In order to investigate the bodily-self processing in children and the development of its neuronal bases, 57 typically developing healthy subjects and 17 subjects with unilateral brain damage (5 right and 12 left sided), aged 4–17 years, were submitted to a matching-to-sample task. In this task, three stimuli vertically aligned were simultaneously presented at the centre of the computer screen. Subjects were required which of two stimuli (the upper or the lower one) matched the central target stimulus, half stimuli representing self and half stimuli representing other people's body-parts and face-parts. The results showed that corporeal self recognition is present since at least 4 years of age and that self and others’ body parts processing are different and sustained by separate cerebral substrates. Indeed, a double dissociation was found: right brain damaged patients were impaired in self but not in other people's body parts, showing a self-disadvantage, whereas left brain damaged patients were impaired in others’ but not in self body parts processing. Finally, since the double dissociation self/other was found for body-parts but not for face parts, the corporal self seems to be dissociated for body and face-parts. This opens the possibility of independent and lateralized functional modules for the processing of self and other body parts during development.

A Unique Child: Inclusion - Supporting … May

A nursery that said ‘no problem’ when a mother sought a place for her brain-damaged child has made all the difference to the family, says Sue Learner - and the staff and children have benefited too.

A Performance Improvement Process for Tackling Tachysystole

Inappropriate use of oxytocin is one of the top five areas of obstetric harm. Cases almost always involve severely brain-damaged children, occasionally involve maternal death, and consistently result in multi-million-dollar jury verdicts. Historically there have been many issues: How many contractions are too many? What if baby looks fine? When do we intervene? Which of many terms for it do we use? The 2008 National Institute of Child Health and Human Development (NICHD) Update on fetal monitoring helped clarify these issues, but putting the evidence into action and avoiding tendencies to “push the pit” can be challenging.

Commentary with a Historical Perspective by a Child Psychiatrist: When “ADHD” Was the “Brain-Damaged Child”

Commentary with a Historical Perspective by a Child Psychiatrist: When “ADHD” Was the “Brain-Damaged Child”

Pediatric evaluation of brain-damaged children

Clinical data on 133 children followed in the cerebral palsy program at the Children's Hospital in San Francisco in the early ‘50s was reviewed to emphasize the complexity of children with brain damage and to highlight the use of both an interdisciplinary team approach and an expectant attitude. There was a male predominance (N = 74), and more than three quarters of the children were below five years of age. The incidence of seizures (N = 17) was low presumably due to the young age of the study population.

Restitution of visual functions in cerebrally blind children

In adult patients who suffer from a visual field defect due to cerebral lesions, visual functions can be restored by systematic visual field training. Such visual field training is not feasible in young, brain-damaged children, who are unable to cooperate like adults. We have already shown earlier [Werth, R., & Moehrenschlager, M. (1999). The development of visual functions in cerebrally blind children during a systematic visual field training. Restorative Neurology and Neuroscience, 15, 229–241.] that systematic visual field training, which requires no ability to understand instructions or to cooperate, is successful in brain-damaged children and may lead to complete recovery of the visual field within 3 months. The present study provides more behavioral evidence and a control of intraocular light scatter. In addition to the earlier study, the luminance difference thresholds in the recovered visual field were compared with those of a normal control group. Seventeen children aged 1–4 years who had been blind for more than 1 year after perinatal asphyxia and two children suffering from homonymous hemianopia due to asphyxic-ischemic lesions participated in systematic visual field training. The functional visual field was assessed with a specially designed arc perimeter. Visual functions developed within a training period of 3 months in 11 children who received visual field training, whereas there was no recovery in the control group ( N = 37). The findings support the assumption that systematic visual field training facilitates the development of vision in cerebrally blind children. In two children who recovered from blindness, it was shown in functional magnetic resonance imaging (fMRI) that brain tissue in the area of the visual cortex contralateral to the blind visual hemifield was activated by light. In two children suffering from asphyxic-ischemic lesions who did not recover only brain tissue in the area of the visual cortex contralateral to the good visual hemifield could be activated by light. These results support the assumption that activity in spared tissue of the striate and extrastriate visual cortex are a necessary condition for recovery of the visual field in children suffering from cerebral blindness.

The lifeboat test

In philosophy it's known as the lifeboat test. Imagine you were in a lifeboat with a cockroach, a chimp, and a child. Who would you throw overboard first to save the rest? Of course, the cockroach would go without a second thought. But now imagine it is a choice between a healthy young chimp and a brain-damaged child in a deep coma. Or a 10 day old viable human embryo and the same terminally ill child. The lifeboat test can be used to draw out the finest ethical distinctions.

Use of the Progressive Figures Test in evaluating brain-damaged children, children with academic problems, and normal controls

This study explores the use of the Progressive Figures Test as an instrument for broad initial screening of children in the 6- through 8-year age range with respect to the possible need for more definitive neuropsychological evaluation. Considering earlier results obtained in comparison of brain-damaged and control children [Clinical Neuropsychology: Current Applications, Hemisphere Publishing Corp., Washington, DC, 1974, p. 53; Proceedings of the Conference on Minimal Brain Dysfunction, New York Academy of Sciences, New York, 1973, p. 65], the Progressive Figures Test seemed potentially useful as a first step in determining whether a comprehensive neuropsychological evaluation is indicated. In this investigation, three groups were studied: (1) children with definitive evidence of brain damage or disease who, when compared with normal controls, help to establish the limits of neuropsychological functioning, (2) a group of children who had normal neurological examinations but also had academic problems of significant concern to both parents and teachers, and (3) a normal control group. Statistically significant differences were present in comparing each pair of groups, with the brain-damaged children performing most poorly and the controls performing best. Score distributions for the three groups make it possible to identify a score-range that represented a borderline or “gray” area and to suggest a cutting score that identified children whose academic problems might have a neurological basis and for whom additional neuropsychological evaluation appeared to be indicated.

Visual function in the brain-damaged child.

The essential role of the primary visual cortex in visual processing has been extensively studied over the last century or more. Injuries to the visual cortex in adult humans can produce blindness, referred to as "cortical blindness". In children some degree of visual recovery has been noted in comparable injuries and for that reason the term "cortical visual impairment" has been suggested as a more appropriate diagnosis in children. This term is, however, inaccurate as a significant number of children with visual loss and neurologic damage have injuries to the noncerebral pathways (for example--optic radiations in children with periventricular leukomalacia). In this study we compare visual outcomes and recovery in children with primary visual cortex lesions vs those with periventricular leukomalacia. We suggest that the poorer outcomes of children with periventricular leukomalacia could have been predicted based on studies of the mechanisms of visual recovery in infant animals following visual cortex ablation.

The significance of sensory-motor functions as indicators of brain dysfunction in children

Sensory-perceptual and motor functions are closely dependent on the integrity of the brain and nervous system. Standardized tests have been developed to assess these functions, but such tests are not routinely used to evaluate children who are suspected of having a neuropsychological basis for their difficulties. Higher-level functions (such as verbal and academic abilities, executive functioning, etc.) are obviously important in producing successful performances, but the brain and nervous system correlates of these abilities are less well defined than the correlates for sensory-motor abilities. Our contention is that tests from these two general areas (higher-level and lower-level aspects of brain functioning) can be used effectively in a complementary manner to evaluate individual children. The first step in this process is to evaluate formal sensory-motor tests and to assess their validity as a brief preliminary examination used to differentiate between brain-damaged and control children. The results of this study demonstrated striking differences between the groups and indicated that sensory-motor testing might serve very effectively, when used in conjunction with higher-level tests, to identify those children whose higher-level impairment is due to brain impairment rather than a lack of environmental opportunities or advantages.

Three ways of understanding Ida

This paper aims to compare the psychoanalytic understanding of three analysts, sharing a similar theoretical background, with regard to the clinical material of an autistic girl with probable organic impairment. The conclusion is that, although the three analysts' ideas about the pathogenesis of the girl's developmental disorder are somewhat divergent, a tendency towards convergence can be noted as the therapy goes on. The paper concludes that there is some common ground of understanding about autistic phenomena among psychoanalysts sharing the same affiliation, that combining the individual views of different analysts may enlarge the understanding of the case as a whole and that the technique Tustin used to treat psychogenic autistic children can also be used to treat brain-damaged autistic children.

Spoken Language Correlates of Reading Impairments Acquired in Childhood

This study reports the reading difficulties of five children following unilateral left hemisphere stroke sustained either before or during the early stages of literacy acquisition. Although each of the children experienced a period of disturbed language processing in the initial stages postonset, at the time of testing none of the children were considered to be clinically aphasic. Yet, on a standardized test of oral reading each of the children achieved a reading age that lagged behind chronological age and marked reading impairments were disclosed in four of the five children. A set of standardized and nonstandardized tests, aimed at measuring aspects of cognitive and spoken language processing that are considered to be important for normal reading acquisition, was administered. Where nonstandardized tests were used, performance of each of the stroke children was compared to that of groups of normally developing control children, closely matched for chronological age. A range of residual deficits in cognitive and spoken language processing was disclosed among the five brain-damaged children that appeared to be associated with their reading impairments. Two children had expectedly poor reading due to a selective impairment in verbal IQ; a specific phonological reading disorder was revealed in two children, each of which had a residual impairment to phonological awareness; and delayed reading acquisition was observed in one child with a general language deficit. It is suggested that when a child suffers damage to the left hemisphere in the early stages of reading acquisition, difficulties with learning to read are likely to ensue and may arise as a consequence of an underlying cognitive or linguistic deficit.

Prediction of Severity of Brain Damage by a Processing Speed Variable in Older Children: A Brief Report

This paper reports an attempt to pi-edict severity of brain damage, as reflected by neuropsychological test scores, based on subtests of Wechsler Intelligence Scale for Children-Revised Factor analytic derived indices mere compared with the Neuropsychological Deficit Scale for Older Children. A sample of 20 normal and heterogeneously brain-damaged children (12 males and eight females) aged 9 14, who have been administered the complete Halstead-Reitan Neuropsychological Test Battery for Older Children, were selected from case records. The hit rates obtained for agreement on level of severity with the Older Children' Neuropsychological Deficit Score was best for Processing Speed (70%). worst for Freedom from Distraction (45%), and intermediate for Perceptual Organization (65%) and Verbal Comprehension (55%).

Development of a Short-Form Screening Index for Severity of Brain Damage in Older Children

This article reports the development of a Short-Form Screening Index (SFSI) for severity of brain damage based on the Wechsler Intelligence Scale for Children-Revised (WISC-R) subtests. The new measure is compared with the Neuropsychological Deficit Scale for Older Children, a 45-variable summary measure from test scores derived from the Halstead-Reitan Neuropsychological Test Battery for Older Children. A sample of 20 normal and heterogeneously brain-damaged children (12 boys and 8 girls) between the ages of 9 and 14, who had been administered the complete Halstead-Reitan Neuropsychological Test Battery for Older Children and WISC-R, were selected from case records. The Older Children's Neuropsychological Deficit Scale and a simple total of scale scores of the selected Performance subtests of the WISC-R were computed for each participant. The SFSI is based on the Performance scale subtests. The hit rate was obtained for agreement on level of severity for the SFSI and the Older Children's Neuropsychological Deficit Score (i.e., 75% or 15/20 correct agreement).