Brain Injury In Adolescents Research Articles

A randomized trial of Teen Online Problem Solving to Improve Behavior and Executive Functioning following Adolescent Brain Injury

A randomized trial of Teen Online Problem Solving to Improve Behavior and Executive Functioning following Adolescent Brain Injury

Schools 2010:Connect, Create, Innovate in Las Vegas

Schools 2010:Connect, Create, Innovate in Las Vegas

Long-term Functional Impairment Following Adolescent Brain Injury and Comprehensive Rehabilitation

Brain injury is a common source of disability among adolescents and young adults. This study analyzed long-term functioning of adolescent participants after completing post-acute rehabilitation. Results of this longitudinal study indicated overall functioning of the participants was significantly improved at follow up as compared with functioning at discharge. However, while participants experienced significant increases with overall functioning, they also experienced nonsignificant decreases in other areas. The results suggest that improvement in functioning reported by youth and young adults recovering from a brain injury may not generalize across all domains of functional activities, and that scores derived from measures of global functioning may obscure significant deficits that impair progress toward independence.

Brain activation while thinking about the self from another person’s perspective after traumatic brain injury in adolescents.

Deficits in self awareness and taking the perspective of others are often observed following traumatic brain injury (TBI). Nine adolescents (ages 12-19 years) who had sustained moderate to severe TBI after an average interval of 2.6 years and nine typically developing (TD) adolescents underwent functional MRI (fMRI) while performing a perspective taking task (D'Argembeau et al., 2007). Participants made trait attributions either from their own perspective or from that of the significant other. The groups did not differ in reaction time or on a consistency criterion. When thinking of the self from a third-person perspective, adolescents with TBI demonstrated greater activation in posterior brain regions implicated in social cognition, the left lingual gyrus (BA 18) and posterior cingulate (BA 31), extending into neighboring regions not generally associated with social cognition, that is, cuneus (BA 31) and parahippocampal gyrus, relative to TD adolescents. We postulate that adolescents with moderate to severe TBI recruited alternative neural pathways during perspective-taking because traumatic axonal injury disrupted their fronto-parietal networks mediating social cognition.

Diffusion tensor imaging of acute mild traumatic brain injury in adolescents

Despite normal CT imaging and neurologic functioning, many individuals report postconcussion symptoms following mild traumatic brain injury (MTBI). This dissociation has been enigmatic for clinicians and investigators. Diffusion tensor imaging tractography of the corpus callosum was performed in 10 adolescents (14 to 19 years of age) with MTBI 1 to 6 days postinjury with Glasgow Coma Scale score of 15 and negative CT, and 10 age- and gender-equivalent uninjured controls. Subjects were administered the Rivermead Post Concussion Symptoms Questionnaire and the Brief Symptom Inventory to assess self-reported cognitive, affective, and somatic symptoms. The MTBI group demonstrated increased fractional anisotropy and decreased apparent diffusion coefficient and radial diffusivity, and more intense postconcussion symptoms and emotional distress compared to the control group. Increased fractional anisotropy and decreased radial diffusivity were correlated with severity of postconcussion symptoms in the MTBI group, but not in the control group. In adolescents with mild traumatic brain injury (MTBI) with Glasgow Coma Scale score of 15 and negative CT, diffusion tensor imaging (DTI) performed within 6 days postinjury showed increased fractional anisotropy and decreased diffusivity suggestive of cytotoxic edema. Advanced MRI-based DTI methods may enhance our understanding of the neuropathology of TBI, including MTBI. Additionally, DTI may prove more sensitive than conventional imaging methods in detecting subtle, but clinically meaningful, changes following MTBI and may be critical in refining MTBI diagnosis, prognosis, and management.

A Critical Comparison of Clinical Decision Instruments for Computed Tomographic Scanning in Mild Closed Traumatic Brain Injury in Adolescents and Adults

A number of clinical decision aids have been introduced to limit unnecessary computed tomographic scans in patients with mild traumatic brain injury. These aids differ in the risk factors they use to recommend a scan. We compare the instruments according to their sensitivity and specificity and recommend ones based on incremental benefit of correctly classifying patients as having surgical, nonsurgical, or no intracranial lesions. We performed a secondary analysis of prospectively collected database from 7,955 patients aged 10 years or older with mild traumatic brain injury to compare sensitivity and specificity of 6 common clinical decision strategies: the Canadian CT Head Rule, the Neurotraumatology Committee of the World Federation of Neurosurgical Societies, the New Orleans, the National Emergency X-Radiography Utilization Study II (NEXUS-II), the National Institute of Clinical Excellence guideline, and the Scandinavian Neurotrauma Committee guideline. Excluded from the database were patients for whom the history of trauma was unclear, the initial Glasgow Coma Scale score was less than 14, the injury was penetrating, vital signs were unstable, or who refused diagnostic tests. Patients revisiting the emergency department within 7 days were counted only once. The percentage of scans that would have been required by applying each of the 6 aids were Canadian CT head rule (high risk only) 53%, Canadian (medium & high risk) 56%, the Neurotraumatology Committee of the World Federation of Neurosurgical Societies 56%, New Orleans 69%, NEXUS-II 56%, National Institute of Clinical Excellence 71%, and the Scandinavian 50%. The 6 decision aids' sensitivities for surgical hematomas could not be distinguished statistically (P>.05). Sensitivity was 100% (95% confidence interval [CI] 96% to 100%) for NEXUS-II, 98.1% (95% CI 93% to 100%) for National Institute of Clinical Excellence, and 99.1% (95% CI 94% to 100%) for the other 4 clinical decision instruments. Sensitivity for any intracranial lesion ranged from 95.7% (95% CI 93% to 97%) (Scandinavian) to 100% (95% CI 98% to 100%) (National Institute of Clinical Excellence). In contrast, specificities varied between 30.9% (95% CI 30% to 32%) (National Institute of Clinical Excellence) and 52.9% (95% CI 52% to 54) (Scandinavian). NEXUS-II and the Scandinavian clinical decision aids displayed the best combination of sensitivity and specificity in this patient population. However, we cannot demonstrate that the higher sensitivity of NEXUS-II for surgical hematomas is statistically significant. Therefore, choosing which of the 2 clinical decision instruments to use must be based on decisionmakers' attitudes toward risk.

Sensitivity of the comprehensive trail making test to traumatic brain injury in adolescents

The current study examined the sensitivity of the Comprehensive Trail Making Test (CTMT Reynolds) to neurocognitive deficits in adolescents with traumatic brain injury (TBI). Participants included 60 adolescents, 30 who had sustained TBI and 30 healthy controls (HC) that were individually matched to the TBI sample on age, gender, ethnicity, and geographical region. For both the TBI and HC groups the mean age was 15.0 years (S.D. = 2.3 years, range = 11–19). The TBI group had a mean IQ of 81.7 (S.D. = 14.9), had sustained moderate to severe brain injury, and was assessed an average of 21.1 months (S.D. = 20.7) following injury. The TBI group performed approximately 2 standard deviations below the control sample mean on each of the five CTMT trails as well as on the composite index and these differences were significant ( p < .001). Significant correlations were present between the CTMT trails and clinical variables associated with brain injury severity. Finally, receiver operating characteristic analyses indicated good classification of the TBI and control cases for the CTMT, although some variability in classification accuracy was present among the various trails. Results suggest that the CTMT is sensitive to TBI in adolescents but continued research is needed with larger samples of individuals with TBI and other types of neurological disorders to further establish the present findings.

Sports related mild traumatic brain injury in adolescents.

While head injuries are not common in youth sports, they may have catastrophic results. Concussion is also referred to as mild traumatic brain injury (MTBI). Although the occurrence of head injuries has been studied more extensively in American football, the findings have wider application for any MTBI. Recently, more attention has been directed at other sports in which both boys and girls participate. The diagnosis of MTBI is based on subjective findings and subtle changes in mental status. Other cerebral injuries requiring emergent or urgent neurosurgical attention should be ruled out. Objective tests such as CT scans and Magnetic Resonance Imaging (MRI) are usually without significant findings in MTBI. Neuropsychological testing may demonstrate areas of deficiencies, however, results may be difficult to interpret because of confounding factors. Complications following MTBI have been known to occur. The most catastrophic of these is second impact syndrome. There are a variety of guidelines for return to play following a concussion, which have been designed in an effort to avoid problems such as second impact syndrome. These guidelines are based more on clinical experience than on scientific evidence. Education, good training and coaching techniques, improved equipment, and rule changes and enforcement, can all help in curbing the sports related head injuries in adolescents.

Subject Review The trauma of paediatric and adolescent brain injury: issues and implications for rehabilitation specialists

The purpose of this article is to define critical issues facing rehabilitation specialists providing services to children or adolescents with a brain injury and their families. These issues will be identified as they evolve temporally-from the period immediately after the injury to many years post-trauma. As the young person heals, the focus of the issues and the recommendations (based on both the clinical experience of the authors as well as the extensive body of literature already in existence) will change from those more appropriate to rehabilitation specialists working in the medical environment to those employed in education and the psychosocial realm. However, the boundaries between these realms, because of the all encompassing nature of the injury, are fluid. Finally, the purpose of this article is also to establish the need for rehabilitation specialists who are educated about traumatic brain injury; who are well versed in the physical, cognitive and emotional sequellae of the injury; who recognize the unique needs and expectations of this population and are willing to adjust; and who are willing to face the challenge that their clients face.

Traumatic brain injury in adolescence: assessment and reintegration.

Traumatic brain injury in adolescence: assessment and reintegration.