Acquired Brain Injury In Children Research Articles

Long-term Functional Connectivity Alterations in the Mismatch Negativity, P300 and N400 Language Potentials in Adults with a Childhood Acquired Brain Injury

ABSTRACT Objective To investigate whether alterations in the functional connectivity of networks underlying phoneme perception and semantic-categorical processing persist in adulthood following childhood acquired brain injury (cABI). Methods EEG was recorded in seven adults with a cABI and seven matched controls during the administration of an inattentive and attentive phoneme-level oddball task and a categorical priming task. Functional connections underlying the mismatch negativity (MMN), P300 and N400 were compared between participant groups in five frequency bands by calculating the weighted phase lag index between 32 × 32 electrode pairs. Network modularity and path length were compared between the cABI and control group. Results We observed a positive network for MMN deviant processing in the low gamma band and N400 related processing in the alpha band, but a negative network for P300 standard processing in the theta band in cABI compared to control adults. No differences in graph measures of functional networks were observed between participant groups. Conclusions Alterations in the functional connectivity of speech perception and semantic-categorical processing networks persist in adulthood following cABI. Nevertheless, normal-like network properties in terms of local segregation and global integration are observed.

Current Research Evidence on Functional Language Deficits After Childhood Acquired Brain Injury

Current Research Evidence on Functional Language Deficits After Childhood Acquired Brain Injury

A Preliminary Investigation of Stakeholders' Perspectives on Cognitive Fatigue After Childhood Brain Injury.

Cognitive fatigue after childhood acquired brain injury (ABI) is known to negatively impact engagement in typical academic and social activities, yet limited evidence is available to inform speech-language pathologists' (SLPs') clinical practices. The purpose of this research study was to explore stakeholders' perspectives on cognitive fatigue for children with ABI to inform future directions for clinicians and researchers. Twelve parents of children with traumatic brain injury and 35 SLPs participated in an online survey with 33 and 49 questions, respectively, including participant characteristics and perspectives on cognitive fatigue. Parents reported being between "somewhat" and "highly aware" about cognitive fatigue, whereas SLPs reported being between "neither aware or not aware" and "somewhat aware." Parents reported being between "somewhat comfortable" and "very comfortable," whereas SLPs reported being between "neither comfortable or uncomfortable" and "somewhat comfortable" addressing cognitive fatigue in children with ABI. SLPs "somewhat" to "strongly" agreed that cognitive fatigue for children with ABI was within their scope of practice. Parents and SLPs reported accommodations and strategies useful to managing cognitive fatigue in children with brain injury, as well as factors that worsen and lessen cognitive fatigue. While additional foundational and translation research is needed, the perspectives of parents and SLPs begin to address a critical gap in SLPs' assessment and management of cognitive fatigue in children with ABI. https://doi.org/10.23641/asha.24216576.

Returning to education after childhood acquired brain injury: Learning from lived parental experience.

Returning to education (RtE) after an acquired brain injury (ABI) can be stressful for children/young people (CYP) and families. While much can be done to support RtE, there has been limited exploration of the lived experience of parents/carers about what can both help and hinder the process. The aim was to understand more about RtE from parents' perspectives to inform best practice and facilitate improvements in service delivery. A service evaluation explored parent/carer views about the RtE process and the support received from healthcare professionals at a regional centre in the UK. Questionnaires (n = 59) were sent to parents of patients treated for an ABI in the last two years. 31 parents (response rate = 51%) completed the survey. Results highlight the many challenges of RtE. Thematic analysis of responses revealed six key themes: Parental mindset and growth; What do they need now?; Specialist support and information; Talk and share; Challenges of new and hidden needs; and Don't forget them! Parents offer crucial insight into the challenges of the RtE process. Their feedback highlights important factors for service development and reminds professionals of the key components of an effective return.

Healthcare Disparities in Early Childhood Brain Injury

<h3>Research Objectives</h3> While healthcare and educational disparities are known to impact minoritized groups, few research studies have been conducted to examine disparities after childhood acquired brain injury (ABI). The purpose of this study was to explore child factors associated with referral (i.e., race, socioeconomic status, type and time since injury, length of hospital stay), parent education, and long-term need for children who experienced an early childhood ABI. <h3>Design</h3> Secondary-analysis of data collected through retrospective cohort chart review and prospective caregiver phone surveys. <h3>Setting</h3> Large, urban Trauma 1 pediatric hospital in the Midwestern US. <h3>Participants</h3> 29 caregivers of children who experienced an ABI before five years of age and currently in elementary or middle school. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Medical records and a 10-min phone survey that included a series of yes/no and short open-ended questions. <h3>Results</h3> Logistic regressions indicated a significant association between child factors and 1) referral to services at hospital discharge (p = .004) and 2) caregiver-reported long-term need for special education services (met and unmet; p = .009). The models for caregiver-reported receipt of education on ABI and caregiver-reported unmet need for special education were not significant. For both significant models, there were no significant individual predictors, but some factors appear to have stronger associations than others. <h3>Conclusions</h3> Differences in acute and long-term service provision and need after childhood ABI are likely influenced by a complex interaction of individual, injury, and social-environmental factors. Future research should consider how healthcare and education practice and policy might account for these interactions to support more equitable access to and utilization of services to improve long-term outcomes for all children with ABI. <h3>Author(s) Disclosures</h3> Jessica Salley Riccardi and Jennifer Lundine have no financial or non-financial relationships to disclose.

Parental narcissistic injury following child acquired brain injury (ABI): Exploring self-object needs and emotional experience.

Parental narcissistic injury following child acquired brain injury (ABI): Exploring self-object needs and emotional experience.

An Exploratory Study on Disparities in Service Provision and Long-Term Need After Early Childhood Acquired Brain Injury.

While health care and educational disparities are known to impact minoritized groups, few research studies have been conducted to examine disparities after childhood acquired brain injury (ABI). The purpose of this study was to explore child and injury factors (i.e., race, socioeconomic status, and length of hospital stay) associated with referral, parent education, and long-term need for children who experienced an early childhood ABI. This study was a secondary analysis of data collected through retrospective cohort chart review and prospective caregiver phone surveys. Exploratory logistic regressions indicated a statistically significant association between child and injury factors and (a) referral to rehabilitation or educational services at hospital discharge (p < .001) and (b) caregiver-reported long-term needs (including both met and unmet needs) for special education services (p = .009). The models for caregiver-reported receipt of education on ABI and caregiver-reported unmet need for special education were not significant. For both significant models, there were no significant individual predictors. Differences in acute and long-term service provision and need after childhood ABI are likely influenced by a complex interaction of individual, injury, and social-environmental factors. Future research should consider how health care and education practice and policy might account for these interactions to support more equitable access to and utilization of services to improve long-term outcomes for all children with ABI. https://doi.org/10.23641/asha.21158878.

Childhood acquired brain injury: the knowledge and training needs of special educational needs coordinators

The aim of this study was to further explore Special Educational Need Co‐ordinators' (SENCos) knowledge of childhood acquired brain injury (ABI) and if they have received training on how to effectively support children and young people (CYP) with an ABI in school. SENCos from Nottinghamshire were asked to complete a survey face‐to‐face or online. Data reported by Howe and Ball (Support for Learning, 32, 1, 85–100), was also used to allow comparisons between different counties in the UK for knowledge of childhood ABI. Results indicated that SENCos from Nottinghamshire hold numerous uncertainties about childhood ABI, although less uncertainties than SENCos from the West Midlands. A majority SENCos from Nottinghamshire had not received training about childhood ABI. Additional challenges in supporting CYP with an ABI were also identified. The findings show a clear need for more training on childhood ABI across UK schools. It is also apparent that obtaining funding for CYP with an ABI can be a challenge for SENCos. However, further research is needed to determine what these barriers to funding are.

Supplemental Material for Parental Narcissistic Injury Following Child Acquired Brain Injury (ABI): Exploring Self-Object Needs and Emotional Experience

Supplemental Material for Parental Narcissistic Injury Following Child Acquired Brain Injury (ABI): Exploring Self-Object Needs and Emotional Experience

Return to school after acquired brain injury in the UK – the educators' perspectives

Childhood acquired brain injury (ABI) is associated with poorer life outcomes. Increasing numbers of children and young people are surviving severe brain injury and returning to mainstream schools with multiple impairments. It is widely acknowledged that for these children, their school becomes by default their rehabilitation centre. International studies of this transition and a recent UK government report criticize educators' inconsistent implementation of support strategies, lack of educator training and poor communication between clinicians, educators, child and family. The educators' perspectives of the return‐to‐school are, however, not well represented in the literature. This study therefore explored the experiences of educators in the UK (N = 10) who had recently facilitated a return‐to‐school of a child with ABI aged 8–12 (N = 5) using semi‐structured interviews analysed by data‐driven thematic analysis. The findings highlight common experiences: a continuum of intensive problem‐solving with heavy reliance on the Special Educational Needs Coordinator; educators valuing collaboration with clinical specialists in context over general ‘training’; uncertainty over the validity of implementing support strategies from prior teaching experience; uncertainty about how to support the child's emotional needs; and frustration with UK statutory processes for Special Educational Needs and Disabilities. Recommendations are made for changes to practice and future research.

Long Term Participation Outcomes for Severe Acquired Brain Injury in Childhood – An Expanded Scoping Review

ABSTRACT Introduction: Participation in childhood Acquired Brain Injury (ABI) lacks clarity in definition and determinants influencing long-term outcome. This paper aims to investigate and identify the factors that impact long-term outcomes, and prioritize the measures that focus on and endorse children, young people, and their family’s concept of participation. Methods: A scoping review was carried out using research literature and non-research data sources including data review, child/family interviews, and expert consultation. Results: Six peer-reviewed papers sourced. Families reported that participation for the whole family is important and recovers in a non-linear manner after rehabilitation. Experts agreed the priority and complexity of participation following severe ABI. Conclusion: Review highlights that regaining participation through the attendance at, and the engagement in life situations, for children after severe ABI, is important, complex and is affected by many factors. Future research requires a flexible approach to understand participation and inform future targeted interventions.

Evaluating functional change using the Physical Abilities and Mobility Scale in acute paediatric neurorehabilitation

Background/Aims Childhood acquired brain injury is the leading cause of death and long-term disability among children and young people in the UK. Following a childhood brain injury, function is shown to improve within a specialist neurorehabilitation setting. Little evidence currently exists to demonstrate gross motor functional change within an acute hospital setting. The Physical Abilities and Mobility Scale is a valid and reliable outcome measure for use within inpatient paediatric neurorehabilitation following brain injury. The primary aim of this study was to evaluate how the gross motor function of paediatric patients with a new acquired brain injury changes during an acute hospital admission. Methods Data were collected for all patients admitted as an inpatient to one acute hospital over a 12-month period. The Physical Abilities and Mobility Scale was completed at baseline, at least weekly and again at discharge. Views relating to the utility of the Physical Abilities and Mobility Scale were sought among physiotherapists using the measure in order to inform acceptability. Results A total of 28 patients were included in this study. A Wilcoxon signed rank test was performed, which showed a highly significant improvement in function as scored on the Physical Abilities and Mobility Scale between baseline assessment (median 29.00, interquartile range 25.00–35.50) and discharge (median 85.00, interquartile range 75.00–95.00, Z=-4.624, P&lt;0.001). A total of five patients (17.86%) were referred on for specialist residential neurorehabilitation. A post hoc analysis found that the rate of change of the Physical Abilities and Mobility Scale appeared to have an impact on final discharge destination, with slow improvers 18.60 times more likely to require specialist rehabilitation than others. The Physical Abilities and Mobility Scale was found to be acceptable among physiotherapists using it. Conclusions Children with a new acquired brain injury make significant improvements in gross motor function during a period of acute inpatient neurorehabilitation. Further work should look to refine the measure and gain a full understanding of its clinical utilities.

Vocabulary skills of school-age children with acquired brain injury: an exploration of tiered word knowledge and naming errors

ABSTRACTBackground: Vocabulary deficits are the most frequently documented communication difficulty following childhood acquired brain injury (ABI). Given the adverse consequences of limited vocabulary on academic success, it is critical to identify the presence and nature of vocabulary impairments to provide effective intervention for children with ABI.Method: Eleven children (7;6–11;11) with moderate/severe ABI (>12 months post-injury) and individually matched typically developing (TD) controls completed an Australian adaptation of a vocabulary assessment based on a three-tiered framework: tier 1 (basic words), tier 2 (high-frequency, cross-curricular words), and tier 3 (curriculum-based words). Overall scores and tiered accuracy were compared at individual and group level. Type and frequency of expressive naming errors were also coded.Results: In this pilot study, children with ABI demonstrated poorer overall scores than TD children. Equivalent accuracy was noted for tier 1 words and tier 2 receptive words. However, significantly poorer accuracy was noted in the ABI group for tier 2 expressive words and all tier 3 words. The majority of naming errors were semantic across both groups although TD participants showed a wider distribution of error types.Conclusions: Findings support the use of tier 2 and 3 vocabulary as intervention targets in this population within education contexts and speech pathology settings.

Parental stress and paediatric acquired brain injury

ABSTRACTObjective: 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.

Siblings’ experiences of their relationship with a brother or sister with a pediatric acquired brain injury

Primary purpose: Child acquired brain injury has significant impact on the family, including siblings. This study aimed to explore siblings’ experiences of their relationship with their brother or sister with acquired brain injury in order to make recommendations for health professionals working with this population.Research design: Semi-structured interviews were conducted with five siblings of children with acquired brain injury aged between 9 and 12 years and analyzed using interpretative phenomenological analysis.Results: The analysis resulted in four themes: (i) Coping with “a nightmare that you live”; (ii) Disconnection from family relationships; (iii) My sibling is different but “still the same underneath all this thing”; and (iv) Changing togetherness.Conclusions: The siblings in this study experienced a high level of distress with the near loss of their brother or sister. This was followed by difficulty in adjusting to the physical and psychological changes in their injured sibling and the impact on their sibling role and relationship. The changes were experienced alongside disruption to family relationships. Important clinical implications include the inclusion of siblings in their injured sibling’s care and the provision of information and support for this group.Implications for RehabilitationSiblings of children with an acquired brain injury experience significant challenges while trying to adapt to their changing sibling relationship and feelings of disconnection with their family.This study highlights a need to work systemically with families of childhood brain injury and recognize siblings’ important role in their family unit and therefore involve them in their brother/sister’s care and rehabilitation.This study also highlights a need to support siblings to cope with the trauma and provide information to validate and understand their experience.

Discourse and cognition in speakers with acquired brain injury (ABI): a systematic review.

Cognitive impairment, particularly of executive functioning, has been implicated in deficits in spoken discourse production following acquired brain injury (ABI). However, due to variation in the methodologies and heterogeneity of findings across studies, the nature and extent of this association is not well understood. This review aims to synthesize the literature investigating associations between cognitive deficits and discourse impairment after ABI. It is reported in accordance with guidelines of The Preferred Reporting Items of Systematic Reviews and Meta-Analyses. Searches were conducted of a variety of databases including Medline, PsycINFO, EMBASE, CINAHL, ProQuest, Cochrane and ERIC. Additional studies were identified via reference harvesting. Studies were included if they reported data on participants with ABI, assessed spoken discourse production and cognitive function, and performed statistical analyses to determine the association between discourse and cognitive variables. This review excluded non-English sources and those not published in peer-reviewed journals. Meta-analyses were not conducted due to variability across tools and terminology used to describe participant injury- and non-injury-related characteristics and outcomes. Twenty-five observational studies were included in the review. Findings revealed significant associations between multiple cognitive functions and discourse across micro-linguistic to super-structural measures. Methodological and terminological inconsistencies were identified across studies, which limited systematic comparison of the results. This review revealed present, yet heterogeneous, relationships between cognitive and discourse deficits in speakers with ABI. Associations were interpreted in light of a well-established model of discourse processing. Greater comparison across studies would have been facilitated by a standard nomenclature in relation to cognitive constructs and standardized discourse assessment. Future research should explore the influence of injury- and participant-related factors on discourse-cognitive relationships. The lack of information on conversational discourse and paediatric ABI limits the generalizability of this review to daily interaction following ABI. While applicable across the lifespan, in-depth investigation of discourse following ABI in childhood and adolescence is a priority due to complex changes in language and cognition, and the potential for impairments profoundly impact social, emotional and academic progression into adulthood. Given the centrality of remediating cognitive-communication difficulties in ABI, the interrelationships between discourse and cognition should retain a critical focus of research. This will inform clinical management and future research with this population. Findings have implications for our theoretical understanding of discourse and the nature of its breakdown in ABI.

Fatigue following Paediatric Acquired Brain Injury and its Impact on Functional Outcomes: A Systematic Review.

Fatigue is a commonly reported sequela following an acquired brain injury (ABI), and can have a negative impact on many areas of a child's life. However, there is minimal research that focuses on fatigue specifically, and so factors such as its occurrence, duration, and impact on functioning remain uncertain. This systematic review aims to provide a comprehensive summary of the research to date, bringing together a number of studies with a focus on paediatric ABI and fatigue. Terms were searched in relevant databases (PsycInfo, Medline, CINAHL), and articles were included or excluded based on specified criteria. Of the 1177 papers identified in the original search, a total of 9 papers met inclusion criteria, and were categorised as traumatic brain injury (TBI; n = 4), meningitis and meningococcal disease (n = 2), brain tumours (n = 2), and mixed ABI group (n = 1). Key findings suggest that fatigue is a problem encountered by a significant proportion of patients in all the studies reviewed, and often occurred regardless of the cause; fatigue was also associated with poor academic achievement, limited physical activity, and social and emotional problems. Injuries of greater severity were associated with higher levels of fatigue and worse outcomes. Several management options were suggested, though their efficacy was not reported. Future research is required with a suggested focus on using multiple time points to better understand the trajectories of fatigue following childhood ABI, and to build an evidence base to determine which management options are most suitable.

Prognostic factors in childhood-acquired brain injury

ABSTRACTBackground: A long-term follow-up study comparing children after anoxic brain injury (AnBI) with those after traumatic brain injury (TBI) was conducted, and prognostic factors were mapped.Methods: A prospective historical study following long-term functional outcome after childhood brain injury was conducted in two phases. The first phase included patients suffering from moderate-severe TBI. The second phase assessed children after AnBI, and the results were compared. Functional outcome was recorded and factors influencing prognosis were outlined.Results: On admission vegetative state (VS) was twice as prevalent in the AnBI subgroup. Approximately 90% of children with TBI and 60% of patients with AnBI gained independency in activities of daily living (ADL) and mobility. Long-term positive outcome, i.e., return to school and open-market employment, were higher in patients with TBI when compared with AnBI (61% and 48.1%, respectively). Significant outcome-predicting factors were VS at admission to rehabilitation, length of loss of consciousness (LOC) up to 11 days and functional independence measure (FIM) score at admission and discharge. Aetiology was not found to be a predicting factor.Conclusions: Duration of unconsciousness is the main long-term negative prognostic outcome factor. Anoxic brain damage, associated with longer periods of unconsciousness also heralds a less favourable outcome.

Clinician modifiable factors associated with better quality of life in children with acquired brain injury undergoing rehabilitation

ABSTRACTObjectives: To identify clinician-modifiable factors related to quality of life (QOL) in children with acquired brain injury (ABI).Participants and methods: Thirty-nine children attending an ABI rehabilitation program (5–18 years) were assessed using the Personality Inventory for Children-2, Vineland Adaptive Behavior Scale-2, Handicap-Related Problems for Parents Inventory and Children’s Assessment of Participation and Enjoyment. The Pediatric Quality of Life Inventory was completed by children and parents six months later.Results: Children with lower levels of internalising and externalising behaviours, health and social skill problems, and higher family functioning had significantly higher levels of total QOL (child and parent rated) (r = −.47 to −.79). In addition, children with higher levels of adaptive behaviour had significantly higher parent rated total QOL (r = .46). Measures of mother’s stressors had moderate but not statistically significant relationships with the child’s total QOL (r = −.31 to −.35). There were moderate and statistically significant relationships between measures of participation in physical activities and total QOL as rated by children (r = .42–.48) but not parents (r = .11–.30).Conclusions: These findings suggest potential targets to be investigated in future clinical research in rehabilitation following ABI in children to optimise QOL.

After a child's acquired brain injury (ABI): An ethnographic study of being a parent.

To explore the meanings associated with being a parent of a child with an aquired brain injury (ABI). An ethnographic study was conducted with parents of children aged 3 to 10 years who had acquired a severe brain injury. Purposeful sampling was used to recruit parents from the Glenrose Rehabilitation Hospital in Edmonton, Alberta. Data collection involved participant observation, fieldwork and semi-structured interviews. Field notes and interviews transcriptions were analysed using a thematic analysis framework and informed by symbolic interactionism theory. Six parent dyads (mothers and fathers) and 4 mothers participated in the study.Parents' meanings of `parenting' a child with severe brain injury were shaped by the injury, wide range of familial dynamics, and interactions. Six main themes related to parental meanings emerged from our data: (1) Getting `back to normal'; (2) Relying on a support system; (3) Worrying something bad may happen after the injury; (4) Going through a range of emotions following the injury; (5) Changing family dynamics after the injury; and (6) Ongoing performativity. Parents' meanings of `parenting' a child are extensively impacted by their child's functioning after the ABI. Having a greater appreciation of these experiences may be beneficial for medical professionals.