Pediatric Brain Injury Research Articles

Apparent diffusion coefficient (ADC) and magnetization transfer ratio (MTR) in pediatric hypoxic-ischemic brain injury

a review of the literature reveals the increasing interest in using Diffusion magnetic resonance imaging, with diffusion weighted images (DWI) and ADC (Apparent Diffusion Coefficient) quantitation, in pediatric hypoxic-ischemic brain injury. However, ADC and MTR (Magnetization Transfer Ratio) as quantitative tools have not been investigated together in these pathological conditions in young pediatric patients. The aim of this study was to apply a quantitative method by using ADC and MTR calculation in order to propose a reproducible quantitation of brain parenchymal lesions. we conducted a prospective study including all children presenting with suspected cerebral hypoxic-ischemic injury. 15 children were included, among them 10 males and 5 females aged from 36 weeks of gestation to 17 months with a median age of 10,5 months. All MR examinations were performed at 1.5 Tesla unit including conventional MR (T1, T2 and Inversion-recovery sequences) and DWI with ADC map. ADC and MTR ROI (region of interest) measurements were made, in the frontal subcortical and periventricular white matter (WM) as well as in the gray matter (GM=basal ganglia), and in focal lesions. ADC and MTR values were abnormal in focal lesions and in diffuse injury with no evidence of lesion on conventional MRI and DWI. We observed a strong inverse correlation between these ADC and MTR (R=0,66 in WM; R=0,61 in GM). ADC and MTR calculation may be helpful as a reproductive method to quantify the lesions and detect diffuse lesions in hypoxic-ischemic pediatric brain injury.

Clinical progression and outcome of dysphagia following paediatric traumatic brain injury: a prospective study

Objectives: To provide a preliminary clinical profile of the resolution and outcomes of oral-motor impairment and swallowing function in a group of paediatric dysphagia patients post-traumatic brain injury (TBI). To document the level of cognitive impairment parallel to the return to oral intake, and to investigate the correlation between the resolution of impaired swallow function versus the resolution of oral-motor impairment and cognitive impairment.Participants: Thirteen children admitted to an acute care setting for TBI.Main outcome measures: A series of oral-motor (Verbal Motor Production Assessment for Children, Frenchay Dysarthria Assessment, Schedule for Oral Motor Assessment) and swallowing (Paramatta Hospital’s Assessment for Dysphagia) assessments, an outcome measure for swallowing (Royal Brisbane Hospital’s Outcome Measure for Swallowing), and a cognitive rating scale (Rancho Level of Cognitive Functioning Scale).Results: Across the patient group, oral-motor deficits resolved to normal status between 3 and 11 weeks post-referral (and at an average of 12 weeks post-injury) and swallowing function and resolution to normal diet status were achieved by 3–11 weeks post-referral (and at an average of 12 weeks post-injury). The resolution of dysphagia and the resolution of oral-motor impairment and cognitive impairment were all highly correlated.Conclusion: The provision of a preliminary profile of oral-motor functioning and dysphagia resolution, and data on the linear relationship between swallowing impairment and cognition, will provide baseline information on the course of rehabilitation of dysphagia in the paediatric population post-TBI. Such data will contribute to more informed service provision and rehabilitation planning for paediatric patients post-TBI.

Guidelines address acute management of pediatric brain injury

![Figure][1] Recently released evidence-based guidelines address the treatment of children with traumatic brain injury. ![Figure][1] Dr. Fortenberry Anecdotal experience and personal preference often guide management of traumatic brain injury (TBI) in children, due to the lack

Poster 131: Evaluation of anoxic brain injuries in children using the coma/near coma scale.

Objective: To evaluate the role that admission coma level plays in predicting recovery from coma secondary to anoxic brain injury. Design: Retrospective cohort review of pediatric anoxic brain injuries. Setting: Inpatient neurotrauma rehabilitation care unit. Participants: 13 patients identified on admission with a diagnosis of anoxic brain injury and in a state of “moderate” to “extreme” coma, as determined by evaluation using the Coma/Near Coma (CNC) Scale. Interventions: Not applicable. Main Outcome Measure: CNC score. Scoring system rates level of coma on a scale ranging from 4 (extreme) to 0 (no coma). Results: Patients in coma with a diagnosis of anoxic brain injury of varying etiology were scored on admission and at discharge. A discussion of extent of recovery between admission and discharge and how this relates to various parameters is presented. All 13 patients were in a state of moderate to extreme coma (CNC score, >2.01), with 70% (n=9) in the marked to extreme coma range (CNC score, >2.9). Regardless of their initial score, 46% (n=5) improved to a state of near to no coma (CNC score, <2). Of the 13 patients reviewed, 23% (n=3) made no improvements at all. Conclusions: In this small cohort, level of coma on admission was not predictive of recovery from a comatose state. A high percentage (46%) of these children were discharged in a state of near to no coma, independent of admission coma level. This does not suggest, however, that recovery from coma is predictive of long-term cognitive and motor recovery. Assessment of long-term outcomes to further evaluate the capacity for recovery from anoxic brain injury is indicated.

Neurocognitive outcomes following pediatric brain injury: A developmental approach

Developmental neuropsychologists postulate that “immaturity” of the cerebral cortex should no longer be perceived as a protective factor. They argue that injury to the young brain may affect new learning by disrupting the skills in the midst of being acquired and skills that are yet to be developed. Cognitive deficits or weaknesses that are not detectable in the acute phase following a traumatic brain injury (TBI) may emerge over development as more complex skills are needed, thereby creating a developmental lag between children who sustained a pediatric TBI and typical age peers. This literature review was conducted to evaluate the developmental perspective on neurocognitive recovery/development following a TBI. Overall, the described findings support a developmental view and suggest that predictions of prognosis should be based on the child's remaining ability to learn.

1. Brain injury: Epidemiology and pathophysiology

Greenwald BD, Burnett DM, Miller MA. Congenital and acquired brain injury. 1. Brain injury: epidemiology and pathophysiology. Arch Phys Med Rehabil 2003;84 Suppl 1:S3-7. This self-directed learning module highlights recent advances in the understanding of brain injury pathophysiology, epidemiology, severity scales, and treatment interventions to minimize brain injury in adults and children. It is part of the chapter on congenital and acquired brain injury in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. In this article, brain injury epidemiology is summarized, and differences in between brain injury in pediatric and elderly persons are highlighted. Underlying physiologic and chemical mechanisms for secondary brain injury are reviewed, along with strategies and research to minimize this injury. Contemporary understanding of the mechanisms and treatments of brain injury in preterm infants is also discussed. Classification of brain injury severity provides a way to stratify this heterogeneous group. Overall Article Objective: (a) To summarize brain injury epidemiology and prevention strategiesacross the age spectrum, (b) to review the pathophysiology of pediatric and adult brain injury, and (c) to classify brain injury by severity scales.

Postacute rehabilitation for pediatric brain injury

Postacute rehabilitation for pediatric brain injury

Developing experimental models to address traumatic brain injury in children.

Traumatic brain injury (TBI) is the leading cause of injury-related death and disability among children under the age of 15 years in the United States. Epidemiological studies have revealed that even within the pediatric population there are differences in incidence, gender differences, causes, types of injuries sustained, and mortality within age subdivisions. This heterogeneity must be taken into account when developing appropriate models to address TBI in children. This review explores the current developmental TBI models, including fluid percussion, weight drop, and controlled cortical impact. It also addresses unique considerations to modeling pediatric brain injury that require special attention when modeling and designing studies: age appropriateness, injury severity, evaluation of recovery, plasticity, and anesthesia.

Outcomes in Pediatric Traumatic Brain Injury

Critical Care| November 01 2002 Outcomes in Pediatric Traumatic Brain Injury AAP Grand Rounds (2002) 8 (5): 56–57. https://doi.org/10.1542/gr.8-5-56 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Outcomes in Pediatric Traumatic Brain Injury. AAP Grand Rounds November 2002; 8 (5): 56–57. https://doi.org/10.1542/gr.8-5-56 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: traumatic brain injuries Source: Hackbarth RM, Rzeszutko KM, Sturm G, et al. Survival and function in pediatric brain injury: A retrospective review and analysis of predictive factors. Crit Care Med. 2002;30:1630–1635. The authors from Grand Rapids, Michigan, present a retrospective cohort study of 320 consecutive patients admitted to a pediatric intensive care unit (PICU) with traumatic brain injuries (TBIs) between March 1992 and June 1996. Seventy-nine patients had severe injury defined as an admission Glasgow Coma Scale (GCS) score ≤10. A large database of clinical variables, including presence of other injuries, loss of consciousness, cranial nerve reflexes, resuscitation therapies, coagulation studies, intracranial pressure (ICP) measurements, and therapies used to control intracranial hypertension, was evaluated. Measurement of ICP was standard care for all children with an admission GCS ≤10. Management of intracranial hypertension routinely included mannitol .25–1.0 gm/kg every 4–6 hours. Arterial CO2 was maintained between 25–30 torr... You do not currently have access to this content.

Mood and Anxiety Disorders Following Pediatric Traumatic Brain Injury: A Prospective Study

Studies utilizing standardized instruments for assessing mood and/or anxiety disorders following pediatric traumatic brain injury have seldom been reported in the literature. Previous reports have largely focused on cognitive impairment, behavioral dysfunction, or adaptive functioning, and have typically relied on parental informants. In this study, children hospitalized for mild (N = 42) and moderate/severe (N = 19) brain injury were assessed 6-months postinjury using the Anxiety disorders Module A and the Mood disorders Module C of the Diagnostic Interview Schedule for Children – IV Revision (DISC-IV). The data collected for the brain injury groups were compared to an orthopedic control group (N = 35). The relationship between a new onset mood and/or anxiety disorder (NOD) and injury severity indices was examined. Sequential logistical regression was also utilized to examine the impact of a brain injury, demographic variables, preinjury psychiatric disturbance, development disorders, litigation status and postinjury environmental stress on emotional outcome. Results indicated a relationship between brain injury and NOD. Multivariate analysis demonstrated that postinjury level of stress and severity of brain injury were the most robust predictors of NOD, accounting for 23% of the variance in the model. These results support the premise that the development of a mood and/or anxiety disorder following pediatric head injury is mediated by multiple determinants. The findings suggest that early psychosocial assessment and interventions aimed at increasing a child's coping may attenuate the emotional consequences of pediatric brain injury.

CHILDREN'S HEALTH PROMOTION THROUGH CAREGIVER PREPARATION IN PEDIATRIC BRAIN INJURY SETTINGS: COMPENSATING FOR SHORTENED HOSPITAL STAYS WITH A THREE-PHASE MODEL OF HEALTH EDUCATION AND ANNOTATED BIBLIOGRAPHY

Shorter hospital and rehabilitation stays in cases of pediatric brain injury necessitate greater preparation and training of family caregivers, who often will be responsible for complex and continued care at home. At the same time, a growing nursing shortage results in less available time for individualized, one-on-one caregiver education in medical settings prior to discharge. What is needed are innovative models of caregiver preparation and education that are comprehensive, systematic, and maximize the use of health professionals' limited time. The model presented here aims to provide a progressive three-phase model of caregiver education that makes efficient use of health professionals' time and delivers crucial information in a time-released manner throughout the entire continuum of care under the guidance of health professionals. An annotated bibliography of published caregiver education resources and the appropriate time for their delivery to family members is provided in the Appendix.

Developing a responsive measure of change for paediatric brain injury inpatient rehabilitation

Primary objective : To describe conceptual and methodological issues to be addressed in developing a responsive clinical performance measure for paediatric brain injury inpatient rehabilitation. Selected statistical approaches used to examine responsiveness of two functional activity scales (daily and social behavioural activity) of a prototype measure are presented to illustrate these issues. Research design : Retrospective chart review. Methods and procedures : Data on 65 children, aged 6 months to 18 years (X bar = 9.5 years) were collected during 1998 and 1999 from eight sites in the USA. Responsiveness was examined using effect sizes and a number of parametric and non-parametric tests. Main outcomes and results : Significant improvements from admission to discharge were found on all item and scale scores ( p < 0.001). Moderate significant relationships were found between activity scale change scores and external ratings of change. Conclusions : Findings provide evidence that the activity scales have the potential to be responsive and point to issues that will need to be addressed in future measurement development.

Buchbesprechungen / Book Reviews

Buchbesprechungen / Book ReviewsBuchbesprechungen / Book ReviewsH. RemschmidtH. Remschmidt Marburg Search for more papers by this authorPublished Online:November 17, 2006https://doi.org/10.1024//1422-4917.29.4.326bView Full Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMoreFiguresReferencesRelatedDetailsCited byTiefgreifende Entwicklungsstörungen Volume 29Issue 4November 2001ISSN: 1422-4917eISSN: 1664-2880 InformationZeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie (2001), 29, pp. 326-327 https://doi.org/10.1024//1422-4917.29.4.326b.© 2001Verlag Hans Huber

Long-Term Family Adaptation Following Pediatric Brain Injury

Long-Term Family Adaptation Following Pediatric Brain Injury

Phenytoin pharmacokinetics altered in paediatric brain injury

Phenytoin pharmacokinetics altered in paediatric brain injury

Traumatic brain injury: developmental differences in glutamate receptor response and the impact on treatment.

Perinatal brain injury following trauma, hypoxia, and/or ischemia represents a substantial cause of pediatric disabilities including mental retardation. Such injuries lead to neuronal cell death through either necrosis or apoptosis. Numerous in vivo and in vitro studies implicate ionotropic (iGluRs) and metabotropic (mGluRs) glutamate receptors in the modulation of such cell death. Expression of glutamate receptors changes as a function of developmental age, with substantial implications for understanding mechanisms of post-injury cell death and its potential treatment. Recent findings suggest that the developing brain is more susceptible to apoptosis after injury and that such caspase mediated cell death may be exacerbated by treatment with N-methyl-D-aspartate receptor antagonists. Moreover, group I metabotropic glutamate receptors appear to have opposite effects on necrotic and apoptotic cell death. Understanding the relative roles of glutamate receptors in post-traumatic or post-ischemic cell death as a function of developmental age may lead to novel targeted approaches to the treatment of pediatric brain injury.

Mechanisms of neurodegeneration after paediatric brain injury.

Trauma to the developing brain constitutes an unexplored field. The few studies attempting to model and study paediatric head trauma, the leading cause of death and disability in the paediatric population, have revealed interesting aspects and potential targets for future research. One feature unique to the developing brain is overactivation by trauma of ongoing physiological programmed neuronal death (apoptosis). Understanding the underlying biochemical and molecular pathomechanisms may help set new pharmacotherapeutic targets for neuroprotection at an early age.

A ‘headstart’ for paediatric brain injury rehabilitation

Penny Weekes describes the setting up of ‘Headstart’, a specialised service that aims to accommodate the needs of brain-injured children and their families to establish comprehensive provision of rehabilitation.

Infant skull and suture properties: measurements and implications for mechanisms of pediatric brain injury.

The mechanical properties of the adult human skull are well documented, but little information is available for the infant skull. To determine the age-dependent changes in skull properties, we tested human and porcine infant cranial bone in three-point bending. The measurement of elastic modulus in the human and porcine infant cranial bone agrees with and extends previous published data [McPherson, G. K., and Kriewall, T. J. (1980), J. Biomech., 13, pp. 9-16] for human infant cranial bone. After confirming that the porcine and human cranial bone properties were comparable, additional tensile and three-point bending studies were conducted on porcine cranial bone and suture. Comparisons of the porcine infant data with previously published adult human data demonstrate that the elastic modulus, ultimate stress, and energy absorbed to failure increase, and the ultimate strain decreases with age for cranial bone. Likewise, we conclude that the elastic modulus, ultimate stress, and energy absorbed to failure increase with age for sutures. We constructed two finite element models of an idealized one-month old infant head, one with pediatric and the other adult skull properties, and subjected them to impact loading to investigate the contribution of the cranial bone properties on the intracranial tissue deformation pattern. The computational simulations demonstrate that the comparatively compliant skull and membranous suture properties of the infant brain case are associated with large cranial shape changes, and a more diffuse pattern of brain distortion than when the skull takes on adult properties. These studies are a fundamental initial step in predicting the unique mechanical response of the pediatric skull to traumatic loads associated with head injury and, thus, for defining head injury thresholds for children.

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.