Discourse Macrolevel Processing After Severe Pediatric Traumatic Brain Injury

The purpose of this study was to determine if discourse macrolevel processing abilities differed between children with severe traumatic brain injury (TBI) at least 2 years postinjury and typically developing children. Twenty-three children had sustained a severe TBI either before the age of 8 (n = 10) or after the age of 8 (n = 13). The remaining 32 children composed a control group of typically developing peers. The groups' summaries and interpretive lesson statements were analyzed according to reduction and transformation of narrative text information. Compared to the control group, the TBI group condensed the original text information to a similar extent. However, the TBI group produced significantly less transformed information during their summaries, especially those children who sustained early injuries. The TBI and control groups did not significantly differ in their production of interpretive lesson statements. In terms of related skills, discourse macrolevel summarization ability was significantly related to problem solving but not to lexical or sentence level language skills or memory. Children who sustain a severe TBI early in childhood are at an increased risk for persisting deficits in higher level discourse abilities, results that have implications for academic success and therapeutic practices.     

Discourse Macrolevel Processing After Severe Pediatric Traumatic Brain Injury

The purpose of this study was to determine if discourse macrolevel processing abilities differed between children with severe traumatic brain injury (TBI) at least 2 years postinjury and typically developing children. Twenty-three children had sustained a severe TBI either before the age of 8 (n = 10) or after the age of 8 (n = 13). The remaining 32 children composed a control group of typically developing peers. The groups' summaries and interpretive lesson statements were analyzed according to reduction and transformation of narrative text information. Compared to the control group, the TBI group condensed the original text information to a similar extent. However, the TBI group produced significantly less transformed information during their summaries, especially those children who sustained early injuries. The TBI and control groups did not significantly differ in their production of interpretive lesson statements. In terms of related skills, discourse macrolevel summarization ability was significantly related to problem solving but not to lexical or sentence level language skills or memory. Children who sustain a severe TBI early in childhood are at an increased risk for persisting deficits in higher level discourse abilities, results that have implications for academic success and therapeutic practices.     

关于血管内亚低温治疗重型颅脑创伤临床研究

目的 对血管内降温治疗急性重型颅脑创伤患者的安全性及有效性进行前瞻性的研究.方法 共30例患者,均于伤后12 h内行血管内降温治疗,体内温度控制在33℃～35℃之间,持续4～7 d平均(21.5±13.7)h.患者均于伤后6个月时根据GOS评估法判定疗效.结果 经6个月随访,良好11例,中残5例,重残6例,植物生存6例,死亡2例、本组患者没有出现与血管内降温系统相关的严重并发症.结论 血管内降温具有降温速度快、目标温度维持稳定、波动性小以及复温速度容易控制等优点.对于重型颅脑损伤的患者是一种安全、有效的治疗方法.     

Selective Changes in Executive Functioning Ten Years After Severe Childhood Traumatic Brain Injury

Pediatric traumatic brain injury (TBI) impacts on children's executive functions, but little is known of how such deficits evolve in the long term. Forty adolescents with TBI were assessed ten years post-injury and compared to 19 typically developing participants on a range of executive measures (attentional control, cognitive flexibility, goal setting, information processing). Children with mild or moderate TBI performed within age expectations on all tests; however, those with severe injuries had poorer performance on goal setting and processing speed tasks. Childhood TBI may result in subtle lasting changes in complex executive skills, which could require ongoing support into adulthood.     

限制性液体复苏对重型颅脑创伤患者凝血功能的影响

目的 观察限制性液体复苏(LFR)对重型颅脑创伤(sTBI)患者凝血功能的影响.方法 以随机数字表法将2013年3月至2017年3我院收治的116例sTBI患者分为2组,各58例,A组选择限制性液体复苏方法,B组选择常规积极液体复苏方法,比较2组ICU入住时间、平均住院时间、复苏效果(胶体液量、总输液量、红细胞压积、血清乳酸水平与血小板计数)、入院时与治疗24h后凝血功能[纤维蛋白原(FIB)、D-二聚体(D-D)、凝血酶时间(TT)、凝血酶原时间(PT)以及活化部分凝血活酶时间(APTT)]、并发症与预后情况.结果 2组胶体液量比较差异无统计学意义(P＞0.05);A组ICU入住时间、平均住院时间、TT、PT、APTT均显著短于B组(P＜0.05);A组总输液量、血清乳酸、D-D水平明显低于B组(P＜0.05),血小板计数、红细胞压积、FIB水平明显高于B组(P＜0.05);A组并发症总发生率(8.62％)显著低于B组(24.14％)(P＜0.05),且预后总良好率(62.07％)显著高于B组(43.10％)(P＜0.05).结论 对sTBI患者给予LFR治疗,可有效改善机体凝血障碍及预后,促进其恢复,获得良好复苏效果,且降低各种并发症风险.     

两岁以下婴幼儿重型颅脑损伤的临床特点与治疗

目的：探讨两岁以下婴幼儿重型颅脑损伤的临床特点与有效治疗方法。方法：2007年1月至2011年12月期间,我科收治两岁以下婴幼儿重型颅脑损伤患儿24例,其中合并其他部位损伤10例。外伤后均有程度不等的意识障碍,改良GCS评分为3～8分,其中5分以下6例,5～8分18例;呕吐13例,瞳孔变化9例,抽搐或癫痫发作9例。保守治疗16例,手术治疗8例。采用格拉斯哥预后评分（GOS）标准评价治疗效果。结果：24例患儿出院时疗效良好率66．7％（16／24）,死亡率16．7％（4／24）;出院后12个月疗效良好率达70．8％（17／24）,死亡率达20．8％（5／24）。入院时GCS改良评分与出院后GOS评分之间呈显著正相关。结论：两岁以下婴幼儿有其特有的生理特点,颅脑损伤后意识障碍、生命体征变化、呕吐、癫痫发作等全身症状严重,对失血敏感,治疗有其特殊性,积极治疗可望改善预后。     

Polymorphism of the APOE Gene and Markers of Brain Damage in the Outcomes of Severe Traumatic Brain Injury in Children

Neuroscience and Behavioral Physiology - Objective. To compare the genotypes at the apolipoprotein E (APOE) gene with outcomes and level of neural markers in children with severe traumatic brain...     

Executive Function Profiles in Pediatric Traumatic Brain Injury

Traumatic brain injury (TBI) results in heterogeneous patterns of neuropsychological impairment. This study investigated heterogeneity in executive function (EF) using the Comprehensive Trail Making Test (CTMT) to evaluate 121 children and adolescents with TBI and 121 matched normal controls. The TBI group performed approximately two standard deviations below controls. Cluster analyses indicated that a three-cluster solution best classified the TBI group and a four-cluster solution best classified controls. Greater impairment in EF was associated with lower intellectual, achievement, and neuropsychological test performance in the TBI group. Results suggest that EF deficits reflected in CTMT performance may be useful for classifying severity of TBI.     

A Critical Examination of Mild Traumatic Brain Injury Management Information Distributed to Parents

Considerable confusion surrounds pediatric mild traumatic brain injury (mTBI) and its management. This study provides a comparison between mTBI management pamphlets distributed by Australasian hospitals and the Centers for Disease Control and Prevention (CDC) gold standard. Twenty-seven different pamphlets were collected from 96 hospitals in Australia and New Zealand and were assessed for readability, compliance with nine CDC criteria, and inclusion of confusing or incorrect information. None of the pamphlets completely complied with the CDC criteria and all included incorrect information. Findings demonstrate that mTBI management information in Australasia needs urgent revision, and evaluation in other countries is strongly advised.     

Clinical Features of Repetitive Traumatic Brain Injury and Chronic Traumatic Encephalopathy

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease characterized by a distinct pattern of hyperphosphorylated tau (p‐tau). Thought to be caused by repetitive concussive and subconcussive injuries, CTE is considered largely preventable. The majority of neuropathologically confirmed cases have occurred in professional contact sport athletes (eg, boxing, football). A recent post‐mortem case series has magnified concerns for the public's health following its identification in six high school level athletes. CTE is diagnosed with certainty only following a post‐mortem autopsy. Efforts to define the etiology and clinical progression during life are ongoing. The goal of this article is to characterize the clinical concepts associated with short‐ and long‐term effects of repetitive traumatic brain injury, with a special emphasis on new clinical diagnostic criteria for CTE. Utilizing these new diagnostic criteria, two cases of neuropathologically confirmed CTE, one in a professional football player and one in a professional boxer, are reported. Differences in cerebellar pathology in CTE confirmed cases in boxing and football are discussed.     

Ecological Assessment of Executive Function in Traumatic Brain Injury

Executive dysfunction is a common outcome in children who have sustained traumatic brain injury (TBI). Appropriate assessment of these complex interrelated regulatory functions is critical to plan for the necessary interventions yet present a challenge to our traditional methodologies. Ecological validity has become an increasingly important focus in neuropsychological assessment with particular relevance for the executive functions, which coordinate one's cognitive and behavioral capacities with real-world demand situations. The Behavior Rating Inventory of Executive Function (BRIEF) was developed to capture the real-world behavioral manifestations of executive dysfunction. Its development and various forms of validity, including ecological validity, are described. Application of the BRIEF's methodology to the assessment of executive dysfunction in TBI is provided. We advocate a multilevel approach to understanding executive function outcome in TBI, including traditional test-based measures of executive function, real-world behavioral manifestation of executive dysfunction, and the environmental system factors that impact the child. In this model, ecologically valid assessment of executive dysfunction provides an important bridge toward understanding the impact of component-level (i.e., test-based) deficits on the child's everyday adaptive functioning, which can assist the definition of targets for intervention.     

Ecological Assessment of Executive Function in Traumatic Brain Injury

Executive dysfunction is a common outcome in children who have sustained traumatic brain injury (TBI). Appropriate assessment of these complex interrelated regulatory functions is critical to plan for the necessary interventions yet present a challenge to our traditional methodologies. Ecological validity has become an increasingly important focus in neuropsychological assessment with particular relevance for the executive functions, which coordinate one's cognitive and behavioral capacities with real-world demand situations. The Behavior Rating Inventory of Executive Function (BRIEF) was developed to capture the real-world behavioral manifestations of executive dysfunction. Its development and various forms of validity, including ecological validity, are described. Application of the BRIEF's methodology to the assessment of executive dysfunction in TBI is provided. We advocate a multilevel approach to understanding executive function outcome in TBI, including traditional test-based measures of executive function, real-world behavioral manifestation of executive dysfunction, and the environmental system factors that impact the child. In this model, ecologically valid assessment of executive dysfunction provides an important bridge toward understanding the impact of component-level (i.e., test-based) deficits on the child's everyday adaptive functioning, which can assist the definition of targets for intervention.     

脑外伤病人记忆功能的康复特点

脑外伤现已成为危害人们健康的主要疾病之一。脑外伤会引起多种认知功能障碍 ,如注意、记忆和语言等 ,其中记忆障碍较为常见。脑外伤后会有一段时间失去意识 ,同时伴有失定向、意识混乱 ,以及情节记忆受损等症状 ,称为创伤后遗忘 (ｐｏｓｔｔｒａｕ ｍａｔｉｃａｍｎｅｓｉａ ,ＰＴＡ) [1- 3] 。ＰＴＡ可以持续几分钟或几个月不等 ,它对于预测脑外伤后认知功能康复的程度等有重要的参考价值 ,ＰＴＡ的持续时间短 ,程度轻 ,其后认知功能的康复就会较好。对ＰＴＡ最简单的评价是询问病人在外伤后能够记起的第一件事 ,以及病人能够记起的外伤前…     

重型创伤性颅脑损伤经标准大骨瓣开颅手术治疗的临床疗效分析

目的：研究分析标准大骨瓣开颅手术在治疗重型创伤性颅脑损伤方面的效果。方法对50例重型创伤性颅脑损伤的患者进行分组,分为两组,对于对照组患者,进行常规的开颅减压手术治疗,对于实验组患者,进行标准的大骨瓣开颅手术治疗。观察记录比较两组患者的临床疗效及并发症发生率。结果实验组在治愈率方面明显高于对照组,实验组为36.0%,对照组为20.0%,在死亡率方面低于对照组,实验组为4.0%,对照组为16.0%,在并发症发生率方面,实验组也大大少于对照组,实验组为21.33%,对照组为42.76%。两者差异均具有统计学意义。结论应用标准大骨瓣开颅手术,能够明显提高重型创伤性颅脑损伤的治愈率,可以很好地预防并发症的发生,推广使用是势在必行的。     

Traumatic Brain Injury Models in Zebrafish (Danio rerio)

Neuroscience and Behavioral Physiology - Current medicine has a high level of interest in studies of the pathogenesis of traumatic brain injury (TBI). This comes particularly from high levels of...     

Social Competence in Young Children With Inflicted Traumatic Brain Injury

As infants develop skills that allow for increasing independence in social and cognitive domains, they acquire the ability to identify goals, sequence behaviors to carry out goals, and to flexibly use strategies for attaining goals in both social and independent play contexts. Little is known about how brain injury in young children may disrupt the precursors to such executive processes. In this study, we examined social and cognitive competence in 25 infants ages 3 to 23 months who sustained moderate to severe traumatic brain injury (TBI) secondary to physical abuse and in 22 healthy community comparison children. Children with TBI were evaluated an average of 1.6 months after the injury. A toy-centered activity with the examiner was used to capture joint attention and social behavior and an exploratory toy play situation was used to measure independent goal-directed play. The inflicted TBI group showed significant reduction in both social and cognitive domains relative to the comparison group. Canonical correlation analyses disclosed that inflicted TBI was associated with reduction in (a) initiation of social interactions, (b) responsiveness to interactions initiated by the examiner, (c) positive affect, and (d) compliance. The groups performed comparably on indexes of gestural and verbal communication and for the occurrence of negative affect. Joint attention was an area of vulnerability for the TBI group in both social initiation and response contexts. Although general cognitive and motor scores were lower in the inflicted TBI group, the complexity of independent toy play did not differ across groups. Early brain injury causes significant disruption in behaviors regulating initiation and responsiveness in social contexts. Longitudinal follow-up will characterize the long-term consequences of early disruption in joint attention and other behaviors on the development of social and cognitive precursors to executive processes.