Selective impairment of inhibition after TBI in children

Inhibition was studied in 12 children who had had sustained as severe traumatic brain injury (TBI) at least 1 year earlier and in 15 control children. On the flanker task, which involved pressing a button corresponding to the direction of an arrow, the TBI group performed less accurately than controls under interference (flankers were incongruent with arrow) and go-no-go (adjacent stimulus signaled child to withhold response) conditions, but not neutral or facilitation (flankers were congruent) conditions. Response latency was related to age and task condition, but not group. Severe TBI in children may disrupt development of distributed networks mediating inhibition.     

Effectiveness of physical therapy for patients with neck pain: an individualized approach using a clinical decision-making algorithm

OBJECTIVE: The purpose of this study was to determine the effectiveness of an individualized physical therapy intervention in treating neck pain based on a clinical reasoning algorithm. Treatment effectiveness was examined by assessing changes in impairment, physical performance, and disability in response to intervention. DESIGN: One treatment group of 30 patients with neck pain completed physical therapy treatment. The control group of convenience was formed by a cohort group of 27 subjects who also had neck pain but did not receive treatment for various reasons. There were no significant differences between groups in demographic data and the initial test scores of the outcome measures. A quasi-experimental, nonequivalent, pretest-posttest control group design was used. A physical therapist rendered an eclectic intervention to the treatment group based on a clinical decision-making algorithm. Treatment outcome measures included the following five dependent variables: cervical range of motion, numeric pain rating, timed weighted overhead endurance, the supine capital flexion endurance test, and the Patient Specific Functional Scale. Both the treatment and control groups completed the initial and follow-up examinations, with an average duration of 4 wk between tests. RESULTS: Five mixed analyses of variance with follow-up tests showed a significant difference for all outcome measures in the treatment group compared with the control group. After an average 4 wk of physical therapy intervention, patients in the treatment group demonstrated statistically significant increases of cervical range of motion, decrease of pain, increases of physical performance measures, and decreases in the level of disability. The control group showed no differences in all five outcome variables between the initial and follow-up test scores. CONCLUSIONS: This study delineated algorithm-based clinical reasoning strategies for evaluating and treating patients with cervical pain. The algorithm can help clinicians classify patients with cervical pain into clinical patterns and provides pattern-specific guidelines for physical therapy interventions. An organized and specific physical therapy program was effective in improving the status of patients with neck pain.     

Development of verbal selective learning

Using incentive-based auditory word recall we studied the efficiency of selective learning in children ages 6-18 years. We found effects of age for both selective learning efficiency and for total words recalled, which differed in developmental trajectory. The number of words recalled showed a nonlinear component, reflecting a negatively accelerated increase with age. In contrast, the measure of selective learning was linear with age. Overall, selective learning efficiency was not related to the total number of words recalled. The findings provide a framework for interpretation of studies of selective learning in clinical populations.     

History of arrest, incarceration and victimization in community-based severely mentally ill

This study examined history of arrest and victimization in an urban community sample of severely mentally ill adults. Adults (n = 308) were consented and interviewed in one of four short-term residential treatment facilities in San Francisco. Nearly three quarters (71.4%) had been arrested at some time in their lives, 28.2% of whom had been arrested in the past 6 months. Substance use and homelessness were associated with history of arrest, while gender and ethnicity were not, although African Americans were more likely to have spent longer time in jail or prison. One quarter (25.6%) reported victimization. Being female (OR 2.02, 95% CI 1.2–3.5, p = 0.032) and homeless (OR 2.1, 95% CI 1.2–3.8, p = 0.013) were associated with reporting victimization. Severe mental illness, in particular in combination with substance abuse and homelessness, is associated with higher prevalence of both arrest and victimization history. Healthcare providers should solicit histories to include these events in order to understand and provide optimal care and case management services.Mary Castle White is Professor, Linda Chafetz, Professor, and Gerri Collins-Bride, Clinical Professor, all at the University of California, San Francisco School of Nursing, Department of Community Health Systems; and John Nickens is Clinical Director of the San Francisco Progress Foundation, San Francisco, California, USA.This work was supported by the National Institutes of Health, National Institute for Nursing Research (RO1-NR05350).     

Diffusion tensor imaging in the corpus callosum in children after moderate to severe traumatic brain injury

Diffusion tensor imaging (DTI) is a recent imaging technique that assesses the microstructure of the cerebral white matter (WM) based on anisotropic diffusion (i.e., water molecules move faster in parallel to nerve fibers than perpendicular to them). Fractional anisotropy (FA), which ranges from 0 to 1.0, increases with myelination of WM tracts and is sensitive to diffuse axonal injury (DAI) in adults with traumatic brain injury (TBI). However, previous DTI studies of pediatric TBI were case reports without detailed outcome measures. Using mean FA derived from DTI fiber tractography, we compared DTI findings of the corpus callosum for 16 children who were at least 1 year (mean 3.1 years) post-severe TBI and individually matched, uninjured children. Interexaminer and intraexaminer reliability in measuring FA was satisfactory. FA was significantly lower in the patients for the genu, body, and splenium of the corpus callosum. Higher FA was related to increased cognitive processing speed and faster interference resolution on an inhibition task. In the TBI patients, higher FA was related to better functional outcome as measured by the dichotomized Glasgow Outcome Scale (GOS). FA also increased as a function of the area of specific regions of the corpus callosum such as the genu and splenium, and FA in the splenium was reduced with greater volume of lesions in this region. DTI may be useful in identifying biomarkers related to DAI and outcome of TBI in children.