Executive functions and attention 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l’Enfant (TGE) cohort

Fur, Clément Le; Câmara-Costa, Hugo; Francillette, Leila; Opatowski, Marion; Touré, Hanna; Brugel, Dominique; Laurent-Vannier, A.; Meyer, Philippe; Watier, Laurence; Dellatolas, Georges; Chevignard, Mathilde

doi:10.1016/j.rehab.2019.09.003

Cited by 29 publications

(36 citation statements)

References 63 publications

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“…While It is unclear to what extent pre-existing EFs problems shape post-injury cognition and behavior in school-aged children and adolescents, there is a growing body of evidence showing significant and persistent adverse effects of TBI on EFs across the first 2 years after injury, with greater disruption following severe TBI than less severe injuries ( 35 , 38 ). Long term follow up studies examining EF outcomes from 3 to 10 years after injury have also shown persistent problems, with EFs not returning to pre-injury levels ( 35 , 62 – 64 ). Executive dysfunction after TBI has serious consequences for post-traumatic adjustment ( 65 ) and contributes to poorer educational outcomes ( 66 , 67 ) and reduced social competence ( 68 ).…”

Section: Discussionmentioning

confidence: 99%

As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury

et al. 2021

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Objective: To model pre-injury child and family factors associated with the trajectory of internalizing and externalizing behavior problems across the first 3 years in children with pediatric traumatic brain injury (TBI) relative to children with orthopedic injuries (OI). Parent-reported emotional symptoms and conduct problems were expected to have unique and shared predictors. We hypothesized that TBI, female sex, greater pre-injury executive dysfunction, adjustment problems, lower income, and family dysfunction would be associated with less favorable outcomes.Methods: In a prospective longitudinal cohort study, we examined the level of behavior problems at 12 months after injury and rate of change from pre-injury to 12 months and from 12 to 36 months in children ages 4–15 years with mild to severe TBI relative to children with OI. A structural equation model framework incorporated injury characteristics, child demographic variables, as well as pre-injury child reserve and family attributes. Internalizing and externalizing behavior problems were indexed using the parent-rated Emotional Symptoms and Conduct Problems scales from the Strengths and Difficulties questionnaire.Results: The analysis cohort of 534 children [64% boys, M (SD) 8.8 (4.3) years of age] included 395 with mild to severe TBI and 139 with OI. Behavior ratings were higher after TBI than OI but did not differ by TBI severity. TBI, higher pre-injury executive dysfunction, and lower income predicted the level and trajectory of both Emotional Symptoms and Conduct Problems at 12 months. Female sex and poorer family functioning were vulnerability factors associated with greater increase and change in Emotional Symptoms by 12 months after injury; unique predictors of Conduct Problems included younger age and prior emotional/behavioral problems. Across the long-term follow-up from 12 to 36 months, Emotional Symptoms increased significantly and Conduct Problems stabilized. TBI was not a significant predictor of change during the chronic stage of recovery.Conclusions: After TBI, Emotional Symptoms and Conduct Problem scores were elevated, had different trajectories of change, increased or stayed elevated from 12 to 36 months after TBI, and did not return to pre-injury levels across the 3 year follow-up. These findings highlight the importance of addressing behavioral problems after TBI across an extended time frame.

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Section: Discussionmentioning

confidence: 99%

As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury

et al. 2021

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“…Neurocognitive impairments and behavioral abnormalities have been consistently observed in children with TBI (Konigs et al, 2015;Poslinder et al, 2015;Dewan et al, 2016;Lumba-Brown et al, 2018). Among the most common cognitive consequences, significant attention deficits were reported in about 35% of children within two years of their TBI (Max et al, 2005), and were observed to strongly contribute to elevated risk for severe psychopathology and impairments in overall functioning in late adolescence, with the pathophysiological underpinning yet to be fully elucidated (Le Fur et al, 2019;Narad et al, 2019). The post-TBI attention problems in children have been evaluated and treated based on endorsements of behavioral symptoms from subjective observations, and have resulted in largely divergent results regarding effectiveness (Backeljauw and Kurowski, 2014;Kurowski et al, 2019;LeBlond et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Topological Aberrance of Structural Brain Network Provides Quantitative Markers of post-TBI Attention Deficits in Children

Cao

Luo

et al. 2020

Preprint

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Traumatic brain injury (TBI)-induced attention deficits are among the most common long-term cognitive consequences in children. Most of the existing studies attenpting to understand the neuropathological underpinnings of cognitive and behavioral impairments in TBI have utilized heterogeneous samples and resulted in inconsistent findings. The current research proposed to investigate topological properties of the structural brain network in children with TBI and their associations with TBI-induced attention problems in a more homogeneous subgroup of children who had severe post-TBI attention deficits (TBI-A). A total of 31 children with TBI-A and 35 group-matched controls were involved in the study. Diffusion tensor imaging-based probabilistic tractography and graph theoretical techniques were used to construct the structural brain network in each subject. Network topological properties were calculated in both global level and regional (nodal) level. Between-group comparisons among the topological network measures and analyses for searching brain-behavioral associations were all corrected for multiple comparisons using Bonferroni method. Compare to controls, the TBI-A group showed significantly higher nodal local efficiency and nodal clustering coefficient in left inferior frontal gyrus and right transverse temporal gyrus, while significantly lower nodal clustering coefficient in left supramarginal gyrus as well as lower nodal local efficiency in left parahippocampal gyrus. The temporal lobe topological alterations were significantly associated with the post-TBI inattentive and hyperactive symptoms in the TBI-A group. The results suggest that TBI-related structural re-modularity in the WM subnetworks associated with temporal lobe may play a critical role in the onset of severe post-TBI attention deficits in children. These findings provide valuable input for understanding the neurobiological substrates of TBI-A, and have the potential to serve as a biomarker guiding the development of more timely and tailored strategies for diagnoses and treatments to the affected individuals.

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“…Severe pediatric TBI, defined by a Pediatric Glasgow Coma Scale (Peds-GCS) score ≤ 8 [6], is associated with long-standing neurological, neuropsychological and behavioral impairments, such as sensory-motor deficits, including hemiparesis and cerebellar dysfunction [7], and deficits in language, visual-spatial skills, processing speed, memory, attention, working memory, executive functioning and behavior regulation [8][9][10][11][12][13]. Those deficits are associated with impaired educational achievement [12,[14][15][16][17], reduced participation, and impaired quality of life in the long term [18][19][20][21].…”

Section: Results Of the Traumatisme Grave De L'enfant (Tge) Studymentioning

confidence: 99%

“…The present work is part of a larger prospective longitudinal study (TGE cohort), aiming at determining overall and specific outcomes following severe childhood TBI [10,12,19,47,[51][52][53][54].…”

Section: Methodsmentioning

confidence: 99%

Memory functioning 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l’Enfant study

Câmara-Costa

Viot

Francillette

et al. 2021

Journal of Neuropsychology

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Objective: to explore memory functioning 7-years after severe pediatric TBI, associated factors, and relationships with other outcomes. Method:Children aged 0-15 years (n=65), consecutively admitted over a 3-year period in a single trauma center, who survived after severe non-inflicted TBI, were included in a prospective longitudinal study. Memory assessments were performed 7-years post-injury using the Children's Memory Scale (CMS) or the Wechsler Memory Scale (WMS IV), according to age. The General Memory Score (GMS-7) was the primary outcome.Results: Thirty-seven patients were available for assessment at 7-years post-injury. Mean GMS-7 was in the low average range (M=84.9, SD=12.1). Lower GMS-7 was significantly associated with markers of higher injury severity, such as length of coma. One-year post-injury functional and disability outcomes explained 74% of the variance of GMS-7. Concurrent intellectual ability and type of ongoing education correlated strongly with GMS-7. Age at injury and parental education were not associated with memory outcome. Conclusions:Memory functioning is variable but often strongly impaired several years after severe pediatric TBI, and is mostly related to injury severity, functional outcomes measured 1year post-injury, and concomitant cognitive and educational outcomes. GMS-7 was lower at 7years than one-year post-injury, supporting the importance of long term follow-up.

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Executive functions and attention 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l’Enfant (TGE) cohort

Cited by 29 publications

References 63 publications

As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury

As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury

Topological Aberrance of Structural Brain Network Provides Quantitative Markers of post-TBI Attention Deficits in Children

Memory functioning 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l’Enfant study

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