Working memory outcomes following traumatic brain injury in children: A systematic review with meta-analysis

Abstract

The aim of this review is to systematically examine the literature concerning multicomponent working memory (WM)-comprising a central executive (CE), two storage components (phonological loop, PL and visuo-spatial sketchpad, VSSP), and episodic buffer (EB)-in pediatric traumatic brain injury (TBI). Electronic searches were conducted of MEDLINE, PsychINFO and EMBASE up to October 2014 with the inclusion criteria of children and adolescents with TBI, and quantitative methods to assess at least one component of WM. Meta-analytic procedures calculated pooled effect sizes for WM outcomes. Of the studies examined, 27 met the inclusion criteria. Children with TBI exhibited deficits in the CE and PL, but not in the VSSP, and no study could be found which examined the EB. Qualitative analysis found that greater TBI severity was associated with poorer CE functioning in five out of nine studies. Differences in patterns of brain activation were evident in four out of five fMRI studies that examined WM in TBI children and controls. Deficits in CE were associated with poorer mathematical skills in the only study that examined relations between WM and academic deficits. Notwithstanding the heterogeneity of the studies reviewed, TBI places children at risk of WM deficits. Moreover, this meta-analysis suggests that various components of WM have differential vulnerability to pediatric TBI, with significant deficits found in the CE and PL, but not in the VSSP (although the VSSP has rarely been examined to date). Future studies should be theoretically driven, employ tasks assessing all components of the WM model and examine the functional ramifications (including academic outcomes) of WM deficits in this population.

Working Memory From the Psychological and Neurosciences Perspectives: A Review

“…Physical injuries impacting the frontal or parietal lobes would reasonably be damaging to one’s working memory. This is supported in studies employing neuropsychological testing to assess cognitive impairments in patients with traumatic brain injury; and poorer cognitive performances especially involving the working memory domains were reported (see Review Articles by Dikmen et al, 2009 ; Dunning et al, 2016 ; Phillips et al, 2017 ). Research on cognitive deficits in traumatic brain injury has been extensive due to the debilitating conditions brought upon an individual daily life after the injury.…”

Working memory training involves learning new skills

“…WM is impaired in developmental disorders of attention (Holmes et al, 2014; Martinussen, Hayden, Hogg-Johnson, & Tannock, 2005), language (Hesketh & Conti-Ramsden, 2013; Montgomery, 2000; Montgomery & Evans, 2009; Newbury, Bishop, & Monaco, 2005; Pimperton & Nation, 2012; Ramus, Marshall, Rosen, & van der Lely, 2013; Schuchardt, Bockmann, Bornemann, & Maehler, 2013), reading (Swanson, Xinhua, & Jerman, 2009) and mathematics (McLean & Hitch, 1999; Swanson & Beebe-Frankenberger, 2004; Szucs, Devine, Soltesz, Nobes, & Gabriel, 2013; Szucs, Nobes, Devine, Gabriel, & Gebuis, 2013). It is also disrupted following brain injury (Cicerone & Giacino, 1992; Dunning, Westgate, & Adlam, 2016; Phillips, Parry, Mandalis, & Lah, 2017). In typically-developing populations, variation in WM skills is closely linked with practical abilities such as maintaining focused attention in everyday life and following instructions (Engle, Carullo, & Collins, 1991; Gathercole, Durling, Evans, Jeffcock, & Stone, 2008; Kane, Bleckley, Conway, & Engle, 2001).…”

Dynamic cognitive remediation for a Traumatic Brain Injury (TBI) significantly improves attention, working memory, processing speed, and reading fluency

“…The N-back task is one of the most frequently used WM paradigms (Gevins & Cutillo, 1993) to investigate the neural basis of WM processes. Meta-analyses indicate that the WM network consists of six reliably activated cortical regions (Owen, McMillan, Laird & Bullmore, 2005; Phillips, Parry, Mandalis & Lah, 2017): (1) bilateral rostral prefrontal cortex (rPFC) including frontal pole (FP, BA 10), ventromedial prefrontal cortex vmPFC, and orbitofrontal cortex (OFC, BA 11); (2) bilateral dlPFC (BA 9, 46); and (3) bilateral ventrolateral prefrontal cortex (vlPFC) or frontal operculum (BA 45,47); (4) bilateral medial posterior parietal cortex (PPC), including the precuneus, and the inferior parietal lobules (approximate BA7,40); (5) bilateral premotor cortex (BA 6, 8); and (6) dorsal cingulate/medial premotor cortex, including supplementary motor area (SMA; BA 32, 6). The cerebellum is also consistently activated during WM.…”