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Long-term cognitive outcome of childhood traumatic brain injury
Stockholm University, Faculty of Social Sciences, Department of Psychology.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There is limited knowledge of cognitive outcome extending beyond 5 years after childhood traumatic brain injury, CTBI. The main objectives of this thesis were to investigate cognitive outcome at 6-14 years after CTBI, and to evaluate if advancements in the neurosurgical care, starting 1992, did influence long-term outcome and early epidemiology. An additional aim was to study the relationship between early brain injury parameters and early functional outcome. Study 1 evaluated cognitive progress during 14 years after CTBI, over three neuropsychological assessments in 8 patients with serious CTBI. Study 2 used patient records to investigate early epidemiology, received rehabilitation and medical follow up in two clinical cohorts, n=82 and n=46, treated neurosurgically for CTBI before and after 1992. An exploratory cluster analysis was applied to analyse the relation between early brain injury severity parameters and early functional outcome. In Study 3, participants in the two cohorts, n=18 and n=23, treated neurosurgically for CTBI before and after 1992, were subject to an extensive neuropsychological assessment, 13 and 6 years after injury, respectively. Assessment results of the two cohorts were compared with each other and with controls. Data were analysed with multivariate analyses of variance. Results and discussion. There were significant long-term cognitive deficits of similar magnitude and character in the two cohorts with CTBI, treated before and after the advancements in neurosurgical care. At 6-14 years after injury, long-term deficits in verbal intellectual and executive functions were found, and were discussed in terms of their late maturation and a decreased executive control over verbal memory-functions after CTBI. Visuospatial functions had a slightly better long-term recovery. The amount of rehabilitation received was equally low in both cohorts. The length of time spent in intensive care and the duration of care in the respirator may have a stronger relationship to early outcome than does a single measure of level of consciousness at admission. Main conclusions are that cognitive deficits are apparent at long-term follow up, 6-13 years after neurosurgically treated CTBI, even after advancements in the neurosurgical care in Sweden. Measures of verbal IQ, verbal memory and executive functions were especially low while visuospatial intellectual functions appear to have a better long-term recovery.

Place, publisher, year, edition, pages
Stockholm: Department of Psychology, Stockholm University , 2010. , 74 p.
Keyword [en]
traumatic brain injury, childhood, adolescence, neurosurgical care, cognitive development, executive functions, memory, verbal functions, long-term outcome, recovery, rehabilitation, follow-up, cluster analysis
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:su:diva-38530ISBN: 978-91-7447-054-3 (print)OAI: oai:DiVA.org:su-38530DiVA: diva2:315423
Public defence
2010-05-28, David Magnusson salen (U31), hus 8, Frescati Hagväg 8, Stockholm, 10:00 (Swedish)
Opponent
Supervisors
Note
At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 3: Manuscript.Available from: 2010-05-06 Created: 2010-04-18 Last updated: 2011-05-25Bibliographically approved
List of papers
1. Neuropsychological progress during 14 yearsafter severe traumatic brain injury in childhoodand adolescence
Open this publication in new window or tab >>Neuropsychological progress during 14 yearsafter severe traumatic brain injury in childhoodand adolescence
2004 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 18, no 9, 921-934 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the impact of time since injury on  neuropsychological and psychosocial outcome after serious TBI in childhood or adolescence. Methods: The subjects were eight patients with serious TBI sustained at a mean age of 14 years who had been assessed neuropsychological at one, seven and 14 years after TBI. A retrospective longitudinal design was chosen to describe the development in six neuropsychological domains on basis of the assessments. Psychosocial data were gathered from clinical knowledge and a semi-structured interview at 14 years after TBI. Results: Performance of verbal IQ shows a declining trend over the three assessments, that the performance of attention and working memory is low and that verbal learning is the cognitive domain, which exhibits the largest impairments. The main psychosocial result is that three of the eight subjects go from a school situation with no adjustments to adult life with an early retirement. Conclusions: Time since insult is an important factor when assessing outcome after TBI in childhood and adolescence and that assessment of final outcome should not be done before adulthood.

Place, publisher, year, edition, pages
Taylor & Francis, 2004
Keyword
traumatic brain injury, childhood, cognitive development, long-term outcome
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-38554 (URN)10.1080/02699050410001671900 (DOI)
Available from: 2010-04-19 Created: 2010-04-19 Last updated: 2017-12-12Bibliographically approved
2. Long-term cognitive outcome after neurosurgically treated childhood traumatic brain injury
Open this publication in new window or tab >>Long-term cognitive outcome after neurosurgically treated childhood traumatic brain injury
2009 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 23, no 13-14, 1008-1016 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To explore the cognitive long term outcome of two cohorts of patients neurosurgically treated for childhood traumatic brain injury (CTBI), either in 1987-1991 according to an older concept, or 1997-2001 with a stronger emphasis on volume targeted interventions. Research design and methods: Participants in the two cohorts were subject to an extensive neuropsychological assessment, 13.2 and 6.1 years post injury, respectively. In a between group design, assessment results of the two cohorts, n 18 and n 23, were compared to each other and to controls. Data were analyzed with multivariate analyses of variance. Results: Long-term cognitive deficits for both groups of similar magnitude and character were observed in both groups. Abilities were especially low regarding executive and memory function and verbal IQ. The cognitive results are discussed in terms of  vulnerability of verbal functions and decreased executive control over memory-functions. Conclusions: There is a definite need for long term follow up of cognitive deficits after neurosurgically treated CTBI, also with the newer neurosurgical concept. Verbal learning and the executive control over memory functions should be addressed with interventions aimed at restoration, coping and compensation.

Place, publisher, year, edition, pages
Taylor & Francis, 2009
Keyword
Traumatic brain injury, paediatric, long-term, outcome, cognitive
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-38550 (URN)10.3109/02699050903379354 (DOI)000272556000003 ()
Available from: 2010-04-19 Created: 2010-04-19 Last updated: 2017-12-12Bibliographically approved
3. Traumatic brain injury in children treated at the neurosurgical unit at Sahlgrenska University Hospital in 1987-1991 and 1997-2001: An analysis of the process of care
Open this publication in new window or tab >>Traumatic brain injury in children treated at the neurosurgical unit at Sahlgrenska University Hospital in 1987-1991 and 1997-2001: An analysis of the process of care
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: In 1992, a new volume targeted treatment, the  “Lund Protocol”, was introduced in the field of neurosurgical care at Sahlgrenska University Hospital. The mortality rate for adults dropped markedly while the number of patients in a vegetative state remained at the same level. As  yet, changes in mortality and outcome for children have not been investigated in detail. Aim: To describe the causes and severity of injury, process of care from emergency care to rehabilitation, and the rate of received rehabilitation and to follow-up two cohorts treated for  child traumatic brain injury (CTBI) before and after the initiation of the  “Lund Protocol”. For group 2, treated after the initiation of  the  “Lund Protocol” an additional aim was to relate brain injury severity parameters in the acute care stage to functional outcome. Methods: A retrospective population-based study of patient records of former paediatric patients treated  neurosurgically for CTBI between 1987-1991 and 1997-2001. Epidemiological results are presented as descriptive statistics. To evaluate the relationship between brain injury parameters and outcome an exploratory cluster analysis was performed on the data from group 2. Results: For both groups traffic accidents were the most common cause of injury. The Glasgow Coma Scale indicated a more severe injury level in group1. The mortality rate in group1 was 8 %  compared with 2 % in group 2 (n.s.). The Glasgow outcome score was on the same level (median 5), and the rate of received rehabilitation was equally low in both groups, 27 % versus 33 %. The cluster analysis revealed that length of care and time in a respirator had a stronger relationship with outcome than the Reaction Level Scale (RLS). Conclusion: There is still no stable process of care after CTBI as 67 % in the later treated group did not receive rehabilitation and 50 % of those did not receive any medical check- ups in the long- term perspective. 

Identifiers
urn:nbn:se:su:diva-38587 (URN)
Available from: 2010-04-19 Created: 2010-04-19 Last updated: 2010-04-29Bibliographically approved

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