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  • 1.
    Aaro Jonsson, Catherine
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Horneman, Göran
    Department of Psychology, Gothenburg University, Sweden.
    Emanuelson, Ingrid
    Institute for the Health of Women and Children, Sahlgrenska Academy at Göteborg.
    Neuropsychological progress during 14 yearsafter severe traumatic brain injury in childhoodand adolescence2004In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 18, no 9, p. 921-934Article in journal (Refereed)
    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.

  • 2.
    Aaro Jonsson, Catherine
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Smedler, Ann-Charlotte
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Leis Ljungmark, Mia
    Institution for clinical sciences, Dept. of pediatrics, Sahlgrenska Academy at Göteborg University.
    Emanuelson, Ingrid
    Institution for clinical sciences, Dept. of pediatrics, Sahlgrenska Academy at Göteborg University.
    Long-term cognitive outcome after neurosurgically treated childhood traumatic brain injury2009In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 23, no 13-14, p. 1008-1016Article in journal (Refereed)
    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.

  • 3.
    Emanuelson, Ingrid
    et al.
    Institute of Clinical Sciences, Dept. of Pediatrics at Sahlgrenska Academy University of Gothenburg.
    Aaro Jonsson, Catherine
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rydenhag, Bertil
    Institute of Neuroscience at Sahlgrenska Academy University of Gothenburg.
    Silander, Hans
    Institute of Neuroscience at Sahlgrenska Academy University of Gothenburg.
    Åkerman, Anna-Karin
    Institute of Clinical Sciences, Dept. of Pediatrics at Sahlgrenska Academy University of Gothenburg.
    Smedler, Ann-Charlotte
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    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 careManuscript (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. 

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