Academic Outcomes After Pediatric Traumatic Brain Injury

儿童脑外伤后的学业成绩

• 批准号: 6862689
• 负责人: LINDA EWING-COBBS
• 金额: $ 59.53万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-05-01 至 2009-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6862689
• 关键词: academic achievement; adolescence (12-20); atrophy; behavioral /social science research tag; brain injury; brain morphology; child behavior; clinical research; cognition; gray matter; human subject; longitudinal human study; magnetic resonance imaging; memory; middle childhood (6-11); neuroimaging; outcomes research; pediatrics; white matter

DESCRIPTION (provided by applicant): The overarching aim of the application is to model multivariate relations between neuroimaging, cognitive, and psychosocial predictors of academic outcomes after traumatic brain injury (TBI). Academic deficits are among the most significant and pervasive areas of deficit after TBI in school-aged children and adolescents. Moderate to severe TBI is associated with deficits in executive processes that influence outcomes in many domains, including academic skill development, academic performance, and child adjustment. Traditional achievement measures grossly underestimate the functional academic deficits of children with TBI as they infrequently examine related components of executive processing. To address these limitations, we developed integrative academic tasks that incorporate more real-world demands for speed and automaticity of symbol manipulation, inferencing, cohesion, strategy use, resistance to distraction, and comprehension monitoring. We will administer a battery of 1) executive processing tasks assessing processing speed, working memory, and inhibitory control, 2) core achievement tasks, 3) integrative academic tasks and 4) measures of child adjustment to characterize post-traumatic deficits impacting academic outcomes. We propose to use multiple quantitative structural neuroimaging methods, including DT-MRI and volumetric analyses of white and gray matter, to characterize microstructural and macrostructural damage to neural systems and to examine brain-behavior relations after TBI. Study 1 prospectively examines academic outcomes 2, 6, 12, and 24 months after moderate to severe TBI in youth ages 6-15 at the time of injury and an orthopedic comparison group. MRI studies will be obtained at 2 and 24 months after injury for both groups. Study 2 will examine extended follow-up 3 to 8 years after moderate to severe TBI in a cohort of children who sustained TBI at 0-14 years of age in relation to healthy controls. Study 2 allows characterization of the impact of indices of diffuse and focal injury on the late consequences of brain injury. Quantitative MRI will examine late changes in diffusion anisotropy as well as global and regional atrophy as they relate to academic outcomes. Our approach to prediction of outcomes is unique as it emphasizes 1) more precise behavioral measures related to executive processes and integrative academic skills, 2) measures of factors affecting child adjustment; and 3) quantitative indices of macrostructural and microstructural brain injury that are linked through a developmental model.

描述（由申请人提供）：该应用程序的总体目标是对创伤性脑损伤（TBI）后学业结果的神经影像、认知和心理社会预测因素之间的多元关系进行建模。学业缺陷是学龄儿童和青少年 TBI 后最显着和最普遍的缺陷之一。中度至重度 TBI 与执行过程的缺陷有关，影响许多领域的结果，包括学术技能发展、学习成绩和儿童适应。传统的成绩衡量标准严重低估了 TBI 儿童的功能性学术缺陷，因为他们很少检查执行处理的相关组成部分。为了解决这些局限性，我们开发了综合性学术任务，其中包含了更多现实世界对符号操作、推理、凝聚力、策略使用、抗干扰和理解监控的速度和自动化的需求。我们将管理一系列 1) 执行处理任务，评估处理速度、工作记忆和抑制控制，2) 核心成就任务，3) 综合学术任务和 4) 儿童适应措施，以描述影响学业成果的创伤后缺陷。我们建议使用多种定量结构神经成像方法，包括 DT-MRI 和白质和灰质的体积分析，来表征神经系统的微观结构和宏观结构损伤，并检查 TBI 后的大脑与行为关系。研究 1 前瞻性地考察了受伤时 6-15 岁青少年中度至重度 TBI 后 2、6、12 和 24 个月的学业结果以及骨科对照组。两组患者均在受伤后 2 个月和 24 个月时进行 MRI 研究。研究 2 将检查一组 0-14 岁遭受 TBI 的儿童与健康对照组相比，中度至重度 TBI 后 3 至 8 年的长期随访。研究 2 描述了弥漫性和局灶性损伤指数对脑损伤后期后果的影响。定量 MRI 将检查扩散各向异性的后期变化以及与学业成果相关的整体和区域萎缩。我们预测结果的方法是独特的，因为它强调1）与执行过程和综合学术技能相关的更精确的行为测量，2）影响儿童适应因素的测量； 3）通过发育模型联系起来的宏观结构和微观结构脑损伤的定量指标。