Children with BEH display long-term subtle neurocognitive difficulties. Non-operated children performed significantly better on some neuropsychological measures and reported less psychosocial problems. This difference may be caused by a selection bias: neurosurgical intervention was more likely in children with clinically more pronounced symptoms.
Cerebral palsy (CP) is associated with cognitive impairments, learning difficulties and reduced social participation. Individual assessment is necessary for individually tailored interventions. This paper describes the development of a systematic follow-up programme of cognition, and the challenges of integrating it into the regular follow-up of children with CP. Initiated by the Nordic users' organisations, a group of psychologists proposed a protocol of follow-up of cognition in children with CPthe CP Cog. This protocol consists of neuropsychological instruments covering general cognitive functioning, visuospatial and executive functioning. The article presents a natural experiment describing development and implementation of the cognitive protocol in three Scandinavian countries. This introduction illustrates challenges associated with implementation, especially how the success of the protocol hinges on structural backup within the different countries. In conclusion the CP Cog assessment protocol holds the promise of increasing the awareness among habilitation professionals that children with CP are in need of cognitive evaluation and educational support.
Descriptions of clinical outcomes in pediatric traumatic brain injury (pTBI) in Scandinavia are sparse. The Oslo site of the European CENTER-TBI study has performed a pTBI outcome study in a hospitalized population. The main objective was to investigate neuropsychological outcomes, self- and parent-reported symptoms associated with brain injury, and quality of life in children aged 1–15 years, 5–8 months after injury. Fifty-two children were included, and 45 completed the assessments. The sample consisted of 15.4% severe, 21.2% moderate, and 63.4% mild TBI. Subjectively experienced problems with concentration and fatigue were reported by the parents of nearly half of the children. Higher brain injury symptom load was associated with lower quality of life, but was unrelated to injury severity. Group average scores of the sample on neuropsychological testing appeared unimpaired relative to normative means aside from lower performance in working memory. However, based on an impairment index (i.e., 2 or more tests being >1.5 SD below the normative mean), the presence of weak cognitive performance was evident in as many as 45.4% of the sample. Two-thirds of the sample also showed abnormally large intraindividual variability in cognitive functioning (i.e., significant WISC-IV index discrepancies). The findings highlight the need to look beyond group averages on neuropsychological testing. Utilizing an impairment index and considering intraindividual performance variability conveyed deficits that may warrant clinical follow-up. The association of brain injury symptoms with quality of life but not injury severity emphasizes the need to consider symptoms after TBI within a biopsychosocial framework.Clinical Trial Registration:ClinicalTrials.gov; identifier: NCT02210221.
AIM: To investigate the impact on quality of life (QoL) of medical complications, adjuvant treatment, cognitive function, gender and age at diagnosis 5 or more years after the initial treatment for brain tumour in childhood. MATERIALS AND METHODS: 66 children were included, 41 girls and 25 boys, 43 with benign and 23 with malignant tumours. All have completed a comprehensive neuropsychological and psychosocial evaluation 5 years after end of treatment, included answering the questionnaire Pediatric Quality of Life Inventory (PedsQL), both children and parents. RESULTS: Children who had benign tumours, but who had medical complications after the initial operation (SC), reported significantly (p , 0.05) more problems compared to those who had an operation only (SO), on all PedsQL dimensions. Children who had adjuvant treatment (SA) reported significantly (p , 0.05) more problems compared to children who had surgery only on the physical, social, and school dimensions, but not on the emotional dimension on PedsQL. No significant differences were found between the groups with medical complications and adjuvant treatment. The parents' ratings on PedsQL did not differ significantly from the children's. There were no significant differences between the three groups with regards to IQ, age at diagnosis and gender. CONCLUSION: Having a childhood benign tumour that needs medical treatment after the operation, has a significant impact on quality of life, long after treatment is completed, equal to having a malignant tumour needing adjuvant treatment. Factors as IQ, gender and age at diagnosis are less influential.
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