Cognitive recovery of children and adolescents with moderate to severe TBI during inpatient rehabilitation

Blackwell, Laura S.; Shishido, Yuri; Howarth, Robyn

doi:10.1080/09638288.2020.1788176

Cited by 11 publications

(11 citation statements)

References 24 publications

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“…Specifically, we investigated the predictive utility of scores on the CALS, a serial measure of cognitive recovery used in many pediatric inpatient rehabilitation settings. Previous studies examining the relationship between CALS scores and outcomes following pediatric TBI have suggested that the CALS is associated with functional outcomes (eg, WeeFIM scores) 15,25,30. Based on our analyses, CALS discharge scores were predictive of outcomes on the GOS-E Peds 2 months after discharge, as well as at 1 year.…”

Section: Discussionsupporting

confidence: 58%

“…Previous studies examining the relationship be-tween CALS scores and outcomes following pediatric TBI have suggested that the CALS is associated with functional outcomes (eg, WeeFIM scores). 15,25,30 Based on our analyses, CALS discharge scores were predictive of outcomes on the GOS-E Peds 2 months after discharge, as well as at 1 year. That said, at each time point, CALS discharge scores accounted for only roughly a quarter of the variance in GOS-E Peds scores, suggesting that other factors also impact a child's functioning during recovery.…”

Section: Discussionmentioning

confidence: 75%

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Predicting Outcomes 2 Months and 1 Year After Inpatient Rehabilitation for Youth With TBI Using Duration of Impaired Consciousness and Serial Cognitive Assessment

Lundine

Koterba

Shield

et al. 2022

Journal of Head Trauma Rehabilitation

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Objective: To examine predictive utility of the Glasgow Coma Scale (GCS), time to follow commands (TFC), length of posttraumatic amnesia (PTA), duration of impaired consciousness (TFC+PTA), and the Cognitive and Linguistic Scale (CALS) scores in predicting outcomes on the Glasgow Outcome Scale–Extended, Pediatric Revision (GOS-E Peds) for children with traumatic brain injury (TBI) at 2 months and 1 year after discharge from rehabilitation. Setting: A large, urban pediatric medical center and inpatient rehabilitation program. Participants: Sixty youth with moderate-to-severe TBI (mean age at injury = 13.7 years; range = 5-20). Design: A retrospective chart review. Main Measures: Lowest postresuscitation GCS, TFC, PTA, TFC+PTA, inpatient rehabilitation admission and discharge CALS scores, GOS-E Peds at 2-month and 1-year follow-ups. Results: CALS scores were significantly correlated with the GOS-E Peds at both time points (weak-to-moderate correlation for admission scores and moderate correlation for discharge scores). TFC and TFC+PTA were correlated with GOS-E Peds scores at a 2-month follow-up and TFC remained a predictor at a 1-year follow-up. The GCS and PTA were not correlated with the GOS-E Peds. In the stepwise linear regression model, only the CALS at discharge was a significant predictor of the GOS-E Peds at the 2-month and 1-year follow-ups. Conclusions: In our correlational analysis, better performance on the CALS was associated with less long-term disability, and longer TFC was associated with more long-term disability, as measured by the GOS-E Peds. In this sample, the CALS at discharge was the only retained significant predictor of GOS-E Peds scores at 2-month and 1-year follow-ups, accounting for roughly 25% of the variance in GOS-E scores. As previous research suggests, variables related to rate of recovery may be better predictors of outcome than variables related to severity of injury at a single time point (eg, GCS). Future multisite studies are needed to increase sample size and standardize data collection methods for clinical and research purposes.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 75%

Predicting Outcomes 2 Months and 1 Year After Inpatient Rehabilitation for Youth With TBI Using Duration of Impaired Consciousness and Serial Cognitive Assessment

Lundine

Koterba

Shield

et al. 2022

Journal of Head Trauma Rehabilitation

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“…Others have confirmed that greater Length of Stay (LOS) is associated with poorer outcome at discharge. 24,25 "Rehabilitation efficiency" measures (functional gain per day) have been suggested as a solution to the LOS issue 26 however the primary aim of this paper is to draw attention to a less-emphasized limitation of basic "input" measures such as the RCS (even without the days multiplier), namely that it and similar measures are insensitive to variation in rehabilitation treatment content.…”

Section: Discussionmentioning

confidence: 99%

Demonstration of functional rehabilitation treatment effects in children and young people after severe acquired brain injury

Forsyth

Hamilton

Ingram

et al. 2021

Developmental Neurorehabilitation

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Purpose: To examine relationships between functional outcomes after pediatric acquired brain injury (ABI) and measures of rehabilitation dose. Methods: An observational study of children receiving residential neurorehabilitation after severe ABI. Results: Basic total rehabilitation dose shows a paradoxical inverse relationship to global outcome. This is due to confounding by both initial injury severity and length of stay, and variation in treatment content for a given total rehabilitation dose. Content-aware rehabilitation dose measures show robust positive correlations between fractions of rehabilitation treatment received and plausibly related aspects of outcome: specifically, between rates of recovery of gross motor function and the fraction of rehabilitation effort directed to active practice and motor learning. This relationship was robust to adjustment for therapists' expectations of recovery. Conclusion: Content-aware measures of rehabilitation dose are robustly causally related to pertinent aspects of outcome. These findings are step toward a goal of comparative effectiveness research in pediatric neurorehabilitation.

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“…However, the relationship between PTA duration groups and cognitive performance at the initial stages of recovery and rehabilitation may suggest a useful way for evaluating cognitive and functional prognoses. As significant changes are commonly reported in cognitive functioning during the first year following msTBI (Anderson & Moore, 1995; Blackwell et al, 2020), the associations between cognitive functioning and the suggested extension of PTA groups should be evaluated also at the chronic phase (e.g., at least 1 year post-injury) as well as in the adult population.…”

Section: Discussionmentioning

confidence: 99%

Prolonged duration of post-traumatic amnesia: A sensitive classification for predicting cognitive outcomes in children recovering from traumatic brain injury

Segev

Silberg

Bar

et al. 2023

J Int Neuropsychol Soc

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Objective: A paucity of data exists regarding the duration of post-traumatic amnesia (PTA) as a predictor of cognitive functioning among children after traumatic brain injury (TBI). The study aimed to assess the relationship between PTA duration and areas of neurocognitive function among the pediatric population in the sub-acute phase of recovery and rehabilitation. Methods: Data were collected from medical files on 103 children aged 5.5–16.5 hospitalized at a pediatric rehabilitation department with a diagnosis of moderate–severe TBI (msTBI) between the years 2004–2019. The Children Orientation and Amnesia Test was used to evaluate PTA duration. Measures of high-order cognitive abilities of attention and executive function were collected using the Test of Everyday Attention–Child version (TEA-Ch). Results: Three PTA duration groups were assembled out of a cluster analysis: “Long PTA” (M = 21 days), “Very Long PTA” (M = 47 days), and “Extremely Long PTA” (M = 94 days). Analyses revealed that the “Long PTA” group preformed significantly better than the “Very Long PTA” and “Extremely Long PTA” groups on all TEA-Ch measures, that is, Selective Attention, Attentional Control Switching, and Sustained Attention. Conclusions: This study is the first to demonstrate that PTA duration is a useful predictor of high-order cognitive functions among children with msTBI in the sub-acute phase of recovery and rehabilitation. The findings emphasize the importance of using a more sensitive classification of prolonged PTA durations to improve outcome prediction and allocation of resources to those who can benefit most after severe brain injuries.

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Cognitive recovery of children and adolescents with moderate to severe TBI during inpatient rehabilitation

Cited by 11 publications

References 24 publications

Predicting Outcomes 2 Months and 1 Year After Inpatient Rehabilitation for Youth With TBI Using Duration of Impaired Consciousness and Serial Cognitive Assessment

Predicting Outcomes 2 Months and 1 Year After Inpatient Rehabilitation for Youth With TBI Using Duration of Impaired Consciousness and Serial Cognitive Assessment

Demonstration of functional rehabilitation treatment effects in children and young people after severe acquired brain injury

Prolonged duration of post-traumatic amnesia: A sensitive classification for predicting cognitive outcomes in children recovering from traumatic brain injury

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