Functional Plasticity in Childhood Brain Disorders: When, What, How, and Whom to Assess

Abstract

At every point in the lifespan, the brain balances malleable processes representing neural plasticity that promote change with homeostatic processes that promote stability. Whether a child develops typically or with brain injury, his or her neural and behavioral outcome is constructed through transactions between plastic and homeostatic processes and the environment. In clinical research with children in whom the developing brain has been malformed or injured, behavioral outcomes provide an index of the result of plasticity, homeostasis, and environmental transactions. When should we assess outcome in relation to age at brain insult, time since brain insult, and age of the child at testing? What should we measure? Functions involving reacting to the past and predicting the future, as well as social-affective skills, are important. How should we assess outcome? Information from performance variability, direct measures and informants, overt and covert measures, and laboratory and ecological measures should be considered. In whom are we assessing outcome? Assessment should be cognizant of individual differences in gene, socio-economic status (SES), parenting, nutrition, and interpersonal supports, which are moderators that interact with other factors influencing functional outcome.

Predictors of longitudinal outcome and recovery of pragmatic language and its relation to externalizing behaviour after pediatric traumatic brain injury

“…Age at brain insult may influence outcome and recovery of neurobehavioural skills (Anderson, Spencer-Smith, & Wood, 2011;Anderson et al, 2009;Jacobs, Harvey, & Anderson, 2007), although this is likely not a linear association, but rather influenced by critical periods during development, such that outcomes are dependent on neurological and cognitive development at the time of insult (Anderson et al, , 2011Crowe, Catroppa, Babl, Rosenfeld, & Anderson, 2012;Dennis, 1988;Dennis et al, 2014;Kolb, Pellis, & Robinson, 2004). It has been argued that neurocognitive skills emerging or developing at the time of insult are at heightened risk for persisting disruption, while established skills may experience transient disruption before recovering to levels that approximate pre-injury baseline (Dennis, 1988;Dennis et al, 2014).…”

“…It has been argued that neurocognitive skills emerging or developing at the time of insult are at heightened risk for persisting disruption, while established skills may experience transient disruption before recovering to levels that approximate pre-injury baseline (Dennis, 1988;Dennis et al, 2014). Since pragmatic communication skills undergo protracted development through the early school years and into adolescence (Didus et al, 1999;Dumontheil, Apperly, & Blakemore, 2010;Gerrard-Morris et al, 2010), a critical period model would predict that these skills are at heightened risk for disruption during middle childhood, when they are undergoing rapid development and refinement.…”

Evidence of Cerebellar Dysfunction in Children with Myelomeningocele?

“…Paralysis of the lower extremities is evident and related to the level of the developmental defect. Two-thirds of children with SBM also exhibit upper extremity impairments due to cerebellar structural changes [13,26]. Despite the ability to learn motor tasks, the ability to adapt tasks while learning a sequence of movements is impaired in this group of children.…”

“…The anterior lobe of the cerebellum is intact and enlarged in children with SBM while the posterior lobe of the cerebellum is reduced [13]. The reduction of the posterior cerebellum produces deficits in the cognitive part of the cerebellum.…”

“…The cerebellum is an important part of the neural network for procedural motor learning [12]. The anterior lobe of the cerebellum is intact and enlarged in children with SBM while the posterior lobe of the cerebellum is reduced [13]. The reduction produces deficits in the cognitive part of the cerebellum.…”