Mathematical Outcomes and Working Memory in Children With TBI and Orthopedic Injury

Abstract

This study compared mathematical outcomes in children with predominantly moderate to severe traumatic brain injury (TBI; n =50) or orthopedic injury (OI; n=47) at 2 and 24 months post-injury. Working memory and its contribution to math outcomes at 24 months post-injury was also examined. Participants were administered an experimental cognitive addition task and standardized measures of calculation, math fluency, and applied problems; as well as experimental measures of verbal and visual-spatial working memory. Although children with TBI did not have deficits in foundational math fact retrieval, they performed more poorly than OIs on standardized measures of math. In the TBI group, performance on standardized measures was predicted by age at injury, socioeconomic status, and the duration of impaired consciousness. Children with TBI showed impairments on verbal, but not visual working memory relative to children with OI. Verbal working memory mediated group differences on math calculations and applied problems at 24 months post-injury. Children with TBI have difficulties in mathematics, but do not have deficits in math fact retrieval, a signature deficit of math disabilities. Results are discussed with reference to models of mathematical cognition and disability and the role of working memory in math learning and performance for children with TBI.

A meta-analysis of working memory impairments in survivors of moderate-to-severe traumatic brain injury.

“…Deficits were also observed in verbal STM. This is consistent with previous reports of specific impairments in verbal aspects of STM (i.e., phonological loop) in children following TBI (Anderson & Catroppa, 2005; Anderson, Catroppa, Rosenfeld, Haritou, & Morse, 2000; Raghubar, Barnes, Prasad, Johnson, & Ewing-Cobbs, 2013), which could arise from damage to parts of the ventral and dorsolateral PFC that support the storage of verbal information (Curtis & D’Esposito, 2003).…”

“…To maintain a degree of homogeneity, we included only studies using healthy comparison groups. Several studies were therefore excluded because their controls were individuals with orthopedic injury (e.g., Newsome et al, 2007; Raghubar et al, 2013; Schwartz et al, 2003). Although this choice of control group is common in TBI research, because it provides a suitable control for nonspecific risk factors (e.g., preinjury risk factors; Taylor et al, 2002), we chose to include only studies with healthy controls to enable us to quantify impairments in TBI survivors relative to individuals with “typical” brain development.…”

Long-Term Neuropsychological Profiles and Their Role as Mediators of Adaptive Functioning after Traumatic Brain Injury in Early Childhood

“…Recent studies have begun to employ mediation analyses to identify neuropsychological skills underlying functional deficits in children with TBI relative to comparison groups. These analyses have identified mediation effects of verbal working memory on math performance, 50 of selfregulation skills on social and behavioral functioning, 51 and of theory of mind skills on social outcomes. 52 To our knowledge, no prior study has examined neuropsychological skills as mediators of the effect of childhood TBI on long-term adaptive functioning.…”

A pilot study evaluating attention and strategy training following pediatric traumatic brain injury.

“…Impairments in attention, working memory (WM), and executive function (EF) are among the most frequently reported symptoms by parents and teachers following pediatric acquired and developmental cognitive impairments (Diamond, 2012; Max et al, 2005). Disruption of these critical cognitive processes are responsible for a wide range of academic and adjustment issues (Diamond, 2012; Holmes, Gathercole, & Dunning, 2009; Raghubar, Barnes, Prasad, Johnson, & Ewing-Cobbs, 2013). These findings are not surprising considering that attention, WM, and EFs underlie most higher order cognition, and that the networks subserving these processes are widely distributed and highly integrated (Klingberg, 2010).…”