Strategic Learning in Youth With Traumatic Brain Injury

Abstract

Little is known about strategic learning ability in preteens and adolescents with traumatic brain injury (TBI). Strategic learning is the ability to combine and synthesize details to form abstracted gist-based meanings, a higher-order cognitive skill associated with frontal lobe functions and higher classroom performance. Summarization tasks were used to measure strategic learning ability through the production of abstracted gist-based concepts, and specific probes measured memory for explicit details. Twenty middle school-aged preteens and teenagers who sustained a moderate to severe TBI 1 year postinjury and a control group of 20 typically developing 10-to 15-year-old subjects participated in this study. The results revealed that the youth with moderate to severe TBI were able to recall specific details at a comparable level to the control group. However, the youth with TBI demonstrated significantly lower strategic learning competence, as manifested by a reduced ability to combine details into gist-based ideas. The present findings advance the notion that skills that have not yet developed at the time of brain injury or are in a stage of development may be particularly vulnerable to the long-term and lasting sequelae of TBI in youth, although a longitudinal study is needed to verify this claim.

Gist reasoning training in cognitively normal seniors

“…The findings related to generalization observed in this study suggest that a strategy-oriented approach to training could yield strengths similar to process training in terms of generalization when the strategies target complex functions that have ecological value. Furthermore, these findings raise the question of potential neural overlap in gist reasoning and executive functions as observed in our previous studies involving clinical populations (Ulatowska and Chapman, 1989;Gamino et al, 2009;Vas et al, 2009). It would be informative to discern the extent to which gist reasoning engages similar top-down cognitive control processes as the selected measures of executive function or alternatively the degree that gist reasoning incorporates components of executive function as basic building blocks.…”

“…(Willis et al, 2006;Levine et al, 2007;van Hooren et al, 2007). For example, training that targets gist reasoning, defined as the ability to derive global meaning from explicit details, has been shown to improve meaning abstraction and other executive functions such as inhibition and working memory in clinical populations such as those with brain injury (Vas et al, 2009(Vas et al, , 2010, stroke (Ulatowska and Chapman, 1989), and attention deficit hyperactivity disorder (Gamino et al, 2009).…”

“…Studies involving individuals with fronto-temporal dementia and adults with traumatic brain injury suggest that gist reasoning relies heavily on the integrity of frontal cortices and its extensive reciprocal connections with other cortical and subcortical structures similar to that of executive functions (Chapman et al, 2005;Wong et al, 2006). Empirical evidence indicates that gist reasoning incorporates components of executive functions such as selective attention and inhibition, all of which engage top-down cognitive control processes (Gamino et al, 2009;Vas et al, 2010). Thus, a strategy-based approach to training gistreasoning mightnot onlystrengthen abstraction skills in seniors but might generalize to untrained executive functions that are engaged during gist reasoning.…”

The Importance of Orientation in Evaluating Recovery in Pediatric Traumatic Brain Injury

“…Evidence indicates that children who sustain a moderate or severe TBI in infancy or early childhood are particularly vulnerable to longer term consequences than are those who sustain injury later in childhood [17]. Chapman et al [18] reported that cognitive and language skills that are not developed at the time of the brain injury, or are in a stage of development, may be particularly vulnerable to long term sequel of TBI. Reliance on elements of orientation, even those most reliable for the child's age is inadequate for predicting broader cognitive and linguistic functioning.…”

Recommendations for the Use of Common Outcome Measures in Pediatric Traumatic Brain Injury Research

“…The Pediatric CDE Workgroup recommends using the vocabulary subtest as a brief measure of language functioning. Although the WASI does not have specific sensitivity to mild injury severity, it has been shown to be sensitive to a range of neurologic conditions including moderateto-severe TBI (Gamino et al, 2009;Wechsler, 1999). Other Wechsler vocabulary scales have been used to measure language in children with TBI (Catroppa and Anderson, 2004;.…”