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To assess the knowledge of professionals on abusive head trauma (AHT) and shaking so as to adapt their training and thus promote the improvement of AHT screening and prevention. A questionnaire was developed on the knowledge of the intensity of movement, the frequency of repetition, the existence and progression of sequelae over time, the legal nature of AHT as a criminal offence leading to the possibility of compensation, and the existence of HAS (French National Authority for Health) recommendations on shaken baby diagnosis and legal consequences. Over a 4-year period 311 physicians, 123 magistrates, and 644 early childhood professionals responded to the questionnaire as an introduction to a course on AHT. Whatever the professional field, incorrect answers (wrong or "I don't know") were frequent as to the possibility that play could induce AHT lesions (51–58%), the violence of the act (43–52%), the repetition of shaking (58–82.5%), the presence of side effects (52–58%), and the existence of recommendations to professionals (48–58.5%). Twenty to 47% of physicians and early childhood professionals were unaware that shaking a baby was a criminal offence and 20–27% were unaware that AHT required a report to the judicial authorities. This lack of knowledge about AHT is detrimental to the child. The improvement of initial and continuing education is necessary to help reduce the dysfunctions existing in the care of child victims of AHT. [ABSTRACT FROM AUTHOR]

Abusive head trauma (AHT) is still too common, and probably underestimated. It is the leading cause of death from child abuse. Crying is thought to contribute to the act of shaking. Objectives of this study were to (a) assess parents’ knowledge about infant crying, their ability to manage crying, and their knowledge about AHT; and (b) assess the feasibility and the impact of a simple educational intervention about crying and AHT with parents shortly after their child's birth. A short questionnaire was completed orally by the parents of 190 consecutive newborns in a maternity hospital at day 2 of life. Then, during the routine examination of the child, the pediatrician gave parents a short talk about infant crying and AHT, and a pamphlet. Finally, parents were contacted by phone at 6 weeks for the post-intervention questionnaire assessing their knowledge about crying and AHT. Among 202 consecutive births, parents of 190 children were included (266 parents; 70% mothers) over a 1-month period and answered the pre-intervention questionnaire. The intervention was feasible and easy to provide. Twenty-seven percent of mothers and 36% of fathers had never heard of AHT. At 6 weeks, 183 parents (68% of the sample; 80% mothers) answered the post-intervention questionnaire. Parents’ knowledge improved significantly post-intervention. Parents found the intervention acceptable and useful. Health care professionals such as pediatricians or nurses could easily provide this brief talk to all parents during systematic newborn examination. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Studies of long-term outcome of the shaken baby syndrome (SBS) are scarce, but they usually indicate poor outcome. Objectives: To describe long-term outcome of a child having sustained a SBS, to ascertain possible delayed sequelae and to discuss medicolegal issues. Methods: We report a single case study of a child having sustained a SBS, illustrating the initial clinical features, the neurological, cognitive and behavioural outcomes as well as her social integration. Results: The child sustained diffuse brain injuries, responsible for spastic right hemiplegia leading to secondary orthopaedic consequences, as well as severe cognitive impairment, worsening over time: the developmental quotient measured at 15 months of age was 55 and worsened as age increased. At 6 years and 8 months, the child''s IQ had fallen to 40. Behavioural disorders became apparent only after several months and precluded any social integration. The child eventually had to be placed in a specialised education centre at age 5. Discussion and conclusion: The SBS has a very poor outcome and major long-standing sequelae are frequent. Cognitive or behavioural sequelae can become apparent only after a long sign-free interval, due to increasing demands placed on the child during development. This case report confirms severity of early brain lesions and necessity for an extended follow-up by a multi-disciplinary team. From a medicolegal point of view, signaling the child to legal authorities allows protection of the child, but also conditions later compensation if sequelae compromise autonomy. [Copyright &y& Elsevier]

Abstract: Introduction: The duration of post-traumatic amnesia (PTA), the period of altered memory that often follows traumatic brain injury (TBI), is a useful index of severity of TBI and a predictor of outcome after TBI. Yet, evaluating PTA in French-speaking brain-injured children is not standardized. Objective: We aimed to translate into the French language and standardize the Children’s Orientation and Amnesia Test (COAT), inspired by the Galveston Orientation and Amnesia Test (GOAT), which estimates PTA duration in adults. Method: Development of a French version of the COAT (COAT-VF) with 16 items: 7 of general orientation, 5 temporal orientation and 4 memory. Normative data were collected for 137 children aged 4, 6, 8 and 10 years who were attending school. Results: Performance on the COAT-VF was influenced by age and sociocultural factors but not sex. Conclusion: The COAT-VF, short and simple to administer, allows for an accurate evaluation of PTA duration in French children. [Copyright &y& Elsevier]

Abstract: The objective of this study was to evaluate the management of multiresistant bacteria infection in French rehabilitation units. We e-mailed a questionnaire to French rehabilitation practitioners asking them what they did and what they knew about multiresistant bacteria colonisation. Their answers are described and analysed. We received 60 answers representing most of the country''s rehabilitation centers. Routine screening was rare, but multiresistant bacteria were often looked for when certain risk factors were present. Methicillin-resistant Staphylococcus aureus and multiresistant enterobacteria were the usual target germs. In general, respondents asked for evidence-based recommendations that are also applicable without too great a prejudice (for the rehabilitation as well as for the psychological state) for a patient hospitalised in a rehabilitation unit. The legal risks and the costs involved are also to be tested. Many questions lay unanswered, although the literature is rich in descriptions of this area. The opposition between the medical advice of isolation and the readaptation objectives of a rehabilitation unit are strong. This study aims to highlight the most important uncertainties so as to promote prospective studies and enlighten the legal authorities. [Copyright &y& Elsevier]

New challenges in rehabilitation for children with neurological diseases directly depend on advances made in medical research and on the quality of the environment. This is relevant to motor function as a whole, to new therapeutic avenues in spasticity, to global approaches in the evaluation of cognitive and learning disabilities, as well as curative perspectives in neuromuscular disease. Networking with the family and other actors in the environmental field is essential to achieve a better social integration. A true collaboration between physicians and pediatricians is necessary to work toward more progress. [ABSTRACT FROM AUTHOR]

Abstract: The Shaken Baby Syndrome (SBS) is a severe inflicted brain injury due to an adult violently shaking an infant. Diagnostic guidelines have been recently published by the “Haute Autorité de santé”. The mortality rate after SBS is 21.6 % and the long-term outcome is good for only 8 to 36 % patients followed over more than 5 years. The aim of this article is to describe sequelae after a SBS, their mechanisms, prognostic factors and recommendations for a better long-term care of the patients. [Copyright &y& Elsevier]

Objective Evaluate the professionals’ knowledge over SBS in order to adapt their training. Method A quiz was set up to know professionals’ knowledge over: intensity of the movement; frequence of the recurrence; shaking a baby vs. willing only to shake it; existence of sequels, their intensity and evolution over time; knowledge that SBS is a penal offense giving way to financial compensations; knowledge of guidelines to professionals issued by the national authority of health. Results 393 physicians/judges and professionals of childcare went through this test. Whatever the speciality, most of the professionals were not able to answer correctly. Typically, they thought that the mechanism was not necessarily violent/that lesions can be induced by game/that most often shaking is not repeated/that it does not trigger sequels/that sequels vanish with time/as well, they ignored that shaking is a penal offense giving way to financial compensation as well as the existence of official guidelines on SBS. Discussion Lack of knowledge in this field is detrimental to children. For instance, detecting the first signs of violence is crucial to prevent reiteration. Taking care adequately of the brain-injured children is crucial to prevent sequels. Better training for everyone is the key. [ABSTRACT FROM AUTHOR]

Severe childhood traumatic brain injury (TBI) leads to long-standing executive function and attention deficits, with negative consequences for participation, academic outcome and independence. This study aimed to assess executive function and attention 7 years after severe childhood TBI in comparison with a matched control group and to investigate associated factors. Children (< 15 years) with severe accidental TBI consecutively admitted in a single trauma center over 3 years were included in the Traumatisme Grave de l'Enfant (TGE) prospective longitudinal study. Of the 81 children initially included, 65 survived. At 7 years post-TBI, executive functions and attention were assessed in 27 participants (42 % of the 65 survivors) by using a combination of computerized tasks from the Test of Attentional Performance (TAP) and the Behavioral Rating of Executive Functions (BRIEF) questionnaire. Patients were compared to a group of 27 typically developing controls who were matched for sex, age and parental education level. Among the 27 participants, mean (SD) age at injury was 7.7 (4.6) years, and mean length of coma 5.6 (4.6) days. Regarding the TAP, the number of errors was significantly higher (P = 0.003) and reaction time marginally slower (P = 0.08) in the TBI than control group. The BRIEF questionnaire completed by parents indicated significantly more executive difficulties in the TBI than control group (Behavior Regulation Index, P = 0.005; Metacognitive index, P = 0.02; Global Executive Composite, P = 0.012). Correlations between BRIEF and TAP scores did not reach statistical significance. BRIEF total score was correlated moderately with length of coma (r = 0.40, P = 0.037), and TAP scores were correlated with the Full-Scale Intellectual Quotient (total number of errors: r = -0.48; P = 0.01; mean reaction time: r = −0.51; P = 0.009). Executive and attention deficits were evident 7 years after severe childhood TBI. Computerized tasks and questionnaires provide complementary and non-redundant information. Systematic long-term follow-up should be provided until the transition to adulthood, to assess ongoing development and to implement timely tailored interventions. [ABSTRACT FROM AUTHOR]

Background Executive function (EF) impairment is a major predictor of overall outcome after traumatic brain injury (TBI). TBI severity is a factor of poor outcome, but most studies include a majority of children with mild and moderate TBI. The aims of this study were to estimate EF impairment after severe childhood TBI and to explore factors predicting EF outcome. The secondary aim was to compare recovery trajectories by age-at-injury groups. Methods This was a prospective longitudinal study of children with severe TBI who were tested for EFs by performance-based tests and questionnaires at 3, 12 and 24 months. Results Children with TBI ( n = 65) showed significant impairment in working memory, inhibition, attention and global EF, with little or no recovery at 24 months. For flexibility and performance-based EF score, children were impaired at 3 months only and showed normal scores by 12 months. No impairment was found in planning. At 3 and 24 months, Glasgow Coma Scale score and parental education predicted global EF. Coma length was not a significant predictor of outcome. Age at injury predicted progress in EF, but the relationship was not linear; children 10–12 years old at injury showed better outcome than older and younger children. Conclusions EFs are impaired after severe TBI in childhood. The relationship between age at injury and outcome is not linear. Relying on only performance-based EF tests can underestimate EF impairment. [ABSTRACT FROM AUTHOR]

Studies about long-term outcome following abusive head trauma (AHT) are scarce. The aims of this study were to report long-term neurological, cognitive, behavioral and academic outcomes, ongoing treatments and/or rehabilitation, several years after AHT diagnosis, and factors associated with outcome. In this retrospective study, all patients admitted to a single rehabilitation unit following AHT between 1996 and 2005, with subsequent follow-up exceeding 3 years, were included. Medical files were reviewed and a medical interview was performed with parents on the phone when possible. The primary outcome measure was the Glasgow Outcome Scale (GOS). Forty-seven children (out of 66) met the inclusion criteria (mean age at injury 5.7 months; SD = 3.2). After a median length of follow-up of 8 years (range 3.7–12), only seven children (15%) had “good outcome” (normal life – GOS I) and 19 children (40%) presented with severe neurological impairment (GOS III and IV). Children sustained epilepsy (38%), motor deficits (45%), visual deficit (45%), sleep disorders (17%), language abnormalities (49%), attention deficits (79%) and behavioral disorders (53%). Most children (83%) had ongoing rehabilitation. Only 30% followed a normal curriculum, whereas 30% required special education services. Children with better overall outcome (GOS I and II) had significantly higher educated mothers than those with worse outcomes (GOS III and IV): graduation from high school 59% and 21% respectively ( p = 0.006). This study highlights the high rate of severe sequelae and health care needs several years post-AHT, and emphasizes the need for extended follow-up of medical, cognitive and academic outcomes. [ABSTRACT FROM AUTHOR]

• Childhood severe traumatic brain injury (TBI) has a long-term impact on morbidity and functional deficits. • About 50% of childhood severe TBI survivors exhibit substantial disability at 7 years after severe TBI. • Socio-behavioural and cognitive deficits are the most common long-lasting sequelae. • Long-term outcome is poorly predicted by early clinical factors / injury severity. • Functional impairments at 1 year after TBI strongly predicts disability at 7 years. Childhood severe traumatic brain injury (TBI) is a leading cause of long-lasting acquired disability, but predicting long-term functional outcome remains difficult. This study aimed to 1) describe the functional outcome at 1 and 7 years post-TBI; 2) determine the initial and concurrent factors associated with long-term outcome; and 3) evaluate the predictive value of functional status, overall disability level and intellectual ability measured at 1 year post-injury to determine 7-year clinically meaningful outcomes. Among the children (<16 years) consecutively included over 3 years in the Traumatisme Grave de l'Enfant (TGE) prospective longitudinal cohort study after accidental severe TBI, we studied the outcomes of 39 survivors at 1 and 7 years post-injury. Overall outcome included disability level (Glasgow Outcome Scale), functional status (Pediatric Injury Functional Outcome Scale), intellectual ability (Wechsler scales), executive functions (Behavior Rating Inventory of Executive Functions), behavior (Child Behavior Checklist) as well as neurological impairments and academic status. Mean (SD) age of the 39 survivors at injury was 7.6 (4.6) years, and long-term evaluation was conducted at a mean of 7.8 years post-injury (range 5.9–9.3); 36% of participants were adults (≥18 years old). Most of the neurological impairments remained stable beyond 1 year after TBI, whereas overall disability level improved significantly from 1 to 7 years but remained highly variable, with almost half of participants presenting significant disability levels (moderate: 26%, or severe: 21%). Almost half of participants had significant cognitive, behavior and/or academic difficulties at 7 years post-TBI. On multivariate regression analysis, functional impairment at 1 year was the best predictor of severe disability at 7 years (F (3,31) =13.18, p < 0.001, sensitivity=100%, specificity=78%). Our results confirm the significant long-term impact of childhood severe TBI. All children with TBI should benefit from systematic follow-up, especially those with persistent functional deficits at 1 year post-injury, because the severity of functional impairment at 1 year seems the best predictor of long-term significant disability up to 7 years post-TBI. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to gain insight into the social (pragmatic) aspects of language use by French-speaking individuals with frontal lesions following a severe traumatic brain injury. Eleven participants with traumatic brain injury performed tasks in three areas of communication: production (interview situation), comprehension (direct requests, conventional indirect requests, and hints), and metapragmatic knowledge. The results of the patients pointed out some strengths (turn-taking in production, and request comprehension, including hints and the speaker''s intention) and some weaknesses (topic maintenance in production and metapragmatic knowledge). The patients’ good comprehension of requests and their difficulty expressing metapragmatic knowledge suggest that they differ from controls in how they “explain the world”: their knowledge of the event sequence was not based on verbally expressible knowledge about the relationship between the structural characteristics of a request utterance and those of its social production context. The pragmatic skills of persons with traumatic brain injury seem to vary across tasks: these individuals have specific strengths and weaknesses in different domains. In addition, marked interindividual differences were noted among the patients: three of them had only one weak point, topic maintenance. These interindividual differences were not systematically linked to performance on executive function tests, but lesion unilaterality (right or left) seems to help preserve patients’ pragmatic and metapragmatic skills. The discussion stresses the need to take each patient''s strengths and weaknesses into account in designing remediation programs. Learning outcomes: As a result of this activity, the reader will be able to explain the social/pragmatic aspects of language in typical and atypical participants with TBI. As a result of this activity, the reader will be able to identify social/pragmatic weaknesses and strengths. [Copyright &y& Elsevier]

Abstract: Constraint-induced movement therapy is a promising technique for improving upper limb function in adults with hemiplegia. It involves restraint of the non-involved limb and intensive movement practice with the paretic limb. Although the technique has been applied successfully to children with cerebral palsy, only two studies have used it in children with acquired brain injury. Objective: To assess the feasibility and efficacy of constraint-induced movement therapy in children with acquired brain injury. Methods: We used a single-subject experimental design in three children (aged five at the time of the intervention) with hemiplegia in the chronic phase following acquired brain injury. The intervention involved restraint of the unaffected arm with a Mayo Clinic elbow brace for seven hours a day in a hospital setting, together with three hours a day of physical and occupational therapy rehabilitation for five days a week for two weeks. The children were assessed twice at baseline and then once immediately post-treatment and again two months post-treatment. Assessment included a range of timed, quantitative measures of upper limb use, assessment of unilateral spatial neglect and qualitative assessment by therapists and parents in terms of activities of daily living. Results: The three children completed the full protocol and improved significantly in all timed, quantitative tests of motor function. These improvements were partially maintained at two months. No improvement in unilateral spatial neglect was found in the paper-and-pencil tasks, although less spatial neglect was observed in activities of daily living such as eating and walking. Conclusion: Constraint-induced movement therapy appears to be both feasible and efficient in children with acquired brain injury. [Copyright &y& Elsevier]

Abstract: School achievement of children with brain tumors is hampered by progressive neurologic and cognitive sequelae. To help the children and their family, we have created in 1997 a multidisciplinary consultation together with Necker''s hospital. Material and methods: The study describes the organization of the consultation and analyses the files of 69 children seen between September 2001 and June 2002. Results and conclusion: The authors conclude that this consultation is an irreplaceable mean to coordinate the complex rehabilitation process of a child treated for a brain tumor. [Copyright &y& Elsevier]

Abstract: Objective: Following cerebral lesions, especially right and frontal cerebral lesions, patients often have difficulties in social cognition. Emotional skills are often impaired. Adults with cerebral lesions have difficulty identifying facial emotional expressions and attributing emotions in situations of communication. However, few studies have involved children and adolescents with cerebral lesions. Our first goal was to determine whether the performance in emotional tasks of young patients with frontal cerebral lesions is as impaired as that of adults, and the second goal was to study the role of emotional cues in pragmatic aspects of language. Method: The study involved 7 children and adolescents with frontal cerebral lesions but no aphasia and 7 control subjects. We used two emotional tasks: one to assess the ability to identify facial emotional expressions, and one to assess the ability to attribute emotions in situations of communication. Results: The control and experimental groups did not differ significantly in identifying and attributing emotions. A further analysis of responses revealed that the patients were more impaired than controls in attributing complex emotions. As well, the patients tended to produce more justifications based on irrelevant elements than the controls. Conclusion: Our first data have shown that the children and adolescents with frontal cerebral lesions retain the ability to analyse emotions in situations of communication but have subtle difficulty in analysing emotional cues in social situations. [Copyright &y& Elsevier]

• Childhood severe traumatic brain injury (TBI) has a long-term impact on morbidity and functional deficits. • Up to 80% of children presented significant disability at 2 years post-TBI. • Socio-behavioural and cognitive deficits were the most common long-lasting sequelae. • Functional outcome at 2 years post-TBI was highly predicted by injury severity. • Multimodal assessment and follow-up could improve interventions and outcomes. Childhood severe traumatic brain injury (TBI) is a leading cause of long-lasting acquired disability, but little is known about functional outcome. We aimed to 1) study clinical recovery and functional outcome over 24 months after severe childhood TBI, 2) identify early sociodemographic and severity factors influencing outcome, and 3) examine the clinical utility of the Pediatric Injury Functional Outcome Scale (PIFOS) to assess functional outcome. Children (0-15 years) consecutively admitted in a trauma centre after accidental severe TBI over 3 years were included in a prospective longitudinal study (Traumatisme Grave de l'Enfant cohort). We measured clinical/neurological recovery, functional status (Pediatric Injury Functional Outcome Scale, [PIFOS]), overall disability (pediatric Glasgow Outcome Scale [GOS-Peds]) as well as intellectual ability (Wechsler scales) and educational outcome (mainstream school vs special education) of survivors at 1, 3, 12 and 24 months post-injury. For 45 children (aged 3 to 15 years at injury), functional impairments were severe within the first 3 months. Despite the initial rapid clinical recovery and significant improvement over the first year, substantial alterations persisted for most children at 12 months post-TBI, with no significant improvement up to 2 years. Up to 80% of children still had moderate or severe overall disability (GOS-Peds) at 24 months. The severity of functional impairments (PIFOS) at 12 and 24 months was mostly related to socio-emotional, cognitive and physical impairments, and was significantly correlated with clinical/neurological deficits and cognitive (intellectual, executive) and behavioural disorders. Initial TBI severity was the main prognostic factor associated with functional status over the first 2 years post-injury. Our results confirm the significant impact of severe childhood TBI on short- and medium-term functional outcomes and overall disability. All patients should benefit from systematic follow-up. The PIFOS appeared to be an accurate and reliable tool to assess functional impairment evolution and clinically meaningful outcomes over the first 2 years post-injury. [ABSTRACT FROM AUTHOR]

Introduction/Background Severe Traumatic Brain Injury (TBI) is the main cause of children mortality and disability in developed countries. Among cognitive sequelae, memory impairment is frequent and impacts everyday functioning and academic achievement. The aims of this study were: (1) to measure memory functioning in children who sustained a severe TBI, and performance's evolution over time; (2) to assess factors associated to memory function and recovery. Material and method In the TGE (Traumatisme crânien grave de l’enfant) cohort, a prospective longitudinal study, 65 children aged 0 to 15 years old who sustained a severe TBI were included. Memory function was assessed using the Children's Memory Scale (CMS) at 3, 12 and 24 months post-injury. Results Memory was assessed in 46 children aged 5–15 years. Significant memory impairment was found at 3months post-injury (mean general memory (GENM) score = 89.1, SD = 20.5). Significant improvement was found at 24 months, but less so for verbal, learning and attention/concentration abilities. At 3 and 24 months post-injury, GENM score was significantly correlated to TBI severity indices (length of coma, Pediatric Traumatic Scale and Injury Severity Score). It was strongly correlated to full-scale intellectual quotient at each time point. Female gender was associated with worse memory impairment, whereas age at injury and socio-economic status were not. Furthermore, presence of motor impairment (MI) was correlated with worse memory recovery, probably as a marker of injury severity. Finally, the GENM score was significantly correlated with less favorable educational outcome. Conclusion Memory functioning is significantly impaired following severe TBI; it is mostly influenced by initial TBI severity and strongly impacts educational outcome. Those patients should benefit from long-term follow-up post injury. [ABSTRACT FROM AUTHOR]

Objective Studies on language outcome following childhood stroke are rare. The aims of this study were to study language, cognitive and school outcomes following childhood stroke. Materials/patients and methods We retrospectively reviewed the files of children (1 month–15 years) consecutively admitted to a physical medicine and rehabilitation department following childhood stroke between 1992 and 2015. Age at onset, aetiology, lesion laterality, initial severity, motor and functional impairments upon admission and discharge, language tests, neuropsychological assessment (or developmental age/quotient) and academic outcome were collected. Results Over the study period, 184 children were hospitalised following ischemic ( n = 79) or hemorrhagic ( n = 105) stroke. Upon admission, after a median time since stroke of 22 days, 89% of the children had motor impairment and 42% were not able to walk. Upon discharge (median 6 months post-stroke), 25% could still not walk independently and 42% could not use their hand. Neuropsychological assessment performed after a median time since stroke of 4 months indicated severe impairment: n = 135 [m (SD)]: full scale IQ 85 (19), verbal IQ 93 (22), performance IQ 85 (20), working memory index 87 (18), processing speed index 79 (18). Language tests performed after a median time since stroke of 3 months also revealed severe impairment ( n = 130). The 4 language skills tested (receptive and expressive, semantic and syntax) were impaired, especially word finding (median SD = –2). Overall, significant impairment was found (scores < –2SD) in 26% of children for lexical extent, 53% for word finding, 38% for syntactic comprehension and 47% for syntactic expression. For 19 children who were under the age of three at assessment, mean developmental quotient was 57 (SD = 23) for the total score and 65 (SD = 24) for the language subscale. Language and verbal IQ were significantly lower ( p < 0.01) in patients with left-hemisphere lesion than in those with right-hemisphere lesions. After a median follow up of 40 months, only 34% of the children were following normal curriculum without adaptations or delay and 28% were attending special education programs. School outcome was highly correlated to language and IQ ( p < 0.0001). Discussion/conclusion Childhood stroke leads to severe language and cognitive impairments, with negative and long lasting consequences on academic achievement. [ABSTRACT FROM AUTHOR]

Objective Childhood acquired brain injury (ABI) is the leading cause of acquired disability in childhood, with significant consequences on independence, academic achievement and participation. The “Child and Adolescent Scale of Participation” (CASP; Bedell 2004) has been specifically developed to assess participation following childhood ABI. The aim of this study was to examine the psychometric properties of the French version of the Child and Adolescent Scale of Participation. Material/patients and methods Cross-sectional, monocentric study. The CASP questionnaire was given to 133 caregivers of children or adolescents (5 to 18 years) who were followed-up in a rehabilitation department following ABI. The CASP is comprised of 20 items in 4 subsections: (1) home participation; (2) neighborhood and community participation; (3) school participation; (4) home and community living activities. Parents are asked to rate the 20 items of the CASP using a four-point Likert scale: (4 = aged expected; 3 = somewhat limited; 2 = very limited; 1 = unable), or “not applicable”. Cronbach's alpha and factor analyses were performed to examine the psychometric properties of the French translation of the CASP and correlations of the CASP with demographic and clinical factors were explored. Results Eighty-five parents [(64%response rate; 61% boys; age at onset 5.66 years (SD = 3.9); age at assessment 10.51 years (SD = 3.4)] answered the questionnaire. There was no significant difference between respondents and non-respondents regarding demographic, medical, injury severity or level of neurological or cognitive impairment. Internal consistency was high (Cronbach alpha 0.84). Factor analysis yielded a five-factor structure explaining 88% of the variance. The total score of the CASP was correlated with the mother's education level ( P = 0.04), but not with any of the other medical data, such as age at injury, age at assessment, injury severity, clinical condition (presence of hemiplegia, epilepsia, cerebellar signs), intellectual ability or number of ongoing rehabilitation types. Discussion - conclusion Our results confirm the cross-cultural psychometric properties of the French adaptation of the CASP. Interestingly, the CASP was not correlated with any of the clinical factors. Parental ratings of their child's participation probably rely on other factors such as emotional status, coping ability and environmental factors. [ABSTRACT FROM AUTHOR]

Introduction Childhood acquired brain injury (ABI) is responsible for severe cognitive and behavioural disorders, sometimes leading to violent and/or offending behaviours. The aim of this study was to review the cases of patients treated in a rehabilitation unit dedicated to children with ABI, who subsequently demonstrated behaviors leading to an intervention of the police and/or the justice, and identify any common characteristics. Methods Retrospective inventory of patients with ABI treated in a single rehabilitation department, who subsequently had contact with the police/justice following offenses. We collected demographic factors, type and severity of ABI, initial neurological examination, first and last neuropsychological assessment, type of schooling pre- and post-injury, and data from their offenses. Results Searches retrieved 40 patients (36 boys): 34 traumatic brain injury (TBI; 27 severe), 4 brain tumours, 1 frontal hemorrhagic stroke and 1 anoxia; mean age at injury was 9.7 years [SD = 4; (2.1–15.7)]. In 88% of cases, none of the parents had graduated from high school. Half of the children had previous school difficulties and 30% had repeated a grade. Overall, children sustained severe injuries, with impaired neurological function, major cognitive deficits [mean initial full-scale IQ 73.1 (SD = 12.8)] without significant improvement [77.4 (SD = 13.4) at the last assessment]. The processing speed index was particularly low [73.2 (±15.4)] and did not improve over time. 76% had behavioural disorders already evident during hospitalization. Upon discharge, 62% required adapted and/or specialized schooling. After an average follow-up of 8 and a half years, only 6 patients still followed an ordinary curriculum and 8 were not attending school anymore. Four girls were victims, and among 36 boys, all were perpetrators, but 3 had been victims previously. The offenses were mainly cases of violence (56%), but also entailed thefts, traffic offences, sexual assaults, drug use and vandalism. Discussion Children with ABI who suffer or commit offenses are mainly boys, from very low socioeconomic background, with pre-injury academic and social difficulties, who sustained severe TBI. They suffer very severe and disabling cognitive deficits and behavioral disorders. Multidisciplinary care and follow-up of those children more at risk is essential in the long-term. [ABSTRACT FROM AUTHOR]