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Objective: To investigate the long-term (2–15 years) functional outcome of children and young adults who received an early intensive neurorehabilitation programme (EINP) after a prolonged period of unconsciousness due to severe brain injury; to differentiate between traumatic brain injury (TBI) and non-traumatic brain injury (nTBI); and to compare the results on two different outcome scales: the Disability Rating Scale (DRS) and the Glasgow Outcome Scale Extended (GOSE). Subjects: One hundred and forty-five patients, who were admitted to EINP between December 1987 and January 2001. Outcome measures: The Post-Acute Level of Consciousness scale (PALOC-s), the DRS, including categorized scores (DRScat), and the GOSE. Results: The long-term functional level of 90 patients could be determined, of whom 25 were deceased. The mean DRS-score of the surviving patients was 6.8 (SD = 6.6); the mean score on the GOSE was 4.5 (SD = 1.7). There was a significant difference in the outcome amongst traumatic and non-traumatic patients (t(88) = 4.21; p < 0.01). The correlation between the DRS and the GOSE was high (Spearman rho = 0.85; p < 0.01), as well as the correlation between the categorized scores of the DRS and the GOSE (Spearman rho = 0.81; p < 0.01). The distribution of outcome scores on the DRScat is more diverse than on the GOSE. Especially item 7 of the DRS, measuring functional independence, showed considerable variance in discriminating between different outcome levels. Conclusions: More patients with TBI than expected reached a (semi-) independent level of functioning, indicating a possible effect of EINP. Patients suffering from nTBI did not demonstrate these outcome levels. Only a few patients stayed in a vegetative state for more than a couple of years. In this cohort of severe brain-injured young people, the DRS offered the best investigative possibilities for long-term level of functioning. [ABSTRACT FROM AUTHOR]

Research objective: Children with acquired brain injury (ABI) can experience severe problems in establishing peer relationships. The attitudes peers hold toward a child with an ABI can significantly impact on their willingness to befriend. The present work sought to investigate the attitudes peers hold toward a fictional child with ABI. Methods and procedures: Fifty children from a primary school were compared against a similar number from a secondary school. Gender was evenly split across both groups. A vignette describing a young boy acquiring a brain injury, and his subsequent change in behaviour, was presented to the children. The Friendship Activity Scale (FAS) was then used to judge how likely the children were to befriend the fictional character. Outcomes and results: Results showed a statistically significant interaction between gender and age [F(1, 96) 6.285, p = 0.014] with older males expressing more positive attitudes than younger males. Conclusion: The study suggests that children with ABI are more likely to experience negative attitudes in primary school, and concludes in calling for additional research to more fully explore the social experience of children with ABI. [ABSTRACT FROM AUTHOR]

Objectives: To explore the relationship between location and pattern of brain injury identified on MRI and prolonged low response state in children post-traumatic brain injury (TBI). Methods: This observational study compared 15 children who spontaneously recovered within 30 days post-TBI to 17 who remained in a prolonged low response state. Results: 92.9% of children with brain stem injury were in the low response group. The predicted probability was 0.81 for brain stem injury alone, increasing to 0.95 with a regional pattern of injury to the brain stem, basal ganglia, and thalamus. Conclusions: Low response state in children post-TBI is strongly correlated with two distinctive regions of injury: the brain stem alone, and an injury pattern to the brain stem, basal ganglia, and thalamus. This study demonstrates the need for large-scale clinical studies using MRI as a tool for outcome assessment in children and adolescents following severe TBI. [ABSTRACT FROM AUTHOR]

The purpose of this study is to determine the presence of profile subtypes on the California Verbal Learning Test–Children's Version (CVLT–C; Delis, Kramer, Kaplan, & Ober, 1994) in 175 children with traumatic brain injury (TBI). Four key z score variables are used in a 2-stage cluster analysis that reveal 4 reliable subtypes. No meaningful differences among the clusters are found on demographic variables. In contrast, statistically significant differences among the 4 clusters in both level and pattern of performance are found on injury severity parameters and the 4 factor index scores from an independent measure of psychometric intelligence (Wechsler Intelligence Scale for Children–Third Edition; Wechsler, 1991). This study concludes that although no unique profile is found on the CVLT–C after TBI in children, performance on this test is affected strongly by injury severity, with a mediating contribution by speed of information processing. [ABSTRACT FROM AUTHOR]

Resistance to passive movement in children with spastic cerebral palsy was assessed by two raters using the Modified Ashworth Scale and the Modified Tardieu Scale. Four muscle groups in the lower limbs were tested using a standardized procedure. Interrater reliability of the scales was evaluated by the intraclass correlation coefficient. Seventeen children, with a mean age of 7 years 9 months, were included. Two children were rated twice. The intraclass correlation coefficients of both scales were low and did not reach the acceptable limit of 0.75. Caution should be used when these scales are applied. [ABSTRACT FROM AUTHOR]

Abstract: Background: Brain-injured children have been thought to have an unreliable abdominal examination. This study evaluates the reliability of physical examination in the prediction of intra-abdominal injury in brain-injured children. Methods: Pediatric patients with a traumatic brain injury or Glasgow Coma Scale (GCS) <15 and intra-abdominal organ injuries were selected. Admission data were reviewed, and findings were tabulated. Results: Fifty patients had an abnormal abdominal examination. Nineteen of 71 patients with head injury and intra-abdominal organ injuries required laparotomy. These 19 patients had abdominal tenderness, distention, abrasions, and/or a positive focused abdominal sonography for trauma (FAST) scan. Seven of 19 patients had a GCS of 3. Of the 12 patients requiring surgery with GSC 4 to 14, all patients had abnormal physical examinations. Conclusions: Patients who required an operation presented with an abnormal examination and/or a positive FAST. These data suggest that examination and/or FAST may reliably identify patients with intra-abdominal organ injuries in need of an operation. [Copyright &y& Elsevier]

This paper investigates whether and to what extent vision with awareness is still possible in the whole visual field after loss of the occipital lobe of one or both cerebral hemispheres or after hemispherectomy in childhood. The visual functions of four children who suffered from unilateral or bilateral loss of the occipital lobe or who had been hemispherectomized were examined. The results show that even after unilateral loss of the striate and prestriate cortex the extent of the visual field may still be in the normal range. The residual visual functions may be mediated by intact extrastriate areas such as V5 and LO of the damaged cerebral hemisphere . It is also shown that even after complete hemispherectomy in early life the visual field may have a normal extent and that conscious visual perception in the whole visual field may be preserved. In hemispherectomized children, the remaining cerebral hemisphere or neural structures in the midbrain, including the superior colliculi and the praetectum, may be able to mediate these visual functions. [ABSTRACT FROM AUTHOR]

A randomized crossover trial of a new form of pediatric rehabilitation was conducted with 18 children with hemiparesis. Half were randomly assigned to receive pediatric constraint-induced therapy involving constraint of the functional upper extremity and intensive therapy with the hemiparetic upper extremity. Controls received conventional physical and occupational therapy and then were crossed over to receive pediatric constraint-induced therapy. Pediatric constraint-induced therapy produced significantly greater gains than conventional rehabilitation services. [ABSTRACT FROM AUTHOR]

Context. Controversy exists about the most appropriate seating position for children with cerebral palsy (CP) to promote energy conservation and maximize upper-extremity function. Evidence Acquisition. Sixteen journal articles published after 1980 were identified by searching allied health, medical, and occupational and physical therapy data bases and evidence-based medicine reviews using specific key terms (positioning, wheelchair, postural control, posture, adaptive seating devices, patient positioning, cerebral palsy, movement disorders, upper extremity, reaching, grasping, and occupational therapy) and reviewing bibliographies of retrieved articles. Evidence Synthesis. The majority of the evidence supports the positive effects of a. neutral to slightly forward orientation (whole chair tilted) on upper-extremity function. Only one study did not demonstrate such effects. Of the supporting studies, one suggested the addition of an abduction orthrosis (AO), one recommended the entire functional sitting position (FSP) package (this orientation plus a hip-belt, footrests, AO, and cutout tray), and one established the long-term effects of the FSP. One less rigorous study opposed the addition of an AO. With the exception of one study, most of the evidence states that seat angle does not affect functional abilities. However, some of these studies contain faulty methodology and/or their results demonstrate clinical significance. Conclusion. Evidence supports that children with CP should be fitted for wheelchairs that place them in a FSP, which includes; orientation in space of 0°-15°, a hip-belt, an AO, footrests, and a cutout tray, with the addition of a sloped forward seat of 0°-15°, to improve upper-extremity function. The exact seat angle and orientation in space within the 0°-15° range should be determined on an individual basis. [ABSTRACT FROM AUTHOR]

Abstract: This review summarises current developments in radiation oncology and how they impact on the management of children with brain tumours. Improved understanding of radiobiology has led to attempts to improve the therapeutic ratio with hyperfractionated radiotherapy. Recent advances in planning and delivery of radiotherapy, including three-dimensional conformal radiotherapy, intensity modulated radiotherapy, and proton therapy allow a more precise localisation of the maximum dose region with maximum sparing of normal brain. Increasingly interactions between drugs and radiotherapy are exploited, but it is important to evaluate toxicity of combined modality therapy. The introduction of models to predict the impact of radiotherapy dose–volume parameters on long-term neuropsychological function will hopefully lead to further benefit with respect to sparing of normal tissue morbidity. [Copyright &y& Elsevier]

Perinatal brain injury in survivors of premature birth has a unique and unexplained predilection for periventricular cerebral white matter. Periventricular white-matter injury (PWMI) is now the most common cause of brain injury in preterm infants and the leading cause of chronic neurological morbidity. The spectrum of chronic PWMI includes focal cystic necrotic lesions (periventricular leukomalacia; PVL) and diffuses myelination disturbances. Recent neuroimaging studies support that the incidence of PVL is declining, whereas focal or diffuse noncystic injury is emerging as the predominant lesion. Factors that predispose to PVL during prematurity include hypoxia, ischemia, and maternal–fetal infection. In a significant number of infants, PWMI appears to be initiated by perturbations in cerebral blood flow that reflect anatomic and physiological immaturity of the vasculature. Ischemic cerebral white matter is susceptible to pronounced free radical-mediated injury that particularly targets immature stages of the oligodendrocyte lineage. Emerging experimental data supports that pronounced ischemia in the periventricular white matter is necessary, but not sufficient to generate PWMI. The developmental predilection for PWMI to occur during prematurity appears to be related to both the timing of appearance and regional distribution of susceptible oligodendrocyte progenitors. Injury to oligodendrocyte progenitors may contribute to the pathogenesis of PWMI by disrupting the maturation of myelin-forming oligodendrocytes. Chemical mediators that may contribute to white-matter injury include reactive oxygen species glutamate, cytokines, and adenosine. As our understanding of the pathogenesis of PWMI improves, it is anticipated that new strategies for directly preventing brain injury in premature infants will develop. MRDD Research Reviews 2006;12:129–140. © 2006 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

This pilot study explored the functional skills in 21 young children with activity limitations caused by a variety of brain complications sustained prenatal or perinatal. The Pediatric Evaluation of Disability Inventory (PEDI) was used for this purpose. Scores were correlated with the Family Functioning Style Scale (FFSS). The children appeared to have many functional limitations in the domains of self-care, mobility, and social function, and extensive assistance was required, taxing the family strengths. This was especially the case in families with a child having cognitive difficulties (also termed learning disability). The results also suggest that needs for assistance in social functions were difficult for caregivers to recognize when the children's overall cognitive level was in the normal range. [ABSTRACT FROM AUTHOR]

Aim To determine the age of development of bladder and bowel control and the frequency of enuresis, encopresis, and urinary infections in children with cerebral palsy. Methods The study included 45 children with cerebral palsy who regularly attended a rehabilitation center in Isparta, Turkey, and two groups of age- and sex-matched children, 37 siblings of the children with cerebral palsy and 37 healthy children. Demographic data and information on the age of development of total bladder and bowel control and presence of possible urinary symptoms in children were collected from their caregivers by use of a questionnaire. Frequency of enuresis and encopresis was estimated among the children aged =5 years. A mid-way urinary sample was obtained from 40, 22, and 21 children in the cerebral palsy, siblings, and healthy children, respectively. Results The mean age of nighttime bladder and bowel control development was 47 months (95% confidence interval [CI], 35-58) and 45 (36-55) months, respectively, for the children with cerebral palsy, 35 months (95% CI, 24-46) and 26 months (95% CI, 24-28), respectively, for their siblings, and 27 months (95% CI, 22-33) and 25 months (95% CI, 23-27) months, respectively, for the healthy children. Among the children aged =5 years, enuresis was present in 11 of 34 children with cerebral palsy, 7 of 30 siblings, and 4 of 30 healthy children (P = 0.200), whereas encopresis was present in 5 children with cerebral palsy, one sibling, and one healthy child. Constipation was significantly more present in children with cerebral palsy than in other two groups (P<0.001). Urine culture was positive in 13 children with cerebral palsy, 1 sibling, and 2 healthy children (P = 0.024). There were no significant differences in other urinary symptoms and laboratory findings among the three groups. Conclusion The children with cerebral palsy gained bladder and bowel control at older age in comparison with their siblings and healthy children. They also had more frequent enuresis and urinary infections. [ABSTRACT FROM AUTHOR]

OBJECTIVE. To estimate, the prevalence of cerebral palsy at 2 years of age among children born very preterm, according to gestational age, infant gender, plurality, and neonatal cranial ultrasound abnormalities. METHODS. All infants born between 22 and 32 weeks of gestation in 9 regions of France in 1997 were included in this prospective, population-based, cohort study. The main outcome measure was cerebral palsy prevalence at 2 years. Of the 2364 survivors eligible for follow-up evaluation, 1954 (83%) were assessed at 2 years of age. RESULTS. Among the 1954 children assessed at 2 years, 8.2% had cerebral palsy. Bilateral spastic cerebral palsy, hemiplegia, and monoplegia accounted for 72%, 9%, and 10% of cases, respectively. Fifty percent of the children with cerebral palsy walked independently at the age of 2, 31% were unable to walk but could sit independently, and 19% could not sit (unable to maintain head and trunk control). The prevalence of cerebral palsy was 20% at 24 to 26 weeks of gestation, compared with 4% at 32 weeks. On the basis of ultrasound findings in the neonatal period, we found that 17% of children with isolated grade III intraventricular hemorrhage and 25% of children with white matter damage (ie, ventricular dilation, persistent echodensities, or cystic periventricular leukomalacia) had cerebral palsy, compared with 4% of children with normal ultrasound scans. CONCLUSIONS. Despite recent improvements in survival rates, cerebral palsy remains highly prevalent among very preterm children. Severe cranial ultrasound abnormalities predict motor disability strongly, but one third of infants with cerebral palsy had no ultrasound abnormalities. [ABSTRACT FROM AUTHOR]

OBJECTIVE. Inflicted traumatic brain injury (iTBI) is the leading cause of death from TBI in infants. Misdiagnosis of iTBI is common and results in increased morbidity and mortality. Biomarkers may be able to assist in screening infants who are at high risk for iTBI and whose injury might otherwise be missed. We investigated whether serum and/or cerebrospinal fluid (CSF) concentrations of neuron-specific enolase (NSE), S100B, and myelin-basic protein (MBP) are sensitive and specific for iTBI in high-risk infants. METHODS. A prospective case-control study was conducted of 98 well-appearing infants who presented with nonspecific symptoms and no history of trauma. Serum or CSF was collected. NSE, S100B, and MBP concentrations were measured by enzyme-linked immunosorbent assay. Abnormal marker concentrations were defined a priori. Patients were followed for 12 months to assess for subsequent abuse. RESULTS. Fourteen patients received a clinical diagnosis of iTBI. Using preestablished cutoffs, NSE was 77% sensitive and 66% specific and MBP was 36% sensitive and 100% specific for iTBI. S100B was neither sensitive nor specific for iTBI. Five patients who were not identified with iTBI at enrollment were identified at follow-up as being possible victims of abuse; 4 had an increased NSE concentration at enrollment. CONCLUSIONS. Serum and/or CSF concentrations of NSE and MBP may be useful as a screening test to identify infants who are at increased risk for iTBI and may benefit from additional evaluation with a head computed tomography scan. S100B is neither sensitive nor specific for iTBI in this study population. The ability to identify iTBI that might otherwise be missed has important implications for decreasing the morbidity and the mortality from iTBI. [ABSTRACT FROM AUTHOR]

Abstract: Posttranslational modifications (PTMs) of histone proteins may result in altered epigenetic signaling after pediatric traumatic brain injury (TBI). Hippocampal histone H3 acetylation and methylation in immature rats after moderate TBI were measured and decreased only in CA3 at 6 h and 24 h with persistent methylation decreases up to 72 h after injury. Decreased histone H3 acetylation and methylation suggest altered hippocampal CA3 epigenetic signaling during the first hours to days after TBI. [Copyright &y& Elsevier]

Background: We designed a randomized prospective study to investigate whether developmentally delayed children with cerebral palsy (CP) need a lower dosage of propofol for induction than normal children using bispectral index (BIS) monitoring criteria. Methods: After approval by the University Ethical Committee and written informed consent obtained from parents, 20 children with noncommunicative/nonverbal CP and 20 normal children requiring general anesthesia for elective orthopedic surgery were enrolled in the study. The patients were not premedicated. BIS leads were placed before the induction of anesthesia. Propofol was administered at a rate of 20 mg·30 s−1 (i.e. 40 mg·min−1).When BIS value had reached a steady number of 35–45, infusion was stopped. Results: There was no significant difference between Group N and Group CP in age and sex distribution ( P > 0.05), however children in Group CP weighed less than Group N ( P = 0.05). The propofol dosage for induction was significantly lower in Group CP than Group N ( P = 0.03). There were no differences in propofol doses administered to children using anticonvulsants and those not on anticonvulsants in Group CP. BIS values were comparable between the two groups (i.e. Group N and Group CP) at baseline and after propofol administration. Conclusions: Our data suggest that noncommunicative/nonverbal children with CP require less propofol to obtain the same BIS values (i.e. 35–45) than do otherwise healthy children. [ABSTRACT FROM AUTHOR]

Aim To investigate the characteristics of paediatric acquired brain injury (ABI) case managers and their organizations in Australia, and to determine the ways in which case managers deliver their service, maintain professional development and evaluate outcomes. Methods Postal survey of 57 known paediatric ABI case managers working at 24 separate organizations in Australia. Results Out of 40 questionnaires returned (70%), the majority of respondents had been providing case management for over 5 years (55%). Co-ordination of services was ranked the most important component of case management, with services most frequently delivered by telephone. Evaluation of case management outcomes was reported by only 52% of the case managers. Whilst the majority of case managers had received some form of training (83%), this varied widely from informal in-house training, to workshops run by insurance companies and government agencies. Discussion This survey provides information about current case management practices for children with ABI in Australia. Detailing what case managers do is a first step towards developing controlled research designs which are required to demonstrate whether case management is effective in terms of clinical outcomes and cost–benefit. [ABSTRACT FROM AUTHOR]

OBJECTIVE:Markers were sought to identify the antenatal starting times and rates at which brain damage advanced in children with hypoxemic–ischemic cerebral palsy.STUDY DESIGN:Fetal bradycardia's onset marked the damage's start. Using this baseline, the following were tested as additional timers of the damage's onset: serial blood counts of neonates’ normoblasts, platelets, lymphocytes,differences at birth between base excess values in umbilical arterial and venous bloods,brain damage patterns.RESULTS:Each timer had a broad antenatal time frame within which it could identify specific damage starting times. The broad time frames are as follows: Blood lymphocyte counts: 0.45 to 13.8 hours before birth, blood normoblast counts: 0.45 to 55.0 hours before birth, blood platelet counts: 0.5 to >72 hours before birth.Brain damage patterns: 0.4 to >0.7 hour before birth. Hyperventilating and hyperoxygenating neonates greatly accelerated the damage's advance.CONCLUSIONS:Commonly obtained laboratory values and brain images can identify when such brain damage began and the rate at which it advanced.Journal of Perinatology (2005) 25, 664–668. doi:10.1038/sj.jp.7211367; published online 4 August 2005 [ABSTRACT FROM AUTHOR]

The vegetative state does occur in children and is most commonly due to acquired traumatic and non-traumatic injuries. However, neurometabolic and degenerative diseases, as well as certain developmental brain malformations such as anencephaly, can also cause this condition. There are limited data available in children concerning recovery of consciousness and function from the vegetative state as well as life expectancy. This review concentrates on these issues and is based primarily on the data published in the Multi-Society Task Force Report on PVS which was published in 1994 as well as other epidemiological studies. Children in a vegetative state do have a poor prognosis for recovery of consciousness and function and do have a shortened life expectancy. Further research is needed to better understand what variables might contribute to recovery and what therapies might be of benefit. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify the main prenatal risk factors for cerebral palsy in very preterm singletons and twins. METHODS: The data were from the Epipage study, which included all very preterm children (« 33 weeks) born in 1997 in 9 regions of France. The analysis included 1,954 children for whom a medical questionnaire was completed at the age of 2 years (83% of the surviving children). The risk factors studied were pregnancy complications and specific factors in twins (type of placenta and death of cotwin). Logistic regression analysis was carried out for singletons and generalized estimating equation models used for twins. RESULTS: The proportion of cerebral palsy was 8% in singletons and 9% in twins. For singletons, spontaneous preterm labor (adjusted odds ratio [OR] 3.4, 95% confidence interval ECI] 1.7–6.7), preterm premature rupture of membranes (PPROM) with short latency (adjusted OR 4.9, 95% CI 2.0–11.8), and prolonged PPROM (adjusted OR 2.7, 95% CI 1.4–5.3) were associated with a higher risk of cerebral palsy than was hypertension. No such link was found between these pregnancy complications and cerebral palsy in twins. For twins, a monochorionic placenta (OR 1.9, 95% CA 1.0–3.6) increased the risk of cerebral palsy, but the OR became nonsignificant after adjustment (OR 1.7, 95% CI 0.8–3.4). CONCLUSION: In very preterm singletons, spontaneous preterm labor and PPROM increased the risk of cerebral palsy compared with hypertension. [ABSTRACT FROM AUTHOR]

Use of complementary and alternative medicine (CAM) for treatment of attention-deficit hyperactivity disorder (ADHD) has become widespread in both referral and primary care populations. We review the purported mechanism of action and available evidence for selected CAM therapies for ADHD. Enduring controversies, such as elimination of artificial food additives, colors, and/or preservatives; the effect of sugar on behavior in children; and the use of EEG biofeedback, have been well studied but lack support as effective sole treatments for ADHD. The initial evidence for some emerging CAM therapies, such as essential fatty acid supplementation, yoga, massage, homeopathy, and green outdoor spaces, suggests potential benefits as part of an overall ADHD treatment plan. More rigorously designed studies are needed to evaluate their effectiveness as single therapy for ADHD. © 2005 Wiley-Liss, Inc. MRDD Research Reviews 2005;11:116–130. [ABSTRACT FROM AUTHOR]

El artículo explora el tratamiento quirúrgico para los niños paralíticos cerebrales capaces de caminar. Se menciona que aunque los ciudados perinatales han mejorado, la incidencia de parálisis cerebral sigue incrementando. Aplicada simultáneamente a múltiples niveles, la cirugía tendinosa sirve para mejorar la marcha de estos pacientes. El artículo explica cómo los métodos de las osteotomías rotatorias mejoran la mala alineación.

Primary objective : To examine parental coping following an acquired brain injury of their child, the relationship between maternal and paternal coping, and the extent to which social support and family environment affect parental coping. Research design : A cross-sectional design was used. Methods and procedures : Parents ( n = 30) of children with acquired brain injury provided relevant demographic data and completed questionnaires investigating coping, social support and perceptions of family environment. Main outcomes and results : Perception-focused coping strategies were used most often by parents. Mothers had a more extensive repertoire than fathers, and the relationship between maternal and paternal coping appeared to be complementary. Relationships were found between emotion-focused coping and instrumental support ( r = 0.39) and perception-focused coping and family cohesion ( r = 0.37). Conclusions : Recognizing parental coping styles, enhancing the development of positive strategies, and underscoring the importance of social support and the family environment will assist parents to cope positively with their child's acquired brain injury. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) leads the causes of death and disability among children and adolescents. Despite the prevalence of TBI among children, few studies have examined memory in children. The purpose of this study was to compare memory functioning, as measured by the Test of Memory and Learning (TOMAL), of children with and without TBI and with moderate and severe TBI to determine if differences existed. Of the 140 participants, 70 had sustained a head trauma and 70 served as controls. The results indicated that, when the TBI and control group were compared, significant differences were found on all of the TOMAL indexes. With the exception of the verbal delayed recall items, significant differences were demonstrated on all the TOMAL subtests. No differences were identified when moderate and severe groups were compared. These findings further the understanding of memory following pediatric TBI, as well as have implications for interventions with this population. [Copyright &y& Elsevier]

The performance of 38 5–8-year-old children with traumatic brain injury (TBI) on the Children’s Category Test-Level 1 (CCT-1; ) was investigated in order to examine the criterion validity of the component subtests. Only subtests III and V varied in a consistent and meaningful manner with levels of injury severity and post-injury psychometric intelligence. In contrast, 21% of the sample performed at chance level on subtest IV, a task that did not demonstrate any criterion validity. It is concluded that when a substantial proportion of the total errors (e.g., ≥50%) on the CCT-1 pertain to items from subtest IV, interpretation of the composite summary T score may not be valid. [Copyright &y& Elsevier]

Primary objective : The study examines the possible relationship between dopamine-enhancing medications and improvement of arousal and awareness in children during persistent low response states (Rancho Los Amigos Levels I, II and III). Research design : A retrospective review was conducted of 10 children enrolled in an existing clinical protocol. The Kluge Children's Rehabilitation Center (KCRC) low response protocol provides a double baseline serial measure (A, A, B, B, B) design. Scores on the Western NeuroSensory Stimulation Profile (WNSSP) are the dependent variable. Methods and procedures : Ten children, mean age of 13.7 years low response state (30 days or more) who were treated with dopamine agonists. Co-morbid or iatrogenic influences were addressed or ruled out. Seven children had traumatic brain injury, one cerebral vascular accident, one anoxia and one encephalitis. Experimental intervention : On average, dopamine medications were started 52.9 days post-event. Main outcomes and results : Paired t -test of WNSSP scores before medications and on medications were significant at p = 0.03 (paired t -test). Also, the distributions of the slopes (rates of change of WNSSP scores over time) were significantly different in the pre-medication and medication phases (Paired T -test, p = 0.02). Random coefficient model comparison of individuals during pre- and medication phase response variability on WNSSP yielded F -test at p = 0.02. Conclusions : These results suggest a promising relationship between acceleration of recovery for some children in a low response state and administration of dopamine-enhancing medications. [ABSTRACT FROM AUTHOR]

Investigates whether the training and experience of educational psychologists has made them aware that young children are vulnerable to the long-term effects of traumatic brain injury. Use of a questionnaire survey in estimating the need and duration of additional social/family and educational support among the children; Degree of adherence to Kennard Principle among educational psychologists.

This article highlights the importance of early intervention for children suffering from alcohol-related neurodevelopmental disorder. The author states that often children with alcohol-related, organically based brain problems are never given a diagnosis of fetal alcohol syndrome or fetal alcohol effects. During infancy, intervention goals is emphasized on aiding the infant's immature nervous system in developing at a pace that does not overwhelm and cause shut down during critical interactions. For toddlers, caregivers should define spaces for play and eating and provide quiet activities to help them stay focused and organized. Furthermore, preschool teachers must be aware that the type of brain damage that children with fetal alcohol syndrome have often leaves them unable to repeat a skill they once did with ease.'

A traditional approach for examining brain–behavior relations has been the lesion method. This method assumes a direct correspondence between the cognitive process compromised and the site of lesion. Historically, studies with adults have used this framework to map brain functions. In contrast, studies of children with early injury have addressed quite different issues. Developmental animal lesion studies and pediatric neuropsychology studies have focused on the level of plasticity exhibited following early injury. Resilency in behavioral development has suggested change in the underlying neural substrate. A new set of studies has applied converging, MRI-based methods to examine anatomical and functional development in intact brain regions following early injury and compared these data with behavioral outcomes on the same children. The findings reveal an interaction between early injury and normal mechanisms of development, which manifest as atypical behavioral, structural, and functional development. © 2002 Wiley Periodicals, Inc. Dev Psychobiol 40: 266–277, 2002. DOI 10.1002/dev.10031 [ABSTRACT FROM AUTHOR]

This paper describes the initial development of the Disruptive Behavior Stress Inventory (DBSI). This 40-item measure, which provides indices of the number of stressors experienced during the past 6 months and the rated stressfulness of these events, is designed to assess behavior-related family stress experienced by families of children with attention-deficit/hyperactivity disorder (ADHD). Findings provide strong support for the internal consistency of the DBSI and suggest adequate test-retest reliability. Support for the validity of the measure is suggested by findings that DBSI stress indices differentiate between parents of children with ADHD and those with no history of this disorder. Additional support is provided by findings that scores on the DBSI also differentiate between parents of children with ADHD, combined type and parents of children with ADHD, inattentive type. It is suggested that this measure may provide useful clinical information regarding stress levels in families of children with ADHD and that it may be of potential value as an ADHD treatment outcome measure. [ABSTRACT FROM AUTHOR]

Conclusion. Plasma CO and NO levels after perinatal asphyxia are related to the severity of neonatal HIE, brain damage, and neurologic outcome. The present study suggests that CO and NO might play important roles in the pathogenesis of neonatal HIE. Pediatrics 2000;106:1307-1317; heme oxygenase, cerebral ischemia, cerebral anoxia. [ABSTRACT FROM AUTHOR]

Examines the effects of head injury on short-term memory and sentence processing performance of children. Memory span of short-term memory tasks relative to other children of the same age; Reduction of speech variables; Observation of the sentence processing performance; Consistency with experiments on brain-damaged adults.

This study examined whether children with early-treated phenylketonuria (ETPKU) exhibited a disruption in communication between the hemispheres as a function of computational complexity (Banich & Belger, 1990; Belger & Banich, 1992, 1998) when compared to neurologically uncompromised children who were matched in age and IQ. This investigation was motivated by findings that phenylketonuria affects myelination of neurons, including those that make up the corpus callosum, the main neural conduit for interhemispheric interaction. Children performed 2 tasks: a less complex physical-identity task and a more complex name-identity task. For both tasks, we compared performance on across-hemisphere trials, which require interhemispheric interaction, and on within-hemisphere trials, in which no hemispheric interaction is required. On the more complex name-identity task, children with ETPKU exhibited less of a benefit from across-hemisphere processing than did neurologically intact children. These results suggest that the interhemispheric interaction required to complete computationally complex tasks is compromised in children with ETPKU. Such an insufficiency may explain some of the attentional deficits observed in this group of children. [ABSTRACT FROM AUTHOR]

In order to investigate the relationship between age at injury and long-term neuropsychological impairment, 29 children and adolescents who sustained traumatic brain injury (TBI) were studied at least 6 years post-trauma. Tests of intellectual, memory, visuospatial and frontal lobe functions were administered to patients and 29 normal matched control subjects. Correlations between performance on neuropsychological tests and age showed the following direction: the younger the child when TBI was sustained, the worse the cognitive outcome. After controlling for injury severity, visuospatial functions remained related to age. Patients' performance differed significantly from that of controls in half of the neuropsychological variables analysed. To further investigate the effects of age at injury, the sample was divided in two groups (TBI before and after age of 8) and then compared with their respective controls. Patients damaged earlier presented impaired intellectual and visuospatial functions. The results suggest that neuropsychological sequelae remain after at least 6 years of evolution, and that there is an age at injury effect. [ABSTRACT FROM AUTHOR]

There are characteristics which are consistent with traumatic brain injury (TBI) which can be sought to determine if TBI has been inflicted. Examination of 40 children from newborn to six years old in the hospital for TBI, but without any documentation of a previous brain injury, found distinctions between those in which TBI had been inflicted and those who were noninflicted. The TBI inflicted group showed CT or MRI evidence of previous brain injury, seizures, retinal hemorrhages, and other problems., Objective. To characterize neuroimaging, physical, neurobehavioral, and developmental findings in children with inflicted and noninflicted traumatic brain injury (TBI) and to identify characteristic features of inflicted TBI. Methods and Patients. Forty children, 0 to 6 years of age, hospitalized for TBI who had no documented history of previous brain injury were enrolled in a prospective longitudinal study. TBI was categorized as either inflicted (n = 20) or noninflicted (n = 20) based on the assessment of hospital and county protective services. Glasgow Coma Scale scores and neonatal history were comparable in both groups. Outcome Measures. Acute computed tomography magnetic resonance imaging studies and physical findings were evaluated. Glasgow Outcome Scale scores, cognitive development, and motor functioning were assessed an average of 1.3 months after TBI. [chi square] analyses assessed differences in the distribution of findings in the inflicted and noninflicted TBI groups. Results. Signs of preexisting brain injury, including cerebral atrophy, subdural hygroma, and ex vacuo ventriculomegaly, were present in 45% of children with inflicted TBI and in none of the children with noninflicted TBI. Subdural hematomas and seizures occurred significantly more often in children with inflicted TBI. Intraparenchymal hemorrhage, edema, skull fractures, and cephalohematomas were similar in both groups. Retinal hemorrhage was only identified in the inflicted TBI group. Glasgow Outcome Scale scores indicated a significantly less favorable outcome after inflicted than noninflicted TBI. Mental deficiency was present in 45% of the inflicted and 5% of the noninflicted TBI groups. Conclusions. Characteristic features of inflicted TBI included acute computed tomography/magnetic resonance imaging findings of preexisting brain injury, extraaxial hemorrhages, seizures, retinal hemorrhages, and significantly impaired cognitive function without prolonged impairment of consciousness. Pediatrics 1998;102:300-307; child abuse, shaken baby syndrome, traumatic brain injury, cognition, outcome, infants, children, neuroimaging, Glasgow Outcome Scale, retinal hemorrhage., ABBREVIATIONS. TBI, traumatic brain injury; CT, computed tomography; MRI, magnetic resonance imaging; GCS, Glasgow Coma Scale. Physical child abuse and traumatic brain injury (TBI) are major public health problems. Injury [...]

This study investigated the neurologic validity of the Wisconsin Card Sorting Test (WCST) with a pediatric population; that is, the ability of the test to detect dysfunction in the frontal lobes. Fifty children with diverse etiologies of brain dysfunction were classified via EEG, MRI, or CT as having left hemisphere, right hemisphere, or bilateral frontal, extrafrontal, or multifocal/diffuse regions of brain dysfunction. Findings failed to support the hypotheses that WCST performance is more impaired in frontal lesions than extrafrontal or multifocal/diffuse lesions, or that WCST performance is more impaired in left hemisphere lesions than right. Although the WCST is not helpful in localizing cerebral area of dysfunction, it may still be a clinically useful test for examining processes that children use to solve complex problems. [ABSTRACT FROM AUTHOR]

Subjective organization (SO) of verbal memory and learning was investigatedfor 44 adolescent neurological patients, who were subdivided into four clinicalgroups by localization of lesion as follows: right hemisphere (RH), left hemisphere(LH), frontal (FL), and brain stem (BS). As expected, patients with RH lesionsperformed best on a verbal learning task, whereas patients with FL and BSlesions demonstrated very poor SO, suggesting a failure in categorizing memoryinput. Patients with LH lesions increased SO following successive trials,suggesting an active learning strategy. It is argued that SO analysis in neuropsychologyappears to be a particularly heuristic direction of further research in orderto establish a better understanding of memory and learning impairments ofpatients with brain damage. [ABSTRACT FROM AUTHOR]

The article presents information about the findings of a survey on two new internship programs and two new university training programs in clinical neuropsychology. The data were collected during 1977. While conducting the survey corrections for 13 programs and information about 2 new internship programs and 2 new university training programs were received. One internship program at Eastern Pennsylvania Psychiatric Institute was cancelled and one at Lafayette Clinic lost its stipends. The institutes offering internship training in clinical neuropsychology are Veterans Administration Medical Center at Palo Alto, California, University of Colorado Health Sciences Center, Connecticut, Lafayette Clinic at Detroit, Michigan, United States Air Force Medical Center Memphis V.A. Medical Center with Memphis Clinical Psychology Internship Consortium and University of Wisconsin Center for Health Sciences Madison, Wincosin. The training programs in clinical neuropsychology are being offered by institutes like Queens College City University of New York, University of Victoria which is offering the program in coordination with the Psychiatric, Gorge Road Rehabilitation, Royal Jubilee Hospitals, The Pearkes Centre and the Cedar Lodge School for Handicapped and Brain-Injured Children.

The article focuses on problem-solving task performance in brain-damaged subjects. It also investigates the relationship between the Haistead Category Test and Wisconsin Card Sorting Test (WCST). Deficits in complex reasoning and problem-solving skills have been identified as the product of many forms of brain dysfunction. The WCST has several advantages over the Category Test, however; it is much less expensive to purchase, takes less time to administer, and is more portable. In addition to these practical advantages, the brevity of administration time may make it a less fatiguing test for the brain-damaged patient.

The article reports on the separation of braindamaged from patients with ability and personality measures. Previous research indicates that many brain-damage screening tests lack the ability to separate organic from functional patients at a satisfactory level. However the Smith Symbol-Digit Modalities Test, the Benton Visual Retention test, the Background Interference Procedure variation of the Minnesota Percepto-Diagnostic Test (MMPI) and the MMPI Psychiatric-Organic scale have shown some promise in earlier studies.

A major problem in the management of children with severe brain damage is the lack of understanding of their behavior on the part of parents and/or caregivers. This article reports attempts to establish some forms of communication between two severely handicapped infants and their caregivers. Drawing upon descriptive case studies, the authors argue that the behavior of normal neonates and reciprocal infant-cost, giver interaction can be used to guide restoration of basic communication patterns in infants and children with severe neurological lesions. In summary, the major stages of therapeutic intervention were: organization of rhythms, leaching the child to delay gratification or make requests, and introduction of social rules. The rehabilitation technique used was based on Bobath's approach, which involves training of intervention for both infants and their caregivers. [ABSTRACT FROM AUTHOR]

Highlights a case study of a student with traumatic brain injury (TBI). Name of the student; Circumstances surrounding his injuries; Information on the student's school performance; What a review of the student's case revealed; Details on what is necessary for the educational success of students with TBI. INSETS: What does research say about traumatic brain injury?;SOS for TBI;Guidelines for families and schools.