Academic Outcomes After Pediatric Traumatic Brain Injury

儿童脑外伤后的学业成绩

• 批准号: 6862689
• 负责人: LINDA EWING-COBBS
• 金额: $ 59.53万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-05-01 至 2009-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6862689
• 关键词: academic achievement; adolescence (12-20); atrophy; behavioral /social science research tag; brain injury; brain morphology; child behavior; clinical research; cognition; gray matter; human subject; longitudinal human study; magnetic resonance imaging; memory; middle childhood (6-11); neuroimaging; outcomes research; pediatrics; white matter

DESCRIPTION (provided by applicant): The overarching aim of the application is to model multivariate relations between neuroimaging, cognitive, and psychosocial predictors of academic outcomes after traumatic brain injury (TBI). Academic deficits are among the most significant and pervasive areas of deficit after TBI in school-aged children and adolescents. Moderate to severe TBI is associated with deficits in executive processes that influence outcomes in many domains, including academic skill development, academic performance, and child adjustment. Traditional achievement measures grossly underestimate the functional academic deficits of children with TBI as they infrequently examine related components of executive processing. To address these limitations, we developed integrative academic tasks that incorporate more real-world demands for speed and automaticity of symbol manipulation, inferencing, cohesion, strategy use, resistance to distraction, and comprehension monitoring. We will administer a battery of 1) executive processing tasks assessing processing speed, working memory, and inhibitory control, 2) core achievement tasks, 3) integrative academic tasks and 4) measures of child adjustment to characterize post-traumatic deficits impacting academic outcomes. We propose to use multiple quantitative structural neuroimaging methods, including DT-MRI and volumetric analyses of white and gray matter, to characterize microstructural and macrostructural damage to neural systems and to examine brain-behavior relations after TBI. Study 1 prospectively examines academic outcomes 2, 6, 12, and 24 months after moderate to severe TBI in youth ages 6-15 at the time of injury and an orthopedic comparison group. MRI studies will be obtained at 2 and 24 months after injury for both groups. Study 2 will examine extended follow-up 3 to 8 years after moderate to severe TBI in a cohort of children who sustained TBI at 0-14 years of age in relation to healthy controls. Study 2 allows characterization of the impact of indices of diffuse and focal injury on the late consequences of brain injury. Quantitative MRI will examine late changes in diffusion anisotropy as well as global and regional atrophy as they relate to academic outcomes. Our approach to prediction of outcomes is unique as it emphasizes 1) more precise behavioral measures related to executive processes and integrative academic skills, 2) measures of factors affecting child adjustment; and 3) quantitative indices of macrostructural and microstructural brain injury that are linked through a developmental model.

描述（由申请人提供）：申请的总体目的是建模神经影像学，认知和心理心理预测因素的学术成果（TBI）（TBI）之间的多元关系。在学龄儿童和青少年中，在TBI之后，学术上的缺陷是最重要，最普遍的赤字领域之一。中度至重度TBI与执行过程中的缺陷有关，这些过程影响了许多领域的成果，包括学术技能发展，学习成绩和调整儿童。传统的成就衡量标准严重低估了TBI儿童的功能性学术缺陷，因为他们很少检查执行处理的相关组成部分。为了解决这些局限性，我们开发了整合的学术任务，这些任务包括对符号操纵，推理，凝聚力，策略使用，分散注意力和理解监测的速度和自动性的更真实需求。我们将管理一个电池1）评估处理速度，工作记忆和抑制控制的执行处理任务，2）核心成就任务，3）综合学术任务和4）儿童调整的措施以表征影响学术成果的创伤后缺陷。我们建议使用多种定量的结构神经影像学方法，包括DT-MRI和白色和灰质的体积分析，以对神经系统的微结构和宏观结构损害进行表征，并检查TBI后脑行为关系。研究1前瞻性检查学术成果在受伤时6-15岁的年轻人和骨科比较组中中度至重度TBI后2、6、12和24个月。两组受伤后2和24个月将获得MRI研究。研究2将在中度至重度TBI后3至8年进行延长的随访，其中一组与健康对照相关的儿童在0-14岁时持有TBI。研究2允许表征弥漫性和局灶性损伤指数对脑损伤后果的影响。定量MRI将检查扩散各向异性以及与学术结果相关的全球和区域萎缩的后期变化。我们预测结果的方法是独一无二的，因为它强调1）与执行过程和综合学术技能有关的更精确的行为措施，2）影响儿童调整的因素的度量； 3）通过发育模型相关的宏结构和微结构脑损伤的定量指数。