Academic Outcomes After Pediatric Traumatic Brain Injury

描述（由申请人提供）：该应用程序的首要目标是对创伤性脑损伤（TBI）后学术成果的神经影像学、认知和心理社会预测因素之间的多变量关系进行建模。学业缺陷是学龄儿童和青少年TBI后最重要和最普遍的缺陷领域之一。中度至重度TBI与执行过程中的缺陷有关，这些缺陷影响许多领域的结果，包括学术技能发展，学习成绩和儿童适应。传统的成就措施严重低估了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，我们开发了综合性的学术任务，包括更多的现实世界的速度和自动化的符号操作，推理，凝聚力，策略的使用，抗干扰，和理解监测的要求。我们将管理一组1）执行处理任务，评估处理速度，工作记忆和抑制控制，2）核心成就任务，3）综合学业任务和4）儿童适应措施，以表征影响学业成绩的创伤后缺陷。我们建议使用多种定量结构神经影像学方法，包括DT-MRI和体积分析的白色和灰质，表征微观和宏观结构损伤的神经系统，并检查脑行为的关系TBI后。研究1前瞻性研究了6-15岁青少年中重度TBI后2、6、12和24个月的学业成绩，并与骨科对照组进行了比较。两组均在损伤后2个月和24个月进行MRI检查。研究2将在0-14岁持续TBI的儿童队列中检查中度至重度TBI后3至8年的延长随访，并与健康对照组进行比较。研究2允许表征弥漫性和局灶性损伤指数对脑损伤晚期后果的影响。定量MRI将检查弥散各向异性的晚期变化以及与学术成果相关的全局和局部萎缩。我们预测结果的方法是独特的，因为它强调1）与执行过程和综合学术技能相关的更精确的行为测量，2）影响儿童适应的因素的测量;和3）通过发展模型联系起来的宏观和微观结构脑损伤的定量指标。

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.