Academic Outcomes After Pediatric Traumatic Brain Injury

描述(由申请者提供)：该应用程序的首要目标是模拟创伤性脑损伤(TBI)后学习结果的神经成像、认知和心理社会预测因素之间的多元关系。在学龄儿童和青少年中，学业缺陷是继脑外伤后最显著和最普遍的缺陷领域之一。中度到重度的脑外伤与执行过程中的缺陷有关，这些缺陷会影响许多领域的结果，包括学习技能发展、学习成绩和儿童适应。传统的成就测量严重低估了脑外伤儿童的功能性学习缺陷，因为它们很少检查执行加工的相关组成部分。为了解决这些限制，我们开发了综合性的学术任务，包括对符号操作、推理、衔接、策略使用、抵抗分心和理解监控的速度和自动化的更多现实需求。我们将实施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)综合学习任务和4)儿童适应措施，以表征创伤后缺陷对学习结果的影响。我们建议使用多种定量结构神经成像方法，包括DT-MRI和白质和灰质的体积分析，来表征脑创伤后神经系统的微结构和宏观结构损伤，并检查脑-行为关系。研究1前瞻性地检查了受伤时6-15岁的青少年和矫形外科对照组在中到重度脑外伤后2、6、12和24个月的学业结果。两组患者将在伤后2个月和24个月进行MRI检查。研究2将检查一组在0-14岁时持续脑损伤的儿童与健康对照组相比，在中到重度脑损伤后的3到8年的延长随访。研究2描述了弥漫性和局灶性损伤指数对脑损伤的远期后果的影响。定量MRI将检查扩散各向异性的晚期变化，以及与学术结果相关的全局和区域性萎缩。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习技能有关的更精确的行为测量，2)影响儿童适应的因素的测量，以及3)通过发展模型联系起来的宏观和微观脑损伤的定量指数。

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.