Academic Outcomes After Pediatric Traumatic Brain Injury

描述（由申请人提供）：该申请的首要目的是建立创伤性脑损伤（TBI）后学业成绩的神经影像学、认知和社会心理预测因素之间的多元关系模型。在学龄儿童和青少年中，学习缺陷是脑外伤后最显著和最普遍的缺陷之一。中度至重度脑外伤与执行过程缺陷有关，执行过程缺陷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能力。传统的成就测量方法严重低估了脑损伤儿童的功能性学业缺陷，因为它们很少检查执行处理的相关组成部分。为了解决这些限制，我们开发了综合学术任务，这些任务结合了更多现实世界对符号操作、推理、内聚、策略使用、抗干扰和理解监测的速度和自动化的需求。我们将执行一系列的处理任务：1)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；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成像方法，包括DT-MRI和白质和灰质的体积分析，来表征神经系统的微观结构和宏观结构损伤，并检查脑损伤后的脑行为关系。研究1前瞻性地检查了6-15岁青少年中至重度TBI损伤后2、6、12和24个月的学术结果，并进行了骨科对照组。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岁发生TBI的儿童队列中，对中度至重度TBI后3 - 8年的延长随访进行研究。研究2允许表征弥漫性和局灶性损伤指标对脑损伤晚期后果的影响。定量MRI将检查扩散各向异性以及全球和区域萎缩的晚期变化，因为它们与学术成果有关。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；3)通过发育模型联系脑损伤宏观结构和微观结构的定量指标。

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.