NEUROBEHAVIORAL OUTCOME OF HEAD INJURY IN CHILDREN

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。我们提出了三个目标来研究儿童中重度创伤性脑损伤（TBI）相对于骨科损伤（OI）的影响：（1）认知控制和动机的变化，包括不同形式的抑制、工作记忆、认知资源的灵活分配和对激励的反应;（2）社会认知的变化，包括情绪表达和意向性的加工;（3）认知控制和社会认知的变化与日常活动中执行功能、学业成绩和心理社会适应的结果域的变化有关。我们还建议研究在认知控制和社会认知的变化与受伤时的年龄，TBI的严重程度，脑区域的体积，并在3个月和18个月后进行磁共振成像（MRI）测量的脑病变体积。我们将评估家庭环境（社会经济水平，压力源和社会资源）的调节作用，并控制创伤前创伤暴露，创伤后应激和抑郁症状的影响。年龄7-16岁的儿童谁持续中度至重度TBI（n=92）或OI（n=92）将在基线（1个月内伤后）和后续3，12，18，24个月伤后进行研究。认知控制任务包括Flanker（干扰和禁止）、斯滕贝格项目识别（干扰和工作记忆）、停止信号（停止反应）、选择性学习转换和暂时性话语（选择性学习属于高奖励类别的项目）、修改的爱荷华州赌博任务和具有外部奖励操纵的前瞻性记忆任务。社会认知通过处理面部和韵律的情感表达来评估，意向性通过区分真实的和明显的情感以及解释动画人物的动作来评估。通过手动追踪和分割灰质和白色物质来测量脑区域体积：（1）额叶亚区，包括外侧、腹内侧和上级内侧区域;（2）杏仁核;（3）上级颞回;以及（4）全脑。我们还将分析这些区域的局灶性病变体积和深度的影响。结果测量将是Woodcock-Johnson III成就测试、执行功能简明行为量表、儿童行为评估系统和Vineland适应行为量表。假设的统计分析将使用一般线性混合模型。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. We propose three aims to study the effects over two years of moderate to severe traumatic brain injury (TBI) relative to orthopedic injury (OI) in children on: (1) change in cognitive control and motivation, including different forms of inhibition, working memory, flexible allocation of cognitive resources, and response to incentives; (2) change in social cognition, including processing of emotional expression and intentionality; (3) change in cognitive control and social cognition in relation to change in outcome domains of executive functioning in everyday activities, academic achievement, and psychosocial adjustment. We also propose to study change in cognitive control and social cognition in relation to age at injury, TBI severity, brain regional volumes, and brain lesion volumes measured from magnetic resonance imaging (MRI) performed at 3 and 18 months postinjury. We would evaluate the moderating effects of family environment (socioeconomic level, stressors and social resources) and control for the effects of preinjury trauma exposure, posttraumatic stress, and depressive symptoms. Children age 7-16 years who sustain a moderate to severe TBI (n=92) or OI (n=92) would be studied at baseline (within 1 month postinjury) and followed-up at 3, 12, 18, and 24 months postinjury. Cognitive control tasks include the Flanker (interference and no-go), Sternberg Item Recognition (interference and working memory), stop signal (stopping a response), selective learning-switching and expository discourse (selectivity in learning items belonging to highly rewarded categories), a modified Iowa Gambling Task, and a prospective memory task with an extrinsic reward manipulation. Social cognition is evaluated by processing facial and prosodic emotional expression and intentionality is assessed by differentiating real from apparent emotion and interpreting the movements of animated figures. Brain regional volumes would be measured by manual tracing and segmentation of gray and white matter for: (1) frontal subregions including lateral, ventromedial, and superior medial regions; (2) amygdala; (3) superior temporal gyrus; and, (4) whole brain. We will also analyze the effects of focal lesion volume and depth in these regions. Outcome measures would be the Woodcock-Johnson III Tests of Achievement, the Brief Behavior Inventory of Executive Function, the Behavior Assessment System for Children, and the Vineland Adaptive Behavior Scale. Statistical analysis of the hypotheses would use general linear mixed models.