Neural Basis of Recovery of Inhibitory Control After Pediatric TBI

描述（由申请人提供）：儿童创伤性脑损伤（TBI）后，抑制控制经常受损，抑制控制缺陷影响儿童在学校和家庭中的功能，并最终影响他们成年后成功融入社区的可能性。长期目标是了解抑制控制恢复的神经机制，包括涉及情绪表达和社交情境的自我控制，以便识别在这些领域存在持续问题的高风险儿童，并评估旨在优化抑制控制的干预措施的效果。本提案的重点是通过实验室评估和家长报告的家庭和社区行为测量来了解儿童TBI后18个月抑制控制的恢复情况，并确定慢性抑制控制的神经影像学预测因素和相关因素。具体目标是：1)描述中度至重度儿童TBI后18个月内不同方面抑制控制的恢复模式；2)确定儿童中度至重度TBI后的影像学指标，a)与当前抑制控制相关，b)预测损伤后一年的抑制控制，c)预测未来影像学结果；3)确定中度至重度TBI儿童，损伤后2个月至1年内影像学指标的变化与同期抑制控制的改善有关。神经成像方法将包括弥散张量成像（DTI）、磁共振光谱成像（MRSI）和形态计量学分析，主要分析包括额叶完整性与抑制控制措施的关系。本项目作为儿童康复医师PI职业发展计划的一部分，旨在获得纵向研究设计和数据分析、儿童TBI后神经行为评估（包括抑制控制和社会功能评估）以及TBI儿童DTI、MRSI和结构成像数据的处理和分析方面的培训。肯尼迪克里格研究所和约翰霍普金斯大学提供了一个特殊的环境，使PI成为一个独立的研究者，研究儿童创伤性脑损伤后的大脑行为关系。

DESCRIPTION (provided by applicant): Inhibitory control is frequently impaired following pediatric traumatic brain injury (TBI), and deficits in inhibitory control impact a child's function in school and at home and ultimately their likelihood for successful community integration as an adult. The long-term goal is to understand the neural mechanisms underlying the recovery of inhibitory control, including that involved in self-control of emotional expression and in social situations, in order to identify children at high risk for ongoing problems in these domains and to evaluate the efficacy of interventions designed to optimize inhibitory control. The focus of this proposal is to understand the recovery of inhibitory control over 18 months following pediatric TBI using laboratory assessments and parent-report measures of behavior in the home and community and to identify neuroimaging predictors and correlates of chronic inhibitory control. The specific aims are to 1) describe the pattern of recovery of varying aspects of inhibitory control over 18 months following moderate to severe pediatric TBI, 2) identify imaging measures which, after moderate to severe TBI in childhood, a) correlate with current inhibitory control, b) predict inhibitory control at one year following injury, and c) predict future imaging findings, and 3) identify, in children with moderate to severe TBI, changes in imaging measures between 2 months and 1 year following injury which are associated with improved inhibitory control over the same time period. Neuroimaging methods will include diffusion tensor imaging (DTI), magnetic resonance spectroscopic imaging (MRSI), and morphometric analyses, with primary analyses consisting of the relationship of frontal lobe integrity with measures of inhibitory control. This project is proposed as part of a career development plan for the PI, a pediatric rehabilitation physician, to obtain training in longitudinal study design and data analysis, neurobehavioral evaluation after pediatric TBI including assessment of inhibitory control and social function, and processing and analysis of DTI, MRSI, and structural imaging data from children with TBI. The Kennedy Krieger Institute and Johns Hopkins University provide an exceptional environment to enable the PI to become an independent investigator studying brain-behavior relationships after pediatric TBI. Public Health Relevance: After brain injury, many children have difficulty with controlling their behavior, which leads to problems in school and at home. The goal of this study is to develop ways to better understand which children are at risk to have this problem long-term after brain injury. This information will help children receive treatment to optimize their behavior as soon as possible and will allow studies of the efficacy of these treatments.