Neural Basis of Recovery of Inhibitory Control After Pediatric TBI

描述(申请人提供)：儿童创伤性脑损伤(TBI)后，抑制控制经常受损，抑制控制缺陷会影响儿童在学校和家里的功能，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，包括情绪表达的自我控制和社会情境中的神经机制，以便识别这些领域中持续问题的高危儿童，并评估旨在优化抑制控制的干预措施的有效性。这项建议的重点是通过实验室评估和家庭和社区行为的父母报告测量，了解儿童脑外伤后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预测因子和相关性。其具体目的是：1)描述在儿童中重度脑损伤后18个月内抑制控制的不同方面的恢复模式；2)确定在儿童时期中到重度脑损伤后，a)与当前抑制控制相关的成像措施，b)预测损伤后一年的抑制控制，以及c)预测未来的成像结果，以及3)在中到重度脑损伤的儿童中，识别在损伤后2个月至1年之间的成像措施的变化，这些变化与同一时间段内抑制控制的改善有关。神经成像方法将包括扩散张量成像(DTI)、磁共振波谱成像(MRSI)和形态计量分析，主要分析额叶完整性与抑制控制措施的关系。该项目是作为一名儿科康复医生的职业发展计划的一部分，目的是在以下方面获得培训：纵向研究设计和数据分析、儿科脑损伤后的神经行为评估(包括抑制控制和社会功能评估)，以及处理和分析脑损伤儿童的DTI、MRSI和结构成像数据。肯尼迪·克里格研究所和约翰斯·霍普金斯大学提供了一个特殊的环境，使PI能够成为研究儿童脑外伤后脑行为关系的独立研究员。 公共卫生相关性：脑损伤后，许多儿童难以控制自己的行为，这导致在学校和家里出现问题。这项研究的目的是开发更好的方法来更好地了解哪些儿童在脑损伤后长期存在这种问题的风险。这些信息将帮助儿童尽快接受治疗，以优化他们的行为，并将有助于研究这些治疗的效果。

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.