NEUROBEHAVIORAL OUTCOME OF HEAD INJURY IN CHILDREN

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。我们提出了三个目标来研究两年内中度至重度创伤性脑损伤（TBI）相对于骨科损伤（OI）对儿童认知控制和动机的影响：(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)社会认知的改变，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、学业成就和心理社会适应的执行功能结果域的变化有关。我们还建议研究认知控制和社会认知的变化与损伤年龄、TBI严重程度、脑区域体积和脑损伤体积的关系，这些变化是在损伤后3个月和18个月通过磁共振成像（MRI）测量的。我们将评估家庭环境（社会经济水平、应激源和社会资源）的调节作用，并控制损伤前创伤暴露、创伤后应激和抑郁症状的影响。7-16岁的中度至重度TBI （n=92）或OI （n=92）的儿童将在基线（损伤后1个月内）进行研究，并在损伤后3、12、18和24个月进行随访。认知控制任务包括Flanker（干扰和不去）、Sternberg项目识别（干扰和工作记忆）、停止信号（停止反应）、选择性学习切换和说明性话语（选择属于高奖励类别的学习项目）、改进的爱荷华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情绪表达来评估，意向性通过区分真实情绪和表面情绪以及解释动画人物的动作来评估。脑区域体积将通过手工追踪和分割灰质和白质来测量：(1)额叶亚区，包括外侧、腹内侧和上内侧区域；(2)扁桃体;(3)颞上回；(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。结果测量将是伍德考克-约翰逊成就测试，执行功能简短行为量表，儿童行为评估系统和维兰德适应行为量表。假设的统计分析将使用一般的线性混合模型。

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.