Long Term Functional Outcomes of Early TBI

描述（由申请人提供）：创伤性脑损伤（TBI）是儿童获得性残疾的主要原因，在美国每年影响大约50万儿童5。然而，之前的研究未能检查早期创伤性脑损伤在日常环境（如学校和家庭）中的长期功能结果。了解日常环境中的表现可以提供关于残障的关键信息，并提出干预目标。参与者：基于一项正在进行的幼儿TBI前瞻性调查的结果，本研究将检查70-85名3 - 7岁之间持续发生TBI的儿童的长期功能结果，长期随访时至少为10岁。TBI组的结果将相对于对照组70-85名在相同年龄遭受不涉及中枢神经系统的骨科损伤的儿童的结果进行评估。这些儿童是多地点纵向队列的一部分，他们在受伤后最初18个月的四个时间点完成了他们的认知能力、适应功能和社会环境的评估。方法：我们的总体目标是：1)描述早期TBI后的长期功能结果，2)检查执行功能（EF）作为功能结果的中介的作用，以及3)识别学校和家庭环境中的风险和保护因素。长期随访评估将在三个不同的环境中进行：教室、孩子的家和实验室/诊所。日常功能的主要测量方法包括对儿童在家庭和社区中的功能进行结构化的临床访谈，以及经过验证的课堂观察，评估多种学习特征，包括任务参与和注意力。将使用标准化评分和正式观察量表（home）对家庭环境进行评估。对家庭和课堂环境的观察将提供关于长期功能的社会调节因子的信息，并将有助于确定有效的教学方法。TBI组和OI组之间的差异将通过单变量或多变量协方差分析进行分析。本研究还将研究早期脑外伤后青春期前EF的出现，以及这些技能缺陷在脑外伤对功能结果影响中的中介作用。长期结果的预测因子/调节因子将通过多元线性回归分析和一般线性混合模型分析进行检验。通径分析将用于探索TBI和环境因素作为日常功能结果预测因素的相对重要性。结论：扩大对有价值的前瞻性队列的随访，并建立在研究者之间近20年的富有成效的合作基础上，该项目将阐明早期儿童脑外伤的发展意义。通过确定与长期学习和行为有关的因素，该项目还将为促进儿童后期功能的方法提供新的思路。公共卫生相关性：脑外伤是儿童期获得性残疾的主要原因，但对日常环境中的长期功能或成功适应的因素知之甚少。拟议的项目将研究对学校、家庭和社区长期日常功能的影响，在前瞻性招募的3至7岁之间遭受创伤性脑损伤的儿童队列和在同一年龄遭受骨科损伤的儿童队列中进行比较。研究结果将为如何减少创伤性脑损伤后的心理残疾和改善长期的现实世界功能提供重要信息。

DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) is the leading cause of acquired disability in children, affecting approximately a half million children each year in the United States5. However, previous research has failed to examine the longer-term functional outcomes of early TBI in everyday settings such as school and home. Understanding performance in everyday settings provides critical information on residual impairments and suggests targets for intervention. Participants: Building on findings from an ongoing prospective investigation of TBI in young children, this study will examine long-term functional outcomes in 70-85 children who sustained a TBI between 3 and 7 years of age and who will be at least 10 years of age at long-term follow-up. Outcomes for the TBI group will be evaluated relative to those in a comparison group of 70-85 children who sustained orthopedic injuries not involving the CNS at the same age. The children are part of a multi-site, longitudinal cohort who have completed evaluations of their cognitive abilities, adaptive functioning, and social environments at four time points over the initial 18-months post injury. Method: Our overarching goals are: 1) to characterize long-term, functional outcomes following early TBI, 2) to examine the role of executive functions (EF) as a mediator of functional outcomes, and 3) to identify risk and protective factors in the school and home environment. Long-term follow-up assessments will be conducted in three distinct settings: the classroom, the child's home, and the laboratory/clinic. Primary measures of everyday functioning include a structured clinical interview of the child's functioning in the home and communityand a validated classroom observation that assesses multiple learning characteristics, including task engagement and attention. The home environment will be assessed using both standardized ratings and a formal observational scale (HOME). Observations of the home and classroom environment will provide information about social moderators of long-term functioning and will help identify effective instructional approaches. Differences between the TBI and OI groups will be analyzed by means of univariate or multivariate analysis of covariance. This investigation will also examine the emergence of EF in preadolescence following early TBI and the role of deficits in these skills as mediators of the effects of TBI on functional outcomes. Predictors/moderators of long-term outcomes will be examined by means of multiple linear regression analysis and general linear mixed model analysis. Path analyses will be used to explore the relative importance of TBI and the environmental factors as predictors of everyday functional outcomes. Conclusion: Extending follow-up of a valuable prospective cohort and building on a productive, nearly 20-year collaboration among the investigators, this project will clarify the developmental implications of early childhood TBI. By identifying factors related to long-term learning and behavior, the project will also shed new light on ways to promote children's later functioning. PUBLIC HEALTH RELEVANCE: TBI is the leading cause of acquired disability in childhood, however little is known about long-term functioning in everyday settings or factors contributing to successful adaptation. The proposed project will examine influences on long-term everyday functioning at school, at home, and in the community in a prospectively recruited cohort of children who sustained TBI between the ages of 3 and 7 and a comparison cohort of children who sustained orthopedic injuries at the same age. Findings will yield important information about how to reduce psychosocial disability and improve long-term, real world functioning following TBI.