Altered cortical thickness following prenatal sodium valproate exposure

Prenatal exposure to sodium valproate (VPA) is associated with neurodevelopmental impairments. Cortical thickness was measured in 16 children exposed prenatally to VPA and 16 controls. We found increased left inferior frontal gyrus (IFG; BA45) and left pericalcarine sulcus (BA18) thickness, an association between VPA dose and right IFG thickness, and a close relationship between verbal skills and left IFG thickness. A significant interaction between group and hemispheric IFG thickness showed absence of the normal asymmetry in the IFG region of VPA-exposed children. These data provide preliminary insights into the putative neural basis of difficulties experienced by some VPA-exposed children

Parenting program versus telephone support for Mexican parents of children with acquired brain injury: A blind randomized controlled trial

Introduction: Acquired brain injury (ABI) during childhood typically causes behavior problems in the child and high levels of stress in the family. The aims of this study are: (1) to investigate the effectiveness and feasibility of a parenting intervention in improving behavior and self-regulation in Mexican children with ABI compared to telephone support; (2) to investigate the effectiveness and feasibility of a parenting intervention in improving parenting skills, parent self-efficacy and decreasing parental stress in parents of children with ABI compared to telephone support. Our secondary aims are (1) to explore the impact that parent characteristics have on the intervention outcomes; (2) to investi

Modeling community integration in workers with delayed recovery from mild traumatic brain injury

Background: Delayed recovery in persons after mild traumatic brain injury (mTBI) is poorly understood. Community integration (CI) is endorsed by persons with neurological disorders as an important outcome. We aimed to describe CI and its associated factors in insured Ontario workers with delayed recovery following mTBI. Methods: A cross-sectional study of insured workers in the chronic phase following mTBI was performed at a rehabilitation hospital in Ontario, Canada. Sociodemographic, occupational, injury-related, clinical, and claim-related data were collected from self-reports, medical assessments, and insurers’ referral files. Community Integration Questionnaire (CIQ) scores were compared using analysis of variance or Spearman’s correlation tests. Stepwise multivariable linear regression models were used to evaluate the associations with CI. Results: Ninety-four workers with mTBI (45.2 ± 9.9 years old, 61.2 % male) at 197 days post-injury (interquartile range, 139–416 days) were included. The CIQ total and subscale scores were similar to those reported in more severe TBI samples. The CIQ scores were moderately to strongly correlated with various sociodemographic, claim-related, and clinical variables. In the multivariable regression analysis, several covariates accounted for 36.4 % of the CIQ variance in the final fully adjusted model. Discussion: This study evaluated CI in workers with mTBI, and analyzed its associated variables. Analysis revealed insomnia, head or neck pain, being married or in a relationship, time since injury, and a diagnosis of possible/probable malingering were independently associated with limited CI. Conclusions: Workers with delayed recovery from mTBI experience difficulty with CI. Insomnia is a particularly relevant covariate, explaining the greater part of its variance. To enhance participation, care should focus on clinical and non-clinical covariates

Cognitieve revalidatie voor kinderen en jongeren met niet-aangeboren hersenletsel:wat zijn de effectieve componenten?

Veel kinderen en jongeren met niet-aangeboren hersenletsel (nah) ervaren problemen met cognitief functioneren, zoals een verminderd geheugen of slechtere concentratie. Dit artikel is gebaseerd op bevindingen en inzichten uit het proefschrift ‘executive functions of children and adolescents: novel perspectives on assessment and intervention’. Een belangrijk doel van het promotietraject was beter inzicht te krijgen in hoe we cognitieve functies en bijbehorende problemen bij kinderen en jongeren met nah kunnen verbeteren. Cognitieve problemen bij kinderen en jongeren kunnen mogelijk worden behandeld met cognitieve revalidatie. Interventies voor cognitieve revalidatie kunnen worden gecategoriseerd op basis van hun hoofdcomponenten: 1) strategiegebruik en/of metacognitie, 2) herhaald oefenen, en 3) externe hulpmiddelen. Resultaten van een literatuurstudie naar cognitieve revalidatie laten zien dat door interventies die zijn gebaseerd op metacognitie en/of strategiegebruik vooral adaptief gedrag en sociaal functioneren verbeteren. Interventies op basis van herhaald oefenen verbeterden de prestaties op taken die vergelijkbaar zijn met de geoefende taken. Multi-componenten-interventies die deze twee componenten combineren, leken te leiden tot verbeteringen in zowel cognitief als adaptief gedrag en sociaal functioneren. Externe hulpmiddelen verbeterden het functioneren in het specifieke gebied waarop het hulpmiddel was gericht, bijvoorbeeld het geheugen. De beschikbare gegevens suggereren dat interventies bestaande uit meerdere componenten, zoals een combinatie van metacognitie- en/of strategiegebruik en herhaald oefenen, veelbelovend zijn, omdat deze kunnen leiden tot verbeteringen in zowel het cognitieve als psychosociale functioneren van kinderen en adolescenten met nah

Identifying factors contributing to child and family outcome 30 months after traumatic brain injury in children

Objective: To examine the contributions of injury severity, physical and cognitive disability, child and family function to outcome 30 months after traumatic brain injury (TBI) in children. Design: A prospective, longitudinal, between group design, comparing function before and after injury across three levels of injury severity. Subjects: One hundred and fifty children, 3.0–12.11 years old, admitted to hospital with a diagnosis of TBI. The sample was divided according to injury severity: mild (n = 42), moderate (n = 70), severe (n = 38). Children with a history of neurological, developmental, and psychiatric disorders were excluded from participation. Main outcome measures: Post injury physical function, cognitive ability (incorporating intellect, memory, and attention), behavioural and family functioning, and level of family burden. Results: A dose–response relation was identified for injury severity and physical and cognitive outcome, with significant recovery documented from acute to six months after TBI. Behavioural functioning was not related to injury severity, and where problems were identified, little recovery was noted over time. Family functioning remained unchanged from preinjury to post injury assessments. The level of family burden was high at both six and 30 months after injury, and was predicted by injury severity, functional impairment, and post injury child behavioural disturbance. Conclusions: These results suggest ongoing problems for the child and significant family burden 30 months after TBI. The nature and severity of the physical and cognitive problems are closely related to injury severity, with child and family function predicted by psychosocial and premorbid factors