2.0 CE Credits - Special Issue: Resilience II
From reading these articles, the learner will be able to:
- Explain what confabulations following brain injury is, and
- Discuss the possible causes for the why very few reports on children confabulating can be found.
- List the most common community neuropsychological rehabilitation goals of young people with Acquired Brain Injury (ABI)
- Describe the association between the types of rehabilitation goals a young person with ABI may have and their sex, age, injury type and time post-injury.
- Describe the prevalence of adaptive competence, or “resilience,” in a cohort of extremely preterm children compared to normal birth weight controls.
- Identify child and family characteristics associated with resilience in the preterm group.
- List risk and protective factors related to cognitive outcomes amongst childhood brain tumor survivors and
- Discuss how aerobic exercise promotes recovery following acquired brain injury.
Cognitive Performance, Aerobic Fitness, Motor Proficiency, and Brain Function Among Children Newly Diagnosed With CraniopharyngiomaAbstract
Objectives: Craniopharyngioma survivors experience cognitive deficits that negatively impact quality of life. Aerobic fitness is associated with cognitive benefits in typically developing children and physical exercise promotes recovery following brain injury. Accordingly, we investigated cognitive and neural correlates of aerobic fitness in a sample of craniopharyngioma patients. Methods: Patients treated for craniopharyngioma [N=104, 10.0±4.6 years, 48% male] participated in fitness, cognitive and fMRI (n =51) assessments following surgery but before proton radiation therapy. Results: Patients demonstrated impaired aerobic fitness [peak oxygen uptake (PKVO2)= 23.9±7.1, 41% impaired (i.e., 1.5 SD< normative mean)], motor proficiency [Bruininks-Oseretsky (BOT2)=38.6± 9.0, 28% impaired], and executive functions (e.g., WISC-IV Working Memory Index (WMI) =96.0± 15.3, 11% impaired). PKVO2 correlated with better executive functions (e.g., WISC-IV WMI r= .27, p= .02) and academic performance (WJ-III Calculation r =.24, p= .04). BOT2 correlated with better attention (e.g., CPT-II omissions r= .26, p= .04) and executive functions (e.g., WISC-IV WMI r= .32, p=.01). Areas of robust neural activation during an n-back task included superior parietal lobule, dorsolateral prefrontal cortex, and middle and superior frontal gyri (p<.05, corrected). Higher network activation was associated with better working memory task performance and better BOT2 (p< .001). Conclusions: Before adjuvant therapy, children with craniopharyngioma demonstrate significantly reduced aerobic fitness, motor proficiency, and working memory. Better aerobic fitness and motor proficiency are associated with better attention and executive functions, as well as greater activation of a well-established working memory network. These findings may help explain differential risk/resiliency with respect to acute cognitive changes that may portend cognitive late effects. (JINS, 2019, 25, 413–425)
Resilience in Extremely Preterm/Extremely Low Birth Weight Kindergarten ChildrenAbstract
Objectives: Research on developmental outcomes of preterm birth has traditionally focused on adverse effects. This study investigated the prevalence and correlates of resilience in 146 extremely preterm/extremely low birth weight (EPT/ ELBW) children (gestational age <28 weeks and/or birth weight<1000 g) attending kindergarten and 111 term-born normal birth weight (NBW) controls. Methods: Adaptive competence (i.e., “resilience” in the EPT/ELBW group) was defined by scores within grade expectations on achievement tests and the absence of clinically elevated parent ratings of child behavior problems. The “adaptive” children who met these criteria were compared to the “maladaptive” children who did not on child and family characteristics. Additional analyses were conducted to assess the conjoint effects of group (ELBW vs. NBW) and family factors on adaptive competence. Results: A substantial minority of the EPT/ELBW group (45%) were competent compared to a majority of NBW controls (73%), odds ratio (95% confidence interval)= 0.26 (0.15, 0.45), p< .001. Adaptive competence was associated with higher cognitive skills, more favorable ratings of behavior and learning not used to define adaptive competence, and more advantaged family environments in both groups, as well as with a lower rate of earlier neurodevelopmental impairment in the EPT/ELBW group. Higher socioeconomic status and more favorable proximal home environments were associated with competence independent of group, and group differences in competence persisted across the next two school years. Conclusions: The findings document resilience in kindergarten children with extreme prematurity and highlight the role of environmental factors as potential influences on outcome. (JINS, 2019, 25, 362–374)
Confabulation Resilience of the Developing Brain: A Brief ReviewAbstract
Objectives: To investigate a possible confabulation resilience of the developing brain. Methods: We performed a literature search on confabulation in PubMed and identified all empirical studies of children and adolescents under the age of 18. Results: The analysis identified only three case studies of confabulation in children under the age of 18 of 286 empirical studies of confabulation. This reveals a striking discrepancy in the number of reported cases caused by brain injury between children and adults. We hypothesize that there may be a resilience toward confabulation in the developing brain and present three tentative explanations regarding the possible underlying mechanisms. Conclusions: Additional awareness on the scarcity of reported cases of confabulation in children could lead to important insights on the nature of confabulation and greater understanding of the resilience and plasticity of the developing brain. (JINS, 2019, 25, 426–431)
What do Kids with Acquired Brain Injury Want? Mapping Neuropsychological Rehabilitation Goals to the International Classification of Functioning, Disability and HealthAbstract
Objective: To increase understanding of the community neuropsychological rehabilitation goals of young people with acquired brain injuries (ABIs). Method: Three hundred twenty-six neuropsychological rehabilitation goals were extracted from the clinical records of 98 young people with ABIs. The participants were 59% male, 2–19 years old, and 64% had a traumatic brain injury. Goals were coded using the International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY). Descriptive statistical analysis was performed to assess the distribution of goals across the ICF-CY. Chi-squared and Cramer’s V were used to identify demographic and injury-related associations of goal type. Results: The distribution of goals was 52% activities and participation (AP), 28% body functions (BF), 20% environmental factors (EF), and <1% body structures (BS). The number of EF goals increased with age at assessment (V = .14). Non-traumatic causes of ABIs were associated with more EF goals (V = .12). There was no association between sex or time post-injury and the distribution of goals across the ICF-CY. Conclusions: Young people with ABIs have a wide range of community neuropsychological rehabilitation goals that require an individualized, context-sensitive, and interdisciplinary approach. Community neuropsychological rehabilitation services may wish to ensure they are resourced to focus intervention on AP, with increasing consideration for EF as a young person progresses through adolescence. The findings of this research support models of community neuropsychological rehabilitation that enable wellness by combining direct rehabilitative interventions with attention to social context and systemic working across agencies.