More than 630,000 children and teenagers in the United States are
treated in emergency rooms for traumatic brain injury (TBI) each year. Doctors are beginning to get answers to the question that every
parent whose child has had a TBI wants to know:
What will my child be like 10 years from now?
In a study to be presented at the annual meeting of
the Association of Academic Physiatrists in Las Vegas, researchers from
Cincinnati Children's will present research on long-term effects of TBI
- an average of seven years after injury.
‘Patients with mild to moderate brain injuries are two times more likely to have developed attention problems, and those with severe injuries are five times more likely to develop secondary ADHD.’
Patients with mild to
moderate brain injuries are two times more likely to have developed
attention problems, and those with severe injuries are five times more
likely to develop secondary ADHD. These researchers are also finding
that the family environment influences the development of these
- Parenting and the home environment exert a powerful
influence on recovery. Children with severe TBI in optimal environments
may show few effects of their injuries while children with milder
injuries from disadvantaged or chaotic homes often demonstrate
- Early family response may be particularly important for
long-term outcomes suggesting that working to promote effective
parenting may be an important early intervention.
- Certain skills that can affect social functioning, such
as speed of information processing, inhibition, and reasoning, show
greater long-term effects.
- Many children do very well long-term after brain injury and most do not have across the board deficits.
But predictors of recovery
following TBI, particularly the roles of genes and environment, are
unclear. These environmental factors include family functioning,
parenting practices, home environment, and socioeconomic status.
Researchers at Cincinnati Children's are working to identify genes
important to recovery after TBI and understand how these genes may
interact with environmental factors to influence recovery.
- They will be collecting salivary DNA samples from more
than 330 children participating in the Approaches and Decisions in Acute
Pediatric TBI Trial.
- The primary outcome will be global functioning at three, six,
and 12 months post injury, and secondary outcomes will include a
comprehensive assessment of cognitive and behavioral functioning at 12
months post injury.
- This project will provide information to inform individualized prognosis and treatment plans.
Using neuroimaging and other technologies, scientists are also
learning more about brain structure and connectivity related to
persistent symptoms after TBI. In a not-yet-published Cincinnati
Children's study, for example, researchers investigated the structural
connectivity of brain networks following aerobic training. The recovery
of structural connectivity they discovered suggests that aerobic
training may lead to improvement in symptoms.
Over the past two decades, investigators at Cincinnati Children's
have conducted a series of studies to develop and test interventions to
improve cognitive and behavioral outcomes following pediatric brain
injury. They developed an innovative web-based program that provides
family-centered training in problem-solving, communication, and
- Across a series of randomized trials, online family
problem-solving treatment has been shown to reduce behavior problems and
executive dysfunction (management of cognitive processes) in older
children with TBI, and over the longer-term improved everyday
functioning in 12-17 year olds.
- Web-based parenting skills programs targeting younger
children have resulted in improved parent-child interactions and reduced
behavior problems. In a computerized pilot trial of attention and
memory, children had improvements in sustained attention and
parent-reported executive function behaviors. These intervention studies
suggest several avenues for working to improve short- and long-term
recovery following TBI.