Developmental trajectories of infants and toddlers with good initial presentation following moderate or severe traumatic brain injury: a pilot clinical assessment project.

OBJECTIVE: The purpose of this study was to review the feasibility and usefulness of instituting a clinical protocol of scheduled assessments for children after a moderate or severe traumatic brain injury (TBI) sustained before the age of 2 years and showing no immediate deficits at hospital discharge, as well as to explore the early developmental trajectories of these children. DESIGN: Exploratory analytical cohort study. SETTING: Pediatric Trauma Center Out-patient services. PARTICIPANTS: 31 children were followed within the clinical protocol of scheduled assessments. OUTCOME MEASURES: The protocol included an immediate post-injury clinical assessment of infants who sustained a TBI and follow-up assessments at the ages of 9 months, 18 months (if injured prior to that age), 30 months, and 42 months. Domains assessed at each scheduled visit included hearing, speech and language, motor performance, personal social abilities, and adaptive behaviors. RESULTS: Clinicians reported few difficulties with scheduling or administering the assessments, maintaining a 67% participation rate at the end of the follow-up period, thus demonstrating the feasibility of the protocol in this population. Scores on the majority of formal tests showed high variability and 15-20% of children presented with clinically significant motor and/or language delays. By 42 months of age, difficulties with adaptive behavior and personal social abilities were identified in our sample of children when compared to published norms. Qualitative clinical findings from professionals identified between 25-50% of children with potential attentional difficulties throughout the follow-up period. CONCLUSION: Findings from this study demonstrate the feasibility of implementing a clinical protocol of assessment for infants and toddlers who sustain a TBI before the age of 2 years and present with no impairments at the time of discharge from hospital. Developmental problems in this population appear to be easier to identify later in the toddler years as opposed to immediately following the TBI, emphasizing the importance of providing screening for developmental issues in this population prior to school entry.

Evaluation of an audiovisual-FM system: investigating the interaction between illumination level and a talker's skin color on speech-reading performance.

A program designed to evaluate the benefits of an audiovisual-frequency modulated (FM) system led to some questions concerning the effects of illumination level and a talker's skin color on speech-reading performance. To address those issues, the speech of a Caucasian female was videotaped under 2 conditions: a light skin color condition and a dark skin color condition. For the latter condition, makeup was applied to the talker's face. For both skin color conditions, the talker was recorded while speaking sentences under 7 different levels of illumination: 2, 3, 4, 16, 60, 256, and 600 footcandles (fc). Fifteen participants completed the speech perception task in a visual-only modality. The results revealed a significant interaction of illumination level and skin color. For the light skin color condition, speech-reading performance improved systematically as the illumination level increased from 3 to 16 fc. For the dark skin color condition, no differences in speech-reading performance were observed between the 2-fc and the 3-fc conditions. However, a large improvement in speech-reading performance was observed as the illumination level increased from 4 fc to 16 fc. It is speculated that in addition to an overall effect of illumination level, the contrast in luminance at the level of the talker's face has an effect on speech-reading performance.