Occurrence of speech-language disorders in the acute phase following pediatric acquired brain injury: results from the Ghent University Hospital.

AIMS: This study investigated the occurrence of speech-language disorders during the acute phase of recovery in children with acquired brain injury (ABI) with an age between 0 and 16 years. METHODS: A retrospective chart analysis was performed including 228 children (n = 118 boys, n = 110 girls) who consecutively presented with ABI over a 10-year period (2006-2016) at the children's rehabilitation center at Ghent University Hospital. Descriptive statistical analyses were applied. RESULTS: 71.1% (162/228) of the children who were admitted to the rehabilitation center presented with a speech-language disorder. Within this sample (n = 162), results demonstrated the occurrence of acquired disorders in language (48.9%), speech (35.1%), learning (33.3%), swallowing (21.5%), and early communicative functions (17.4%). The proportion of children presenting with disturbances in early communicative functions differed by ABI cause. More than half (10/18, 58.8%) of the children who presented with ABI following inflammatory processes demonstrated disorders in early communicative functions. CONCLUSIONS: Especially in young children who present with inflammatory processes as the ABI cause, speech-language pathologists (SLPs) must be aware of disorders in early speech-language development. The present findings allow the SLP to appropriately plan research, education, and clinical management.

Correlations between white matter integrity and motor function in traumatic brain injury patients.

BACKGROUND: Deterioration of motor function is one of several clinical manifestations following traumatic brain injury (TBI) in children and adolescents. OBJECTIVE: To investigate the relationship between white matter (WM) integrity using diffusion tensor imaging (DTI) and motor functioning in young TBI patients. METHODS: A group with moderate to severe TBI (n = 24) and a control group (n = 17) were scanned using DTI along with standard anatomical scans. Using ExploreDTI software, WM regions/tracts that carry efferent output (motor) from the brain were evaluated, as well as the corpus callosum, brainstem, internal capsule, and subcortical WM structures. Motor function was assessed using the Movement Assessment Battery for Children (M-ABC), consisting of manual dexterity, ball skills, and static and dynamic balance items. RESULTS: TBI patients were less successful on the M-ABC than the controls and showed lower WM fractional anisotropy (FA) in the corpus callosum, anterior corona radiata, corticospinal tract, and cerebellum. Decreased FA was associated with lower motor performance in the TBI group but not in the control group. CONCLUSION: This study provides evidence for a structural alteration of motor pathways and regions in children and adolescents with TBI that are correlated with motor functioning. Further studies may be able to identify therapeutic targets and monitor the effects of new interventions.

Brain-behavior relationships in young traumatic brain injury patients: DTI metrics are highly correlated with postural control.

Traumatic brain injury (TBI) is a major cause of impairment and functional disability in children and adolescents, including deterioration in fine as well as gross motor skills. The aim of this study was to assess deficits in sensory organization and postural ability in a young group of TBI patients versus controls by using quantitative force-platform recordings, and to test whether balance deficits are related to variation in structural properties of the motor and sensory white matter pathways. Twelve patients with TBI and 14 controls (aged 8-20 years) performed the Sensory Organisation Test (SOT) protocol of the EquiTest (Neurocom). All participants were scanned using Diffusion Tensor Imaging (DTI) along with standard anatomical scans. Quantitative comparisons of DTI parameters (fractional anisotropy, axial and radial diffusivity) between TBI patients and controls were performed. Correlations between DTI parameters and SOT balance scores were determined. Findings revealed that the TBI group scored generally lower than the control group on the SOT, indicative of deficits in postural control. In the TBI group, reductions in fractional anisotropy were noted in the cerebellum, posterior thalamic radiation, and corticospinal tract. Degree of white matter deterioration was highly correlated with balance deficits. This study supports the view that DTI is a valuable tool for assessing the integrity of white matter structures and for selectively predicting functional motor deficits in TBI patients.

Static and dynamic visuomotor task performance in children with acquired brain injury: predictive control deficits under increased temporal pressure.

OBJECTIVE: To compare performance of children with acquired brain injury (ABI) on static versus dynamic visuomotor tasks with that of control children. PARTICIPANTS: Twenty-eight children with ABI and 28 normal age- and gender-matched controls (aged 6-16 years). MAIN MEASURES: Two visuomotor tasks on a digitizing tablet: (1) a static motor task requiring tracing of a flower figure and (2) a dynamic task consisting of tracking an accelerating dot presented on a monitor. RESULTS: Children with ABI performed worse than the control group only during the dynamic tracking task; the duration within the target was shorter, the distance between the centers of cursor and target was larger, and the number of velocity peaks per centimeter and the number of stops (ie, the number of submovements) were higher than those of the control group. Rather than resulting from movement execution problems, this might be due to less adequate processing of fast incoming sensory information, resulting in a decreased ability to anticipate the movement of the target (predictive control). CONCLUSION: Deficits in eye-hand coordination require careful attention, even in the postinjury chronic phase.