The Effect of Admission Functional Independence on Early Recovery in Pediatric Traumatic and Nontraumatic Brain Injury.

OBJECTIVE: To examine functional independence at admission as a predictor of outcomes during an initial inpatient hospitalization for a pediatric brain injury. PARTICIPANTS: A total of 531 pediatric inpatients with traumatic (n = 298) or nontraumatic (n = 233) brain injuries. DESIGN: Retrospective analysis of data extracted from the Uniform Data System for Medical Rehabilitation. MAIN MEASURE: The Functional Independence Measure for Children, a measure of self-care, mobility, and cognitive independence. RESULTS: Logistic regression analyses indicated that children with traumatic brain injury showed greater odds of making large functional gains in comparison with children with nontraumatic brain injury. For both groups, children entering rehabilitation with a moderate level of functional independence had the highest probability of making large gains. Children with a nontraumatic brain injury entering treatment with a high level of functioning made greater gains than those entering with low functioning. The opposite trend emerged for children with traumatic injuries. CONCLUSIONS: Level of functioning at admission may be a useful predictor of progress during an inpatient stay for youth with brain injuries. Children with nontraumatic brain injury entering treatment with low functioning are expected to make slower progress during hospitalization.

Retrieval practice as an effective memory strategy in children and adolescents with traumatic brain injury.

OBJECTIVE: To investigate whether retrieval practice (RP) is a more effective memory strategy than restudy in children and adolescents with traumatic brain injury (TBI). DESIGN: Three × two within-subjects experiment: 3 (learning condition: massed restudy [MR], spaced restudy [SR], retrieval practice [RP]) × 2 (stimulus type: verbal paired associates [VPAs] and face-name pairs [FNPs]). The dependent measure was delayed recall of VPAs and FNPs. SETTING: Subacute pediatric neurorehabilitation center. PARTICIPANTS: Pediatric survivors of TBI (N=15) aged 8 to 16 years with below-average memory. INTERVENTION: During RP, participants were quizzed on to-be-learned information (VPAs and FNPs) shortly after it was presented, such that they practiced retrieval during the learning phase. MR consisted of repeated restudy (tantamount to cramming). SR consisted of restudy trials separated in time (ie, distributed learning). MAIN OUTCOME MEASURES: Delayed recall of 24 VPAs and 24 FNPs after a 25-minute delay. VPAs and FNPs were equally divided across 3 learning conditions (16 per condition). RESULTS: There was a large main effect of learning condition on delayed recall (P<.001; ηp(2)=.84), with better mean recall of VPAs and FNPs studied through RP (6.23±1.39) relative to MR (3.60±1.53; P<.001) and SR (4.77±1.39; P<.001). Moreover, RP was the single best learning strategy for every participant. CONCLUSIONS: Memory problems and related academic learning difficulties are common after pediatric TBI. Herein, we identify RP as a promising and simple strategy to support learning and improve memory in children and adolescents with TBI. Our experimental findings were quite robust and set the stage for subsequent randomized controlled trials of RP in pediatric TBI.

Retrieval practice improves memory in survivors of severe traumatic brain injury.

OBJECTIVE: To investigate whether retrieval practice (RP) improves delayed recall after short and long delays in survivors of severe traumatic brain injury (TBI) relative to massed restudy (MR) and spaced restudy (SR). DESIGN: 3(learning condition: MR, SR, RP)×2(delayed recall: 30min, 1wk) within-subject experiment. SETTING: Nonprofit medical rehabilitation research center. PARTICIPANTS: Memory-impaired (<5th percentile) survivors of severe TBI (N=10). INTERVENTION: During RP, patients are quizzed on to-be-learned information shortly after it is presented, such that patients practice retrieval. MR consists of repeated restudy (ie, cramming). SR consists of restudy trials separated in time (ie, distributed learning). MAIN OUTCOME MEASURES: Forty-eight verbal paired associates (VPAs) were equally divided across 3 learning conditions (16 per condition). Delayed recall for one half of the VPAs was assessed after 30 minutes (8 per condition) and for the other half after 1 week (8 per condition). RESULTS: There was a large effect of learning condition after the short delay (P<.001, η(2)=.72), with much better recall of VPAs studied through RP (46.3%) relative to MR (12.5%) and SR (15.0%). This large effect of learning condition remained after the long delay (P=.001, η(2)=.56), as patients recalled 11.3% of the VPAs studied through RP, but nothing through MR (0.0%) and only 1.3% through SR. That is, RP was essentially the only learning condition to result in successful recall after 1 week, with most patients recalling at least 1 VPA. CONCLUSIONS: The robust effect of RP among TBI survivors with severe memory impairment engenders confidence that this strategy would work outside the laboratory to improve memory in real-life settings. Future randomized controlled trials of RP training are needed.