Communication in children and adolescents after acquired brain injury: An exploratory study.

OBJECTIVE: The usability of the Communicative Effectiveness Index (CETI) in adolescents with acquired brain injury was investigated and compared with linguistic, cognitive and brain injury data. DESIGN: A prospective, longitudinal, between-group design. SUBJECTS: Thirty participants were divided into 2 subgroups: CETI+ and CETI- groups. METHODS: Parental CETI ratings of daily communication were compared with linguistic data and IQ test results. Lesion site and aetiology were also studied. RESULTS: The CETI+ group (n = 16) had a mean score greater than 75 out of 100, while the mean score of the CETI- group (n = 14) was below 75. Complex daily communication was impaired in both groups, but the CETI- group scored significantly lower on verbal IQ and grammar comprehension tests and had more naming difficulties. A majority of subjects in the CETI- group had a left hemisphere injury. Traumatic vs non-traumatic acquired brain injury did not differentiate the results.  Conclusion: Specific complex CETI items provided unique information that is not easily measured by linguistics and cognitive tests for use with the acquired brain injury group. Parental evaluations of communication skills were well reflected in language and verbal IQ test results. Left hemisphere injury was associated with poorer communication outcome.

Cognitive outcome in children and young adults who sustained severe and moderate traumatic brain injury 10 years earlier.

OBJECTIVE: This study is a population-based, retrospective follow-up study of neuropsychological functions after severe and moderate TBI. METHODS: One hundred and sixty-five survivors of TBI injured in 1987-1991 in the 0-17-year age group were identified. Of the traceable individuals (149), 53 patients who sustained injury at a mean of 9.96 years participated in a neuropsychological investigation 10 years post-injury. A control group of 40 healthy subjects, matched for age and sex was chosen. An extensive neuropsychological test battery was used. RESULTS: The TBI group showed significantly poorer performance in tests of intellectual function, with substantially lower results in verbal tests and in tests of verbal learning and memory, visuo-constructive ability and executive functions. The severely injured group showed substantial recovery. Poor results in visuo-constructive tests and tests of executive functions remained. CONCLUSIONS: Severity of injury is an important factor when assessing outcome, even 10 years after childhood TBI. The TBI group obtained poorer results on most of the measurements compared with healthy controls. Verbal function was strongly affected which needs to be taken into consideration when preparing for rehabilitation programmes. Evaluations of final outcome should not be made before the subjects reach adulthood.

Health-related quality of life of adolescents and young adults 10 years after serious traumatic brain injury.

The aim of this study was to investigate health-related quality of life (HRQoL) in a population-based group of young adults with serious traumatic brain injury (TBI) acquired 10 years earlier. In the time period 1987--1991, all 165 residents (<18 years of age) in the south-western health care region of Sweden who had suffered a serious TBI were followed up. Of these, 109 (67%) participated in this follow-up study, which was conducted using the 15-dimension (15D) HRQoL instrument. Their HRQoL was compared with that of 1,039 individuals drawn randomly from the National Population Register for the Finnish Health Care Survey 1995/1996 and matched for age and sex. Nine (mobility, vision, hearing, eating, speech, mental status, depression, distress and usual activities) of the 15 dimensions were significantly aberrant in the TBI group. This TBI group differed markedly from children with organ transplantation, as the transplantation children did not differ from a control group in terms of HRQoL. Compared with other groups of children with congenital or long-lasting conditions, the TBI group had more medical and mental problems.

Neuropsychological progress during 14 years after severe traumatic brain injury in childhood and adolescence.

OBJECTIVE: To investigate the impact of time since injury on neuropsychological and psychosocial outcome after serious TBI in childhood or adolescence. METHODS: The subjects were eight patients with serious TBI sustained at a mean age of 14 years who had been assessed neuropsychologically at 1, 7 and 14 years after TBI. A retrospective longitudinal design was chosen to describe the development in six neuropsychological domains on the basis of the assessments. Psychosocial data were gathered from clinical knowledge and a semi-structured interview 14 years after TBI. RESULTS: Performance of verbal IQ shows a declining trend over the three assessments, that the performance of attention and working memory is low and that verbal learning is the cognitive domain which exhibits the largest impairments. The main psychosocial result is that three of the eight subjects went from a school situation with no adjustments to adult life with early retirement. CONCLUSIONS: Time since insult is an important factor when assessing outcome after TBI in childhood and adolescence and that assessment of final outcome should not be done before adulthood.