Article

Traumatic brain injury (TBI) is a common, acquired childhood disability,
which has been shown to have a significant impact on children's cognitive and
educational function. While behavioral problems are also noted, there is ongoing
debate about the contribution of preinjury factors in this domain. Few studies
have attempted to measure the impact of these preinjury functions on postinjury
behavior. OBJECTIVE: To compare pre and postinjury adaptive ability, behavior,
executive function and quality of life (QOL) and to identify factors that
contribute to outcomes in these domains including injury severity,
socio-demographic and preinjury characteristics. DESIGN: Consecutive recruitments
to a prospective, longitudinal study, utilizing a between factor design, with
injury severity as the independent variable. PARTICIPANTS AND METHODS: Children
admitted to hospital with a diagnosis of TBI aged between 6 and 14 years (n =
205) were divided according to injury severity (mild, moderate and severe).
Adaptive behavior (Vineland Adaptive Behavior Scales), child behavior (Child
Behavior Checklist), everyday executive functions (Behavior Rating Inventory of
Executive Function) and QOL (Child Health Questionnaire) assessed at 6 months
post-TBI. RESULTS AND CONCLUSIONS: Severity by time interactions were identified
across a range of outcome domains demonstrating that more severe injury is
associated with a decrease in functional ability at 6 months post-TBI. This
effect was most pronounced for everyday executive skills, social function and
internalizing aspects of child behavior. Preinjury function was a consistent
predictor of postinjury status. Injury severity contributed little to the
prediction of functional outcomes once preinjury functioning was accounted for in
the model. Age at injury and family cohesion were relevant to specific outcome
domains only. Socio-economic status did not contribute significantly to outcome
at 6 months. Preinjury functioning as reported by parents in the acute phase may
be a useful predictive tool for identifying children who may be at risk of
functioning difficulties 6 months post-TBI.

Langue : ANGLAIS