Research Reports - Executive function after severe childhood traumatic brain injury - Age-at-injury vulnerability periods

Ann Phys Rehabil Med. 2016 Aug 23. pii: S1877-0657(16)30342-6. doi:
10.1016/ [Epub ahead of print]

Krasny-Pacini A(1), Chevignard M(2), Lancien S(3), Escolano S(4), Laurent-Vannier
A(5), De Agostini M(6), Meyer P(7).

BACKGROUND: Executive function (EF) impairment is a major predictor of overall
outcome after traumatic brain injury (TBI). TBI severity is a factor of poor
outcome, but most studies include a majority of children with mild and moderate
TBI. The aims of this study were to estimate EF impairment after severe childhood
TBI and to explore factors predicting EF outcome. The secondary aim was to
compare recovery trajectories by age-at-injury groups.
METHODS: This was a prospective longitudinal study of children with severe TBI
who were tested for EFs by performance-based tests and questionnaires at 3, 12
and 24 months.
RESULTS: Children with TBI (n=65) showed significant impairment in working
memory, inhibition, attention and global EF, with little or no recovery at 24
months. For flexibility and performance-based EF score, children were impaired at
3 months only and showed normal scores by 12 months. No impairment was found in
planning. At 3 and 24 months, Glasgow Coma Scale score and parental education
predicted global EF. Coma length was not a significant predictor of outcome. Age
at injury predicted progress in EF, but the relationship was not linear; children
10-12 years old at injury showed better outcome than older and younger children.
CONCLUSIONS: EFs are impaired after severe TBI in childhood. The relationship
between age at injury and outcome is not linear. Relying on only
performance-based EF tests can underestimate EF impairment. 

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