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Descriptors:
Neurological Impairments; Head Injuries; Children; Brain Hemisphere Functions; Speech Impairments; Diagnostic Tests; Visual Aids

Abstract:
Severe and persistent speech disorder, dysarthria, may be present for life after brain injury in childhood, yet the neural correlates of this chronic disorder remain elusive. Although abundant literature is available on language reorganization after lesions in childhood, little is known about the capacity of motor speech networks to reorganize after injury. Here, we examine the structural and functional neural correlates associated with chronic dysarthria after childhood-onset traumatic brain injury. Forty-nine participants aged 12 years 3 months to 24 years 11 months were recruited to the study: (i) a group with chronic dysarthria (n = 17); matched for age and sex with two control groups of (ii) healthy control subjects (n = 17); and (iii) individuals without dysarthria after traumatic brain injury (n = 15). A high-resolution 3D T[subscript 1]-weighted whole-brain data set was acquired for voxel-based morphometry analyses of group differences in grey matter. Functional magnetic resonance imaging was used to localize activation associated with speaking single words (baseline: listening to words). Group differences on voxel-based morphometry revealed widespread grey matter reductions in the dysarthric group compared with healthy control subjects, including in numerous speech motor regions bilaterally, such as the cerebellum, the basal ganglia and primary motor cortex representation of the articulators. Relative to the non-dysarthric traumatic brain injury group, individuals with dysarthria showed reduced grey matter bilaterally in the ventral sensorimotor cortex, but this reduction was concomitant with increased functional activation only in the left-hemisphere cluster during speech. Finally, increased recruitment of Broca's area (Brodmann area 45, pars triangularis) but not its right homologue, correlated with better speech outcome, suggesting that this "higher-level" area may be more critically involved with production when associated motor speech regions are damaged. We suggest that the bilateral morphological abnormalities within cortical speech networks in childhood prevented reorganization of speech function from the left- to right-hemisphere. Rather, functional reorganization involved over-recruitment of left-hemisphere motor regions, a reorganization method that was only partly relatively effective, given the presence of persisting yet mild speech deficits. The bilateral structural abnormalities found to limit functional reorganization here, may also be critical to poor speech prognosis for populations with congenital, degenerative or acquired neurological disorders throughout the lifespan. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Neurological Impairments; Head Injuries; Chronic Illness; Brain; Males; Athletes; Veterans; Self Destructive Behavior; Symptoms (Individual Disorders); Comorbidity; Alzheimers Disease; Dementia; Depression (Psychology); Attention; Executive Function; Short Term Memory; Language Impairments; Aggression

Abstract:
Chronic traumatic encephalopathy is a progressive tauopathy that occurs as a consequence of repetitive mild traumatic brain injury. We analysed post-mortem brains obtained from a cohort of 85 subjects with histories of repetitive mild traumatic brain injury and found evidence of chronic traumatic encephalopathy in 68 subjects: all males, ranging in age from 17 to 98 years (mean 59.5 years), including 64 athletes, 21 military veterans (86% of whom were also athletes) and one individual who engaged in self-injurious head banging behaviour. Eighteen age- and gender-matched individuals without a history of repetitive mild traumatic brain injury served as control subjects. In chronic traumatic encephalopathy, the spectrum of hyperphosphorylated tau pathology ranged in severity from focal perivascular epicentres of neurofibrillary tangles in the frontal neocortex to severe tauopathy affecting widespread brain regions, including the medial temporal lobe, thereby allowing a progressive staging of pathology from stages I-IV. Multifocal axonal varicosities and axonal loss were found in deep cortex and subcortical white matter at all stages of chronic traumatic encephalopathy. TAR DNA-binding protein 43 immunoreactive inclusions and neurites were also found in 85% of cases, ranging from focal pathology in stages I-III to widespread inclusions and neurites in stage IV. Symptoms in stage I chronic traumatic encephalopathy included headache and loss of attention and concentration. Additional symptoms in stage II included depression, explosivity and short-term memory loss. In stage III, executive dysfunction and cognitive impairment were found, and in stage IV, dementia, word-finding difficulty and aggression were characteristic. Data on athletic exposure were available for 34 American football players; the stage of chronic traumatic encephalopathy correlated with increased duration of football play, survival after football and age at death. Chronic traumatic encephalopathy was the sole diagnosis in 43 cases (63%); eight were also diagnosed with motor neuron disease (12%), seven with Alzheimer's disease (11%), 11 with Lewy body disease (16%) and four with frontotemporal lobar degeneration (6%). There is an ordered and predictable progression of hyperphosphorylated tau abnormalities through the nervous system in chronic traumatic encephalopathy that occurs in conjunction with widespread axonal disruption and loss. The frequent association of chronic traumatic encephalopathy with other neurodegenerative disorders suggests that repetitive brain trauma and hyperphosphorylated tau protein deposition promote the accumulation of other abnormally aggregated proteins including TAR DNA-binding protein 43, amyloid beta protein and alpha-synuclein. (Contains 4 tables and 6 figures.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Interpersonal Relationship; Intimacy; Victims of Crime; Homicide; Criminals; At Risk Persons; Head Injuries; Injuries; Weapons

Abstract:
There are numerous examples in the homicide literature of a presumed connection between the victim-offender relationship and the manner, extent, and body location of wounds inflicted in homicides. The current study examined variations in wounding patterns according to the intimacy of the victim-offender relationship in a sample of urban homicides to explore the investigative utility of this information in an average homicide event. The findings demonstrated that victims who had a current or former intimate relationship with their offender were more likely to receive wounds to the face and be injured with a weapon from the scene compared with all other relationship groups, whereas injury to the head and use of manual violence were more likely among intimates and family/friends compared with acquaintances or strangers. However, the groups did not significantly differ in terms of the overall amount of wounds inflicted. Implications of the findings and suggested areas of future research are discussed. (Contains 4 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Adolescents; Neurological Impairments; Brain; Control Groups; Classification; Head Injuries; Children; Diagnostic Tests

Abstract:
The sensitivity of the Trail Making Test to brain damage has been well-established over many years, making it one of the most commonly used tests in clinical neuropsychological evaluations. The current study examined the validity of scores from a newer version of the Trail Making Test, the Comprehensive Trail Making Test (CTMT), in children and adolescents with traumatic brain injury (TBI). Participants included 242 children and adolescents, 121 with sustained TBI and 121 normal control participants, who were matched to the individuals with TBI on age and sex. Receiver operating characteristic analysis indicated that the CTMT composite index provided the best overall classification, with a correct classification rate of 79%. Differences between the TBI and control groups remained stable across age. These findings indicate that the CTMT is sensitive to TBI and overall demonstrates classification rates that are comparable with some other versions of the Trail Making Test. Whether the CTMT will exhibit similar classification accuracy in adults with TBI and for other neurological disorders awaits further investigation. (Contains 2 figures and 3 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Head Injuries; Neurological Impairments; Mild Disabilities; Attention; Cognitive Processes; Athletes; College Students; Young Adults; Team Sports; Cognitive Tests; Computer Assisted Testing; Performance Tests; Accuracy; Responses

Abstract:
We assessed the extent to which failures in sustained attention were associated with chronic mild traumatic brain injury (mTBI) deficits in cognitive control among college-age young adults with and without a history of sport-related concussion. Participants completed the ImPACT computer-based assessment and a modified flanker task. Results indicated that a history of mTBI, relative to healthy controls, was associated with inferior overall flanker task performance with a greater number of omission errors and more frequent sequentially occurring omission errors. Accordingly, these findings suggest that failures in the ability to maintain attentional vigilance may, in part, underlie mTBI-related cognition deficits. (Contains 1 table and 1 figure.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Outcome Measures; Brain; Diagnostic Tests; Head Injuries; Multivariate Analysis; Severity (of Disability); Correlation; Psychiatry; Mental Disorders; Children; Adolescents; Longitudinal Studies

Abstract:
Objective: To study magnetic resonance imaging (MRI) correlates of novel (new-onset) psychiatric disorders (NPD) after traumatic brain injury (TBI) and orthopedic injury (OI). Method: Participants were 7 to 17 years of age at the time of hospitalization for either TBI or OI. The study used a prospective, longitudinal, controlled design with standardized psychiatric assessments conducted at baseline (reflecting pre-injury function) and 3 months post-injury. MRI assessments including diffusion tensor imaging (DTI)-derived fractional anisotropy (FA), volumetric measures of gray and white matter regions, volumetric measures of lesions, and cortical thickness were conducted. Injury severity was assessed by standard clinical scales. The outcome measure was the presence of an NPD identified during the first 3 months after injury. Results: There were 88 participants (TBI, 44; OI, 44). NPD occurred more frequently in the TBI (21/44; 48%) versus the OI (6/44; 14%) group (Fisher's exact test, p = 0.001). NPD in TBI participants was not related to injury severity. Multivariate analysis of covariance of the relationship between FA in hypothesized regions of interest (bilateral frontal and temporal lobes, bilateral centrum semiovale, bilateral uncinate fasciculi) and NPD and group (TBI versus OI) was significant, and both variables (NPD, p less than 0.05; group, p less than 0.001) were jointly significantly related to FA. NPD was not significantly related to volumetric measures of white or gray matter structures, volumetric measures of lesions, or cortical thickness measures. Conclusions: Lowered white matter integrity may be more important in the pathophysiology of NPD than indices of gray matter or white matter atrophic changes, macroscopic lesions, and injury severity. (Contains 3 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Adolescents; Brain; Head Injuries; Educational Needs; Neurological Impairments; Intervention; Educational Environment; Attention Control; Disabilities; Self Control; Executive Function; Classification; Children; Memory; Behavior Problems

Abstract:
Traumatic brain injury (TBI) in children and adolescents can significantly affect their lives and educational needs. Deficits are often exhibited in areas such as attention, concentration, memory, executive function, emotional regulation, and behavioral functioning, but specific outcomes are not particular to any one child or adolescent with a TBI. Therefore, educators must provide specific interventions to accommodate the needs of each individual student with a TBI. This article, first, addresses the definition of TBI in the schools and provides an overview of TBI including causes, classifications, and the primary areas of head injury. Second, the article presents recommendations and suggestions for school interventions for children and adolescents with TBI. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Special Education; Developmental Delays; American Indians; Language Impairments; Hearing Impairments; Mental Retardation; Multiple Disabilities; Disproportionate Representation; Racial Differences; Preschool Education; African American Students; Asian American Students; Hispanic American Students; White Students; Physical Disabilities; Ethnicity; Speech Impairments; Visual Impairments; Brain; Head Injuries; Child Health; Eligibility; Socioeconomic Influences; Low Income Groups; Place of Residence

Abstract:
More than 67,000 preschoolers with disabilities across five states were examined for disproportionate special education eligibilities using risk ratios (RRs). Results indicated children classified as American Indian (RR = 2.25) and Black (RR = 1.64) were disproportionate in one state, whereas children classified as Asian, Hispanic, and White showed no disproportionality. Significant differences were found for preschoolers under orthopedic impairment (F = 43.99, p = 0.002, eta[superscript 2] = 0.971). Child ethnicity was significant for speech or language impairments (F = 3.313, p = 0.034, eta[superscript 2] = 0.424), mental retardation (F = 65.215, p = 0.001, eta[superscript 2] = 0.963), multiple disabilities (F = 5.244, p = 0.048, eta[superscript 2] = 0.636), hearing impairments (F = 4.181, p = 0.047, eta[superscript 2] = 0.611), other health impairments (F = 24.148, p = 0.003, eta[superscript 2] = 0.906), autism (F = 48.570, p = 0.001, eta[superscript 2] = 0.930), and developmental delay (F = 6.407, p = 0.003, eta[superscript 2] = 0.631). (Contains 4 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Priming; Control Groups; Semantics; Linguistics; Head Injuries; Pathology; Brain Hemisphere Functions; Diagnostic Tests; Pediatrics; Adults; Adolescents; Neurology; Language Processing; Pictorial Stimuli; Task Analysis; Comparative Analysis

Abstract:
The immediate and long-term neural correlates of linguistic processing deficits reported following paediatric and adolescent traumatic brain injury (TBI) are poorly understood. Therefore, the current research investigated event-related potentials (ERPs) elicited during a semantic picture-word priming experiment in two groups of highly functioning individuals matched for various demographic variables and behavioural language performance. Participants in the TBI group had a recorded history of paediatric or adolescent TBI involving injury mechanisms associated with diffuse white matter pathology, while participants in the control group never sustained any insult to the brain. A comparison of N400 Mean Amplitudes elicited during three experimental conditions with varying semantic relatedness between the prime and target stimuli (congruent, semantically related, unrelated) revealed a significantly smaller N400 response in the unrelated condition in the TBI group, indicating residual linguistic processing deviations when processing demands required the quick detection of a between-category (unrelated) violation of semantic expectancy. (Contains 2 tables and 4 figures.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Marital Status; Head Injuries; Conflict; Brain; Psychology; Investigations; Attachment Behavior; Theories; Surveys; Family Counseling; Intervention; Predictor Variables

Abstract:
Recovery from a mild-to-moderate traumatic brain injury (TBI) is a challenging process for injured persons and their families. Guided by attachment theory, we investigated whether relationship conflict, social support, or sense of belonging were associated with psychological functioning. Community-dwelling persons with TBI (N = 75) and their relatives/significant others (N = 74) were surveyed on relationship variables, functional status, and TBI symptom severity. Results from this cross-sectional study revealed that only sense of belonging was a significant predictor of postinjury psychological functioning, although interpersonal conflict approached significance. No relevant preinjury or injury-related variables impacted these relationships, except marital status. Our findings suggest that interventions targeting strengthening the injured persons' sense of belonging and lowering interpersonal conflict may benefit those living with TBI. (Contains 1 figure and 2 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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