Recovery in Memory Function,and its Relationship to Academic Success,at 24 Months Following Pediatric TBI*

While a number of research papers have reported findings on memory deficits following traumatic brain injury (TBI), only limited studies have monitored the recovery of these skills over time. The present study examined memory ability and its effect on academic success in a group of children who had sustained a mild, moderate, or severe traumatic brain injury (TBI). Results showed that the severe TBI group exhibited greater deficits on memory tasks, irrespective of modality, in the acute, 6-, 12-, and 24-month postinjury stages, in comparison to mild and moderate TBI groups. Performance on academic measures was dependent on both injury severity and task demands. Preinjury academic ability and verbal memory indices best predicted academic success.     

Recovery in memory function, and its relationship to academic success, at 24 months following pediatric TBI.

While a number of research papers have reported findings on memory deficits following traumatic brain injury (TBI), only limited studies have monitored the recovery of these skills over time. The present study examined memory ability and its effect on academic success in a group of children who had sustained a mild, moderate, or severe traumatic brain injury (TBI). Results showed that the severe TBI group exhibited greater deficits on memory tasks, irrespective of modality, in the acute, 6-, 12-, and 24-month postinjury stages, in comparison to mild and moderate TBI groups. Performance on academic measures was dependent on both injury severity and task demands. Preinjury academic ability and verbal memory indices best predicted academic success.     

The academic outcomes of working memory and metacognitive strategy training in children: A double‐blind randomized controlled trial

Working memory training has been shown to improve performance on untrained working memory tasks in typically developing children, at least when compared to non‐adaptive training; however, there is little evidence that it improves academic outcomes. The lack of transfer to academic outcomes may be because children are only learning skills and strategies in a very narrow context, which they are unable to apply to other tasks. Metacognitive strategy interventions, which promote metacognitive awareness and teach children general strategies that can be used on a variety of tasks, may be a crucial missing link in this regard. In this double‐blind randomized controlled trial, 95 typically developing children aged 9–14 years were allocated to three cognitive training programmes that were conducted daily after‐school. One group received Cogmed working memory training, another group received concurrent Cogmed and metacognitive strategy training, and the control group received adaptive visual search training, which better controls for expectancy and motivation than non‐adaptive training. Children were assessed on four working memory tasks, reading comprehension, and mathematical reasoning before, immediately after, and 3 months after training. Working memory training improved working memory and mathematical reasoning relative to the control group. The improvements in working memory were maintained 3 months later, and these were significantly greater for the group that received metacognitive strategy training, compared to working memory training alone. Working memory training is a potentially effective educational intervention when provided in addition to school; however, future research will need to investigate ways to maintain academic improvements long term and to optimize metacognitive strategy training to promote far‐transfer. A video abstract of this article can be viewed at https://youtu.be/-7MML48ZFgw     

A rehabilitative program for central executive deficits after traumatic brain injury

Deficits affecting Central Executive System (CES) of working memory (WM) are the main neuropsychological outcome after traumatic brain injury (TBI) and can also explain deficits in other domains, like divided attention, executive functions and long-term memory. For this reason we developed a rehabilitative program based on CES functions and we expected to find an improvement in WM as well as in those cognitive functions controlled by the CES.The experimental group was composed by 9 TBIs, selected for WM deficits, whereas the control group was composed by 6 TBIs, without WM deficits, but with speed processing deficits. All patients performed a cognitive training, based on PASAT (Gronwall & Wrightson, 1981)and two new versions of this task.The results showed in the experimental group an improvement in WM and in the cognitive functions controlled by the CES, whereas control patients did not show any improvement after the cognitive training.     

Central executive system impairment in traumatic brain injury

The aim of the present study was to identify cognitive functions affected by traumatic brain injury (TBI) and to verify the mechanism underlying cognitive impairment. More precisely, cognitive deficits following TBI can be considered as a consequence of (a) a speed processing deficit, that is a general slowing of perceptual, motor and cognitive subroutines; (b) an impairment of the Central Executive System of working memory (CES).Thirty-seven patients were submitted to a neuropsychological battery, aimed to evaluate different cognitive functions.Results showed severe deficits in speed processing, divided attention,working memory, executive functions and long term memory.Regression analyses, performed to test the two hypotheses, showed that the working memory deficit hypothesis is able to explain divided attention, executive functions and long term memory deficits more than speed processing hypothesis.     

Application of a metacognitive strategy to assessment, intervention, and consultation: A think-aloud technique

Research on metacognition is reviewed and suggestions are made for application of this knowledge by school psychologists in assessment, intervention, and consultation. Two empirical studies illustrate the application of a specific metacognitive strategy — the think-aloud procedure—to assessment and intervention. The first study showed that asking students to give reasons for responses improved performance on a test of reading comprehension. The second study showed that incorporating the think-aloud technique in remedial reading instruction resulted in substantial gains in reading comprehension.     

Cognitive reserve as a moderator of responsiveness to an online problem-solving intervention for adolescents with complicated mild-to-severe traumatic brain injury

Children and adolescents with traumatic brain injury (TBI) often experience behavior difficulties that may arise from problem-solving deficits and impaired self-regulation. However, little is known about the relationship of neurocognitive ability to post-TBI behavioral recovery. To address this question, we examined whether verbal intelligence, as estimated by Vocabulary scores from the Wechsler Abbreviated Scale of Intelligence, predicted improvements in behavior and executive functioning following a problem-solving intervention for adolescents with TBI. One hundred and thirty-two adolescents with complicated mild-to-severe TBI were randomly assigned to a six-month Web-based problem-solving intervention (CAPS; n = 65) or to an Internet resource comparison (IRC; n = 67) group. Vocabulary moderated the association between treatment group and improvements in metacognitive abilities. Examination of the mean estimates indicated that for those with lower Vocabulary scores, pre-intervention Metacognition Index scores from the Behavior Rating Inventory of Executive Function (BRIEF) did not differ between the groups, but post-intervention scores were significantly lower (more improved) for those in the CAPS group. These findings suggest that low verbal intelligence was associated with greater improvements in executive functioning following the CAPS intervention and that verbal intelligence may have an important role in response to intervention for TBI. Understanding predictors of responsiveness to interventions allows clinicians to tailor treatments to individuals, thus improving efficacy.     

Social Cognition in Paediatric Traumatic Brain Injury: A Systematic Review and Meta-analysis

Neuropsychology Review - Recent evidence suggests social cognitive deficits may be among the most profound and disabling consequences of childhood traumatic brain injury (TBI); however, it is only...     

Children's Narratives Following Traumatic Brain Injury: Linguistic Structure, Cohesion, and Thematic Recall

Narrative discourse and intellectual functioning were examined 3 years following traumatic brain injury (TBI) in children 1 to 8 years of age at the time of injury. The language-impaired TBI group (n= 9) had language deficits during the subacute stage of recovery; their performance was contrasted with that of a TBI comparison group equated on neurologic and demographic variables that did not show subacute language impairment (n= 8) and a sibling comparison group (n= 9). The language-impaired TBI group had lower Verbal and Full-Scale IQ scores and produced fewer words and utterances than the sibling group on a story retelling task; their stories were characterized by fewer complete referential and lexical ties and more referential errors, indicating difficulty conjoining meaning across sentences. The language-impaired TBI group recalled approximately one-third of the propositions needed to maintain the story theme and made more errors sequencing the propositions than either the TBI or the sibling comparison groups. Group differences were not obtained on the Performance IQ scores or on measures of rate or fluency of speech production, mazes, use of conjunctives, or naming errors. The discourse deficiencies of children with TBI and acute language impairment were most pronounced at the level of cognitive organization of the text reflecting text macrostructure and were least apparent at the level of lexical and sentential organization reflecting text microstructure. Results are discussed in terms of the vulnerability of developing language abilities to disruption by brain injury.     

The effect of age-at-testing on verbal memory among children following severe traumatic brain injury

Memory deficits are a common sequelae following childhood traumatic brain injury (TBI), which often have serious implications on age-related academic skills. The current study examined verbal memory performance using the Rey Auditory Verbal Learning Test (RAVLT) in a pediatric TBI sample. Verbal memory abilities as well as the effect of age at-testing on performance were examined. A sample of 67 children following severe TBI (age average = 12.3 ± 2.74) and 67 matched controls were evaluated using the RAVLT. Age effect at assessment was examined using two age groups: above and below 12 years of age during evaluation. Differences between groups were examined via the 9 RAVLT learning trials and the 7 composite scores conducted out of them. Children following TBI recalled significantly less words than controls on all RAVLT trials and had significantly lower scores on all composite scores. However, all of these scores fell within the low average range. Further analysis revealed significantly lower than average performance among the older children (above 12 years), while scores of the younger children following TBI fell within average limits. To conclude, verbal memory deficits among children following severe TBI demonstrate an age-at-testing effect with more prominent problems occurring above 12 years at the time of evaluation. Yet, age-appropriate performance among children below 12 years of age may not accurately describe memory abilities at younger ages following TBI. It is therefore recommended that clinicians address child’s age at testing and avoid using a single test as an indicator of verbal memory functioning post TBI.     

Cognitive training programs for childhood cancer patients and survivors: A critical review and future directions

A robust literature has developed documenting neurocognitive late effects in survivors of leukemia and central nervous system (CNS) tumors, the most frequent cancer diagnoses of childhood. Patterns of late effects include deficits in attention and concentration, working memory, processing speed, and executive function, as well as other domains. As childhood cancer survivors are living longer, ameliorating deficits both in broad and specific neurocognitive domains has been increasingly recognized as an endeavor of paramount importance. Interventions to improve cognitive functioning were first applied to the field of pediatric oncology in the 1990s, based on strategies used effectively with adults who had sustained a traumatic brain injury (TBI). Compilation and modification of these techniques has led to the development of structured cognitive training programs, with the effectiveness and feasibility of such interventions currently an active area of research. Consequently, the purpose of this critical review is to: (1) review cognitive training programs intended to remediate or prevent neurocognitive deficits in pediatric cancer patients and survivors, (2) critically analyze training program strengths and weaknesses to inform practice, and (3) provide recommendations for future directions of clinical care and research.     

Prospective Memory and Pediatric Traumatic Brain Injury: Effects of Cognitive Demand

This study investigated the effects of pediatric traumatic brain injury (TBI) on prospective memory. Fourteen children and 14 adolescents with TBI were compared with 25 and 23 noninjured children and adolescents, respectively. Based on a prefrontal model, the cognitive demand on the ongoing component of a prospective-memory task was manipulated. Overall, those with TBI had poorer prospective-memory performance than their noninjured peers. Performance was worse in a high cognitive-demand condition than a low, and younger children performed worse than adolescents. Decreases in performance from the low- to high-demand conditions were not significantly different between the two children's groups but were between the two adolescents' groups. Furthermore, the age and injury effects were reflected in the performances on executive function tests: the Self-ordered Pointing Task (SOPT), and the Stroop Color Word Interference Test. The Tower of London (TOL), which did not produce age or injury effects, was nevertheless found to be an important predictor of performance on the high-demand task in those with TBI. Although previous research has demonstrated impaired prospective memory performance in children with TBI, this study attempted to explain why this might occur, specifically that the prefrontal regions might be implicated.     

Selective Learning in Children after Traumatic Brain Injury: A Preliminary Study

Selective learning (SL) is the ability to select items to learn from among other items. It requires the use of the executive processes of metacognitive control and working memory, which are considered to be mediated by the frontal cortex and its circuitry. We studied the efficiency with which verbal items of greater value are selectively learned from among items varying in value in 14 children ages 8-15 years who had sustained severe traumatic brain injury (TBI) and in 39 typically developing age-matched children. We hypothesized that children with TBI would be disproportionately compromised in selective learning efficiency in contrast to memory span when compared to normally developing children. The results supported our hypothesis, as children with TBI performed significantly worse than controls on a measure of selective learning efficiency, but the two groups performed similarly on a measure of word recall within the same task. Furthermore, the effect of TBI on performance was demonstrated to take place at the time of encoding, rather than at retrieval.     

Selective learning in children after traumatic brain injury: a preliminary study.

Selective learning (SL) is the ability to select items to learn from among other items. It requires the use of the executive processes of metacognitive control and working memory, which are considered to be mediated by the frontal cortex and its circuitry. We studied the efficiency with which verbal items of greater value are selectively learned from among items varying in value in 14 children ages 8-15 years who had sustained severe traumatic brain injury (TBI) and in 39 typically developing age-matched children. We hypothesized that children with TBI would be disproportionately compromised in selective learning efficiency in contrast to memory span when compared to normally developing children. The results supported our hypothesis, as children with TBI performed significantly worse than controls on a measure of selective learning efficiency, but the two groups performed similarly on a measure of word recall within the same task. Furthermore, the effect of TBI on performance was demonstrated to take place at the time of encoding, rather than at retrieval.     

抑制控制与高级认知功能的关系

近年来抑制控制与高级认知功能关系的研究受到了越来越多的重视。大量实证研究表明, 抑制控制是解释工作记忆、阅读理解、液态智力等高级认知功能个体差异的一个重要机制。脑成像研究表明, 抑制控制与工作记忆和液态智力等高级认知功能都激活了前额叶和顶叶等共同脑区。同时, 认知发展和认知老化, 以及认知干预领域的研究都一致表明, 抑制控制与高级认知功能关系密切。未来研究应注意抑制控制的定义和测量问题, 以及脑机制和训练干预等方面的问题。     

Does multitasking mediate the relationships between episodic memory,attention, executive functions and apathetic manifestations in traumatic brain injury?

Apathy is frequently described in patients with traumatic brain injury (TBI); its negative consequences particularly affect functional independence. Among apathetic manifestations, lack of initiative and lack of interest have mainly been associated with cognitive impairments. However, few studies have been conducted to precisely identify the underlying cognitive processes. Our aims were (1) to determine the best predictor of apathy from among several cognitive processes, including episodic memory and attention/executive mechanisms and multitasking, and (2) to examine to what extent multitasking could mediate the relationships between specific cognitive processes and lack of initiative/interest. Seventy participants (34 patients with TBI matched with 36 control participants) were given a questionnaire to assess anxio‐depressive symptoms, four tasks to assess specific cognitive processes, and one task to assess real‐life multitasking. Participants’ relatives completed an apathy questionnaire. Multitasking, as assessed by the number of goals not achieved, was the only significant predictor of apathetic manifestations. In addition, the mediation analyses revealed that multitasking performance mediated the relationships between verbal episodic memory and lack of initiative/interest, whereas executive and attentional functions were only indirectly related to lack of initiative/interest due to their significant impacts on multitasking. These results shed new light on the aetiology of apathetic manifestations in patients with TBI, indicating how specific cognitive deficits are expressed in real‐life multitasking, and consequently, how they may lead to the development and/or maintenance of apathetic manifestations.     

Prospective memory and pediatric traumatic brain injury: effects of cognitive demand.

This study investigated the effects of pediatric traumatic brain injury (TBI) on prospective memory. Fourteen children and 14 adolescents with TBI were compared with 25 and 23 noninjured children and adolescents, respectively. Based on a prefrontal model, the cognitive demand on the ongoing component of a prospective-memory task was manipulated. Overall, those with TBI had poorer prospective-memory performance than their noninjured peers. Performance was worse in a high cognitive-demand condition than a low, and younger children performed worse than adolescents. Decreases in performance from the low- to high-demand conditions were not significantly different between the two children's groups but were between the two adolescents' groups. Furthermore, the age and injury effects were reflected in the performances on executive function tests: the Self-ordered Pointing Task (SOPT), and the Stroop Color Word Interference Test. The Tower of London (TOL), which did not produce age or injury effects, was nevertheless found to be an important predictor of performance on the high-demand task in those with TBI. Although previous research has demonstrated impaired prospective memory performance in children with TBI, this study attempted to explain why this might occur, specifically that the prefrontal regions might be implicated.     

Attentional Skills in the Acute Phase Following Pediatric Traumatic Brain Injury

Only a limited number of studies have investigated attention following pediatric head-injury. The present study examined sustained attention and processing speed in a group of children who had sustained a mild (n = 27), moderate (n = 33) or severe (n = 16) traumatic brain injury (TBI). No significant differences were evident between the TBI groups on reaction time measures. Results did show that the severe TBI group exhibited greater deficits in the area of sustained attention, in comparison to children with mild and moderate injuries, in the acute stage following traumatic brain injury. This difficulty may impact on the future development of skills dependent on intact attentional capacity.     

Attentional skills in the acute phase following pediatric traumatic brain injury.

Only a limited number of studies have investigated attention following pediatric head-injury. The present study examined sustained attention and processing speed in a group of children who had sustained a mild (n = 27), moderate (n = 33) or severe (n = 16) traumatic brain injury (TBI). No significant differences were evident between the TBI groups on reaction time measures. Results did show that the severe TBI group exhibited greater deficits in the area of sustained attention, in comparison to children with mild and moderate injuries, in the acute stage following traumatic brain injury. This difficulty may impact on the future development of skills dependent on intact attentional capacity.     

Knowledge-based inferencing after childhood head injury

Inferencing was studied with a story comprehension task that required inferences to be made from a controlled knowledge base. Despite similar rates of knowledge base acquisition, knowledge base retention, and speeded access to the knowledge base across groups, the 18 children with severe head injury had lower rates of inferencing than the 15 children with mild head injury or the 18 age-matched controls. Results suggest that cognitive functions such as working memory and metacognitive skill that are disrupted by severe head injury may also play a role in some of the text- and discourse-level deficits commonly reported in these children, notably those involving inferencing.