Long‐Term Outcomes of Traumatic Brain Injury in Early Childhood

Mild traumatic brain injury (mTBI) is a leading cause of injury among children, with approximately 15% of children experiencing a TBI prior to 15 years of age. Acutely, mTBI has been associated with a range of cognitive, physical, emotional and behavioural impairments. However, few studies have examined outcomes beyond five years post injury, long before the developmental process is complete and the full extent of any deficits may manifest. Our group had the unique opportunity to use data from a longitudinal birth cohort of 1265 children (Christchurch Health and Development Study) to examine the long term outcomes of early injury (0–5 years). Information about these children, including mTBI events, had been collected at birth, 4 months and at yearly intervals until age 16, and again at ages 18, 21 and 25 years. We found that even after statistical control for a wide range of child and family confounds, children who had been hospitalized for an mTBI had increased inattention/hyperactivity and conduct as rated by mothers and teachers over ages 7–13 years. Increased rates of psychiatric disorders were over 14–16 years for those injured in the preschool, including symptoms consistent with Attention Deficit/Hyperactivity Disorder (ADHD), Odds Ratio = 4.6, Conduct Disorder (CD), Odds Ratio = 5.6 and Substance Abuse (Odds Ratio = 9.1). Over ages 21–25 ongoing behaviour problems were assessed using self‐reported arrests, violent offenses and property offenses. Compared to non‐injured individuals, mTBI groups were more likely to be arrested, involved in property, and violent offences. We controlled for a wide range of factors and there was still clear evidence of ongoing problems for individuals who had experienced a mTBI compared to their non injured counterparts. These findings provide compelling evidence of long term psychosocial and psychiatric outcomes following mTBI.     

Neurophysiological marker of inhibition distinguishes language groups on a non-linguistic executive function test

Successful interaction with the environment depends on flexible behaviors which require shifting attention, inhibiting primed responses, ignoring distracting information, and withholding motor responses. These abilities, termed executive function (EF), are believed to be mediated by inhibitory processes in the frontal lobes. Superior performance on EF tests (i.e., faster reaction times (RT), and fewer errors) has been shown in bilinguals compared to monolingual speakers. However, findings are inconsistent, and no study has directly linked this bilingual advantage to frontal lobe inhibitory processes. To clarify this uncertainty, we concomitantly tested neural inhibitory processes and behavioral responses on an EF test in bilinguals and monolinguals. Specifically, we compared English monolinguals (N = 15) to Spanish/English bilinguals (N = 13) on event-related brain potentials (ERP) during a non-linguistic, auditory Go/NoGo task, a task linked to non-motor, cognitive inhibition in monolinguals. Participants responded with a button press on trials in which target tone-pairs (Go trials) were presented and withheld their responses on non-target trials (NoGo trials). Results revealed significantly greater inhibition (i.e., greater mean N2 amplitude) in bilinguals compared to monolinguals during NoGo trials even though both groups performed the task equally well (i.e., withheld a motor response). On Go trials where participants pressed a response button, neither ERPs nor RT distinguished the groups. Additionally, scores on a second language proficiency test (i.e., English in our bilingual group) were positively correlated with N2 amplitude. These findings are the first to directly link this bilingual advantage to a neural correlate of inhibition and to reveal that inhibition in bilinguals is moderated by second language proficiency. Results are discussed in the context of plasticity, and we propose that evaluating bilinguals at varying levels of second-language proficiency may serve as a model of human neuroplasticity.     

Cerebral perfusion and neuropsychological follow up in mild traumatic brain injury: Acute versus chronic disturbances?

In a subgroup of patients with mild traumatic brain injury (TBI) residual symptoms, interfering with outcome and return to work, are found. With neuropsychological assessment cognitive deficits can be demonstrated although the pathological underpinnings of these cognitive deficits are not fully understood. As the admission computed tomography (CT) often is normal, perfusion CT imaging may be a useful indicator of brain dysfunction in the acute phase after injury in these patients.In the present study, directly after admission perfusion CT imaging was performed in mild TBI patients with follow-up neuropsychological assessment in those with complaints and a normal non-contrast CT. Neuropsychological tests comprised the 15 Words test Immediate Recall, Trailmaking test part B, Zoo Map test and the FEEST, which were dichotomized into normal and abnormal. Perfusion CT results of patients with normal neuropsychological test scores were compared to those with abnormal test scores.In total eighteen patients were included. Those with an abnormal score on the Zoo Map test had a significant lower CBV in the right frontal and the bilateral parieto-temporal white matter. Patients with an abnormal score on the FEEST had a significant higher MTT in the bilateral frontal white matter and a significant decreased CBF in the left parieto-temporal grey matter. No significant relation between the perfusion CT parameters and the 15 Words test and the Trailmaking test part B was present.In conclusion, impairments in executive functioning and emotion perception assessed with neuropsychological tests during follow up were related to differences in cerebral perfusion at admission in mild TBI. The pathophysiological concept of these findings is discussed.     

A Dance with Many Secrets: The Experience of Emotional Harm from the Perspective of Past Professional Female Ballet Dancers in Canada

Originating in the Italian and French courts, ballet is an age-old art that fuses aesthetics and athleticism (Wulff, 2008). Despite changing times, ballet masters and mistresses tenaciously hold on to a sense of deep traditionalism. However, some scholars suggest that unwavering devotion to the art may conceal troubled embodied relations and oppressive practices (Gvion, 2008). In this study, we drew on the phenomenological research tradition in an effort to further examine the power relations that play out on the body in the world of Canadian professional ballet (Papaefstathiou, Rhind, & Brakenridge, 2013). Twenty past professional female ballet dancers from across Canada participated in this study. Our dedicated dancers were relentless. They sacrificed body and mind in the pursuit of excellence in a broader cultural context that expected nothing less. The dancers normalized harmful emotional experiences, inappropriate sexual transgressions, and chronic injury (Gvion, 2008). They also described experiences of neglect—and feeling replaceable—after the onset of injury. We have attempted to theorize our findings within the context of embodiment literature and the work of gender theorists. Emboldened by our dancers’ voices, we have shed light—and broken secrets—regarding some of the harmful practices that still characterize professional ballet in Canada. We hope that our work might further continue efforts to democratize power imbalances in professional ballet and ultimately enhance holistic dancer development and health.     

Maternal distress in the context of their child’s type 1 diabetes: exploring the role of adaptive maternal emotion regulation on child outcomes

Parents of children with Type 1 diabetes (T1D) experience high levels of distress, which may negatively impact child functioning. However, little is known about mechanisms that may buffer the adverse impact of parental distress. The current study explored the possible buffering role of maternal adaptive cognitive emotion regulation (CER) for the relationship between maternal distress and child psychological functioning. Forty-three children with T1D (8–15 years) completed measures assessing trait anxiety and depressive symptoms. Their mothers reported on general distress, illness-related parenting stress, and adaptive CER. Maternal illness-related parenting stress (but not general distress) was significantly associated with child psychological functioning. No buffering role for maternal adaptive CER was observed. As the current study is rather preliminary, future research using other methods to examine maternal adaptive CER, and examining other parental variables that may buffer against the negative impact of parental distress is warranted.     

Moral injury and the ethics of teaching tainted legacies

Cases like that of John Howard Yoder – a pacifist theorist who perpetrated sexual violence – raise difficult questions about teaching material implicated in traumatic pasts. This paper argues that “moral injury” provides a useful framework for understanding the dynamics of teaching prominent cases of tainted legacies like Yoder's and for developing best pedagogical practices across the field of religious ethics. The moral injury framework empowers students to think critically and self‐reflectively about authority, conceptions of the good, the various stakes for different persons and communities in social issues, and the need for moral repair. It establishes the importance of professor and student preparation; propels students into the moral questioning and analysis that constitutes “ethics”; draws attention to the connections between and intersectionality of various moral problems while also attending to important moral distinctions; and affords opportunities to study individual and institutional efforts at moral repair.