quiz 6 (pediatric TBI) Flashcards
what is the demographic profile of children and adolescents at risk for TBI
age: 0-4 and teens 15-19 particularly at risk (males higher incidence)
cause: about 1/2 of all pediatric TBI are from falls
- motor vehicles are a large %
- shaken baby syndrome
- sports/recreational activities
- sports related brain injuries are about 1/3 of brain-injury-related emergency department visits of children
what is the difference between a TBI and an ABI
TBI: caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain
- either closed or open head injury
- several mechanisms of neurological injury can occur due to TBI -> focal brain damage at the site of injury, widespread brain damage due to diffuse axonal injury, ischemia, or other secondary effects
ABI: brain damage caused by other etiologies
- things like near-drowning, brain infections, congenital heart defects, chemotherapy and radiation, and drug overdose
- associated with loss of oxygen & widespread disruption of cell functioning
- brain tumors, ruptured arteriovenous malformations, and strokes
- more focal lesions
how does children and adolescents age result in differences in the biological mechanisms of TBI?
- younger children are more likely to have eiffuse cerebral edema than focal contusions
- older adolescents show diffuse axonal injury and focal contusion similar to those seen in adults
- they differ from adults in many ways:
- brain anatomy
- cerebrovascular response to injury (eg. autoregulation of cerebral blood flow and cerebral perfusion pressure)
- injury effects on cell signaling
- biomarkers of cell damage
- risks of complication (like post traumatic epilepsy)
- response to hypothermia and other acute therapies
3 key points about recovery
- recovery occurs in the context of development
- the nature and extent of recovery depened in part on age at injury
- the nature and extent of recovery are influenced by the child’s environment
recovery occurs in the context of development
affects the development of new skills/knowledge in the future
- impaired declarative learning, aquizition of skills underlying moral reasoning, social cognition, & executive functions
the nature and extent of recovery depend in part on age at injury
overall, injuries earlier in development are associated with poorer long-term outcome for cognitive function related to communication
the nature and extent of recovery are influenced by child’s environment
socioeconomic status and family functioning
what is the phenomenon of ‘cognitive stall’?
development of some cognitive functions might ‘stall’ years after injury, so that higher-level cognitive processes never develop
- may be a feature specifically for recovery of executive functions
- prefrontal cortex appears less plastic than other regions and might have less ability to ‘rewire’ after TBI
what are the 5 general aspects of cognition related to communication that are often negatively afffected by a pediatric TBI
- working memory
- executive functions
- attention
- declarative learning
- social cognition
understand how comprehension of indirect language forms might be impaired in a child with a TBI
deficits in comprehending sarcasm, humor, metaphors, implicature, proverbs, and deception
be able to describe the challenges of assessing congition-communication in very young children
- no standardized language tests have been validtaed for use with very young children with TBI
- informal assessments relying on discourse skills and independent execution of everyday tasks may not be applicable to young children, as they are not yet expected to have developed these skills
- there is substantial variability in knowledge across preschool-aged children, due to differences in amount of school experience, parenting style, and exposure to pre-academic concepts (so you need detailed info about pre-injury knowledge)
understand teh role of an SLP in intervention in acute care
- management of feeding and swallowing and establishing a reliable system for communicating with the child
- slps are an integral part of the concussion-management team in many settings
- particularly for college-age adolescents and school-age children with persistent postconcussion symptoms who may require intervention to manage cognitive impairments in the classroom
differences between the medical/developmental model and the international classification of functioning model
medical model: focused on remediation of impairments
international classification of functioning model: social disability model -> person w/ communication disorder is central in decision making about intervention, and factors like environmental supports and personal preferences and beliefs are considered explicitly in treatment planning
- the link between an impairment and participation-level outcome is not linear, but influenced by a variety of personal and environmental factors
- clinician shares responsibility for improving life participation beyond the clinic
medical model focused on remediation of impairments and social disability model had a goal of full participation in meaningful life roles
