There has been lots of attention given to concussion from sport-related injuries in the popular press recently. Just take a look at all of these stories that have recently been published:
These are just a sample of the stories, there are many others. The importance of cognitive impairments related to the effects of concussions cannot be understated. Football players, hockey players, boxers and others are, for lack of a better term, a great population of people for studying the cumulative effects of repeated concussions or traumatic brain injuries (TBI) on cognitive health later in life (one important concept to keep in mind is that concussions and TBI are synonymous). These groups have much greater incidences of concussion/TBI compared to the rest of the population due solely to the nature of their profession.
However, there are many cases of TBI that do not occur in sports. In fact, according to the Brain Injury Association of America, there are estimated to be 1.4 million TBIs in America each year. The majority of the cases result from falls or auto-accidents and roughly 3.5% of all the patients die from the injury. The lasting effect of TBI on cognitive function has been very well studied. Research has been comprehensive in scope and there is data on adults and children. This entry will focus on a recent paper which examined the changes in cognitive abilities in children after they have suffered a TBI.
The study, published in the Journal of the International Neuropsychological Society, looked at children ages 3-6 years who have suffered various levels of TBI from mild to severe. According to the NIH,
“symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking. A person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation.”
Generally, children who suffer a TBI have lower scores in the academic setting, and frequently show behavioral and psychological problems. The researchers wanted to answer how the cognitive development of the children has been altered by the event and what were some of the factors that might mitigate some of the injury’s consequences. Importantly, researchers used non-TBI controls (meaning children of similar age, who had not suffered a head injury, but were hospitalized for an orthopedic issue) for comparisons with their TBI subjects. This had not been done effectively in previous studies, and the results from previous studies were somewhat ambiguous. However, in this study, the results showed that children with severe and moderate TBI, when controlling for various background factors, do show deficits in several neuropsychological skills. Namely, issues with spatial reasoning, memory, and some executive functions were lower than the orthopedic controls. Interestingly, the researchers did not find an age-related co-factor with the extent to which there were cognitive deficits after TBI. Meaning at least within this group of children, age at the time of the TBI did not correlate with performance on any given cognitive test (their hypothesis was that younger children would have more severe deficits than older kids).
A major conclusion that the authors mention is the mitigating effects that the children’s environment has on recovery. There are previous reports that show that environmental factors, like home environment, can have a positive effect on recovery from TBI. These findings corroborate those previous reports. An interesting limitation, also mentioned by the authors, was the use of CT scans as an assay for the severity of the injury. The authors agree that there are other imaging modalities better suited for this measurement.
Proper care and rest are critical for recovery, but even more important is that children recovery differently from TBI than adults do. Perhaps it is more rest, but perhaps it is more cognitive intervention which could augment their recovery and get them back up to speed. And not to be forgotten, a loving home and supportive parents may help to curtail some of the ill effects of TBI.
Taylor HG, Swartwout MD, Yeates KO, Walz NC, Stancin T, Wade SL. Traumatic brain injury in young children: postacute effects on cognitive and school readiness skills. J Int Neuropsychol Soc. 2008 Sep; 14(5):734-45
http://www.biausa.org/aboutbi.htm
http://www.ninds.nih.gov/disorders/tbi/tbi.htm