27| Pediatric Traumatic Brain Injury – With Dr. Keith Yeates

We discussed INS leadership and research productivity with Keith Yeates, Ph.D., ABPP-CN, in a previous episode (click here to listen to Episode 16 and see Keith’s bio).  As the most published investigator of pediatric traumatic brain injury (TBI) in the world over the last 10 years, he returns today to discuss the prevalence rates and causes, behavioral sequalae, differences in outcomes, and psychosocial interventions for children with TBI.  We also discuss symptom rating scales and performance validity tests in the assessment and management of children with TBI, among many other topics.

Show notes (with time stamps)

  • Intro – defining terminology
    • Characterization of traumatic brain injury (TBI) (5:32)
    • Limitations of the Glasgow Coma Scale (6:01)
    • Mild TBI (mTBI) vs. concussion (6:39)
    • Complicated mTBI vs. moderate-to-severe TBI (8:23)
  • Outcome predictors in pediatric TBI (11:15)
  • Are mild, moderate, and severe TBI outcomes similar across children and adults? (13:52)
  • Prevalence of TBI in children (17:29)
  • Factors that explain the decline of moderate-to-severe TBI in children and adolescents (20:05)
  • When should parents take their post-concussed child to the hospital? (21:21)
  • Recent study (Yeates et al., 2019) identified factors that grouped children with concussion into distinct clinical phenotypes (23:34)
  • Clinical implications of translating research based on groups of people and to an individual person (26:32)
  • Can artificial intelligence (AI) be used to aid or replace clinical neuropsychology? (28:56)
  • Differences between adult and pediatric TBI (31:13)
  • Pros and cons of children undergoing neuroimaging (34:07)
  • Misconceptions of neuroplasticity and the Kennard principle (39:30)
  • Crowding effects in children with TBI (43:05)
  • Cognitive and emotional sequalae (46:35)
  • How has current research changed the clinical recommendations regarding rest and recovery following TBI? (51:04)
  • Differentiating second-impact syndrome from risk of additional concussions during the period of vulnerable recovery (52:41)
  • Is second-impact syndrome common? (54:33)
  • Return-to-play guidelines (56:26)
  • Post-concussive syndrome/symptoms (PCS) in children (1:00:54)
  • The complex factors associated with the symptom profiles in PCS (1:02:48)
  • The role of a neuropsychologist in predicting outcomes in the post-acute phase of TBI patients (1:07:01)
  • The utility of symptom rating scales and performance validity tests in the assessment and management of children with TBI (1:10:29)
  • Why failing a performance validity test does not necessarily indicate low effort (1:12:53)
  • Psychosocial interventions for kids with TBI (1:15:20)

Selected References

Brooks, B. L., Low, T. A., Plourde, V., Virani, S., Jadavji, Z., MacMaster, F. P., et al. (2019). Cerebral blood flow in children and adolescents several years after concussion. Brain Inj, 33(2), 233-241.

Giza, C. C., Mink, R. B., & Madikians, A. (2007). Pediatric traumatic brain injury: not just little adults. Curr Opin Crit Care, 13(2), 143-152.

Harmon, K. G., Clugston, J. R., Dec, K., Hainline, B., Herring, S. A., Kane, S., et al. (2019). American Medical Society for Sports Medicine Position Statement on Concussion in Sport. Clin J Sport Med, 29(2), 87-100.

Harmon, K. G., Drezner, J., Gammons, M., Guskiewicz, K., Halstead, M., Herring, S., et al. (2013). American Medical Society for Sports Medicine position statement: concussion in sport. Clin J Sport Med, 23(1), 1-18.

Kuehn, B. (2019). Traumatic Brain Injuries Among Youth. JAMA, 321(16), 1559.

Leddy, J. J., Haider, M. N., Ellis, M. J., Mannix, R., Darling, S. R., Freitas, M. S., et al. (2019). Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatr, 173(4), 319-325.

Lumba-Brown, A., Yeates, K. O., Sarmiento, K., Breiding, M. J., Haegerich, T. M., Gioia, G. A., et al. (2018a). Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children. JAMA Pediatr, 172(11), e182853.

Lumba-Brown, A., Yeates, K. O., Sarmiento, K., Breiding, M. J., Haegerich, T. M., Gioia, G. A., et al. (2018b). Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children. JAMA Pediatr, 172(11), e182853.

McCrory, P., Meeuwisse, W., Dvořák, J., Aubry, M., Bailes, J., Broglio, S., et al. (2017). Consensus statement on concussion in sport-the 5. Br J Sports Med, 51(11), 838-847.

Patricios, J. S., Ardern, C. L., Hislop, M. D., Aubry, M., Bloomfield, P., Broderick, C., et al. (2018). Implementation of the 2017 Berlin Concussion in Sport Group Consensus Statement in contact and collision sports: a joint position statement from 11 national and international sports organisations. Br J Sports Med, 52(10), 635-641.

Rose, S. C., Yeates, K. O., Fuerst, D. R., Ercole, P. M., Nguyen, J. T., & Pizzimenti, N. M. (2019). Head Impact Burden and Change in Neurocognitive Function During a Season of Youth Football. J Head Trauma Rehabil, 34(2), 87-95.

Wade, S. L., Kaizar, E. E., Narad, M., Zang, H., Kurowski, B. G., Yeates, K. O., . . . Zhang, N. (2018). Online family problem-solving treatment for pediatric traumatic brain injury. Pediatrics, 142(6), e20180422.

Yeates, K. O., Tang, K., Barrowman, N., Freedman, S. B., Gravel, J., Gagnon, I., . . . Craig, W. (2019). Derivation and Initial Validation of Clinical Phenotypes of Children Presenting with Concussion Acutely in the Emergency Department: Latent Class Analysis of a Multi-Center, Prospective Cohort, Observational Study. Journal of neurotrauma, 36(11), 1758-1767.

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