#1 cause of pediatric death & disability in the united States

#1 cause of pediatric death & disability in the united States

• #1 cause of pediatric death & disability in the united States
• Boys : Girls = 2 : 1
• Each Year, approximately...
• 400,000 children go to Emergency Rooms for TBI
• 29,000 are hospitalized
• 3,000 die
• Some common causes of pediatric TBI:
• Non-accidental trauma (infants), Falls (toddlers)
• Motor vehicle accidents & pedestrian accidents (school-age children) , Sports-related injuries (children & teens)

Most children with TBI have

• Most children with TBI have

• mild injury (81%)
• Good long-term recovery
• No lasting effects of their TBI

• However, the remaining approx. 20%:

• 8% have moderate TBI
• 6% severe TBI
• 5% fatal TBI

No “classic” outcome , but some more common effects are:

• No “classic” outcome , but some more common effects are:

• Slower processing speed
• Difficulty learning new information
• Less efficient learners
• Less capacity (learn less information at one time)
• Difficulty with higher-level language/conversation
• “reading between the lines”
• Drawing inferences
• Lower IQ

• Children with greater attention problems before brain injury also had greater attention problems after a brain injury.

MYTH: Younger children have better outcomes from TBI, because the brain is more “plastic” or “resilient”

• MYTH: Younger children have better outcomes from TBI, because the brain is more “plastic” or “resilient”

• FACT: Early TBI interferes with critical phases of rapid brain development

• But… negative outcomes may not be apparent until years later

• when brain functions that required early development finally come ‘online’
• Academic and social demands increase over time.

Children’s nervous system is still developing.

• Children’s nervous system is still developing.
• at the time of injury, is a given skill...
• ...emerging, developing, established?
• (will the child ‘grow into’ a new area of deficit?)
• Plasticity: young brain ≠ better recovery
• Acquired injury overlays ongoing brain development

Genetic disease, X-linked

• Genetic disease, X-linked
• Missing enzyme can’t break down “Very Long Chain Fatty Acids (VLCFA)”
• VLCFA accumulation = breakdown in myelin sheath
• Has a parietal-occipital pattern of demyelination
• Severe (Cerebral) form = progressive, neurodegenerative, leads to death if untreated.

Behavioral changes

• Behavioral changes

• withdrawal, aggression, hyperactivity, learning problems

• Sensory loss (vision, hearing)

• Cognitive decline & dementia

• Seizures

• Motor decline

• …ultimately, premature death

Bone marrow (blood stem cells) transplantation

• Bone marrow (blood stem cells) transplantation
• Is now an established treatment option for COCALD…
• …but is not successful for all patients
• Must be offered before cerebral disease has advanced too far, or child will not benefit from the treatment.
• How do doctors know which children will benefit from this treatment?

• Children’s nervous system is still developing.
• How does a progressive disease interact with brain development?

Does not involve ‘seeing’ letters/words backwards, up-side down, transposed, etc.; i.e., is not a primary visual processing disorder.

• Does not involve ‘seeing’ letters/words backwards, up-side down, transposed, etc.; i.e., is not a primary visual processing disorder.

• Is properly defined as, “an unexpected difficulty in reading”.

• Involves core deficits in:

• Phonemic processing
• Sound recognition
• Mapping sounds to the written code of letters and letter groups.

• And also impacts

• Reading fluency and reading rate
• Reading comprehension

Dyslexia occurs in between 5-15% of the population.

• Dyslexia occurs in between 5-15% of the population.

• Is familial and heritable.

• Up to 50% of parents (of dyslexic child) may also have dyslexia
• Up to about 40% of siblings also have dyslexia
• When looking at parents with dyslexia, up to 65% of children
• also affected
• Boys & girls are equally affected
• Teachers over estimate
• reading problems in boys, and
• under estimate them in girls.

Plasticity: sometimes, plasticity is beneficial, but we might have to help it along

• Plasticity: sometimes, plasticity is beneficial, but we might have to help it along
• Developmental (and neurobiological) basis for Specific Learning Disability in Reading (dyslexia)

• Thank you

• Please don’t hesitate to contact me with any questions:

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• Extra slides

Pre-morbid (pre-injury) function

• Pre-morbid (pre-injury) function
• IQ (“cognitive reserve”)
• Emotional / behavioral well being
• Learning disability
• ADHD or other neurodevelopmental problem
• Age & Sex
• Severity of injury
• Psychosocial resources
• Family function
• Educational level (parent)
• Economic resources