Jaclyn: I am going to be talking about evaluation tools for pediatric traumatic brain injury. I am doing a post-doctoral fellowship in pediatric traumatic brain injury. My time here is 100% dedicated to research. I am working within an interdisciplinary research team and we are trying to better understand pediatric traumatic brain injury. I am hoping to share some of that knowledge with you today. I am going to introduce what we are talking about today, I will move into behavioral measures for pediatric traumatic brain injury, and then I am going to start talking about neuroimaging measures and techniques. This is not only going to be an introduction for these kind of measures and techniques that can be used to study pediatric traumatic brain injury, but also just a way to help you as the audience become familiarized with tools that maybe you have not used before. Some of those things are a little bit more approachable than maybe they have been in the past. I remember when I was a clinician that if I read a neuroimaging paper, I felt a little bit overwhelmed, so I am going to try to get rid of some of that mystery on those techniques. Finally, I want to have a conversation with you about research to practice. This is an area that I am particularly passionate about as both an OT clinician and also a scientist. I think that is going to be a really important part of our presentation today, and I am hoping that I can get some feedback and interaction from all of you.
Introduction
Again, I am getting my PhD in Cognitive Neuroscience. I have learned how much we do not know about the healthy human brain, and this lack of knowledge makes it even more complicated when someone sustains a brain injury. When we have trouble understanding how the healthy brain works, it is particularly challenging to understand how an injured brain works, especially when we are trying to help people who have sustained brain injuries. I have had experience with both adults and children that have sustained brain injuries in my clinical practice. But, I am coming at this from a research perspective, but I hope that I can keep it in the clinical framework for you.
Figure 1 shows the International Classification of Functioning, or the ICF.
Figure 1. ICF.
Occupational therapists work within each tier of this conceptual framework. This framework is really nice because it helps give people across different disciplines a common, shared language to discuss things like pediatric traumatic brain injury. When I present at research conferences, I am often talking to OT, PT, speech, but also MDs, neuroscientists, bioengineers. So, it is helpful to have this kind of framework, and I think it is important for us to understand when we are discussing clinical research, at what level or tier of this framework that we are operating in. Ror today, I am going to be talking about body functions and structure. This is going to be the tier that I am in for the health condition of pediatric TBI.
Cognitive and Emotional Consequences
Something that is relatively well established in the literature is that after traumatic brain injury of mild, moderate, or severe severity there are cognitive and emotional consequences. Even on the milder side of traumatic brain injury, you will see kids that have difficulty paying attention and with inhibition, whether that is cognitive inhibition or motor inhibition, the ability to stop a behavior that they know they are supposed to stop. These things are discussed quite a bit because they certainly affect school work. I think some of the cognitive, behavioral, emotional issues that occur after a traumatic brain injury are better understood because they are so relevant for a population that is in an academic setting all the time.
Physical and Motor Consequences
Something that is a little bit less discussed are the physical and motor consequences of traumatic brain injury. Now the exception to this is after a severe traumatic brain injury. After a severe injury, often children will have overt motor impairments if the motor cortex is affected. You might see upper or lower extremity impairments that are quite obvious. The reason I am talking about overt or obvious deficits is because we in our research have started to see some more of the subtle motor deficits that have not really been discussed as much in the academic or clinical literature.
Subtle Deficits After mTBI
I am going to switch focus here for the behavior assessments, because we have seen some subtle deficits after traumatic brain injury that have not really been discussed in the literature before. We have some relatively novel findings that we think are quite important to share. The novel behavioral measure that I would like to describe is the Physical and Neurological Evaluation of Subtle Signs.
PANESS
PANNESS was developed by Martha Denckla, who is here at Kennedy Krieger Institute (Figure 2).
Figure 2. PANESS overview.
Her office is just across the hallway from mine. She developed this in 1985 and has been using it in various pediatric populations, primarily with children with Autism Spectrum Disorder or Attention Deficit/Hyperactivity Disorder. Our research lab has been using this to study pediatric traumatic brain injury. Figure 2 shows you a table that is in an article that I published in 2016 in the Journal of Motor Behavior. We created this table to talk about the subscores that go into the PANESS, and I will briefly go through this table.
