Discuss about the Predictors of Cognitive Function and Recovery.
The working memory of a child does not respond to the social and academic factors if a traumatic brain injury (TBI) occurs at very early age of the child (Treble, 2013). Research findings support the long term recovery of the patient suffering TBI at an early age. Parental guidance and support in case of TBI also has a positive effect on the recovery of the child. The scope of development in case of TBI at different age levels is a matter of further study. The age of the child at the time of traumatic brain injury has a significant effect on the working memory. Earlier research works observed that children with low working memory due to brain injury at earlier stages of life had difficulty to recover and the process of recovery was very long. Sometimes the problems stayed for the entire life of the child (Anderson, 2012). The major problems were academic, neurocognitive and psychological deficits. The child in its entire life suffered from adaptive challenges and poor academic performance management.
In the current work, school going children with TBI were chosen as subjects of the study. Children were chosen under two age brackets. The first group of children was in the age bracket of 7 to 8 years and in the second group age was around 13 years. To minimize the drawbacks of earlier research work an orthopaedic control (OC) group of children were studied along with the TBI children for numerical as well as social cognitive abilities (Gorman, 2017).
Three set of null hypotheses were set for the current study.
The alternate hypotheses were two tailed in nature and a decline or improvement was examined for each of the null hypotheses. The alternate hypotheses were non directional in nature as decline or improvement for each of the three cases was possible (McMahon, 2014). The two factors of the independent variables due to two age groups were checked against the alternate hypotheses.
Children sustaining a TBI were enrolled through participation at the Emergency Department of the Monash Children’s Hospital in Melbourne, Australia between January 2009 and 2012. Incorporation criteria were based on age of the children, reported proof of TBI including a time of changed cognizance, and capacity to finish subjective tests (Catroppa, 2012). A control group of teenagers with orthopaedic harms were selected through advertisement at the clinic. Avoidance criteria for the two groups were: English as a moment dialect, earlier TBI, and prior neurological or formative issue. They were followed-up in the vicinity of 24 and 45 months after damage. The investigation was affirmed by the Human Research Ethics Committee at the Monash Children’s Hospital (Nigrovic, 2012). Children of 7 and 13 years took part in a neuropsychological workshop which was conducted by a trained child psychologist. The parents of the concerned children were briefed about the entire process of the study. Information was collected from parents regarding child behavioral functioning and socio economic level of the family. At the end of the session with parents 32 orthopaedic control group children took interest in the study and were allowed by their parents. Twenty eight (28) TBI children from the clinic joined in the process (Phillips, 2017). Psychological experts and doctors reviewed the forms and collected medical data.
The subjects of the study were of two age groups and working memory of those children was measured by using the Digit Span Backwards method from the Wechsler Intelligence Scale for Children – Fourth Edition (WISC-IV). A series of digits were read to the children and their short term cognitive memory was tested.
Assuming the collected data to be normally distributed the Cohen’s d of the TBI child group was found to be -25.21 which implied that the data had huge effect size. Further examination was done for testing the null hypotheses (Smith, 2012). The control group of children had average age of 89.95 months (S.D of 2.4 months) with minimum age of 78 months and maximum of 106 months. The average age in the 13 year age bracket was 162 months (S.D 2.2 months). Children in this age group had minimum age of 153 months and maximum age of 169 months. The average age of TBI children was 89.92 months (S.D 2.35 months) and 160.95 months (S.D 2.2 months) for two age brackets.
The control group at 7 year of age bracket on average recalled 11.13 words (S.D 2.88) compared to 7.59 words (S.D 3.5) recalled by TBI children in the 13 year bracket average words recalled was 9.88 (S.D 3.51) and 7.93 (S.D 3.22) for control and TBI children respectively. The data of the backward digit span revealed the limitations of TBI children in both age groups.
TBI children group had 18 male and 10 female participants and equal gender distribution for control group was with 16 participants in each group. The distribution of gender for trauma affected children was skewed in nature with maximum data in male category.
Independent sample t-test was performed for each age bracket. The t-test data in the 7 year age bracket explained standard error for TBI participants as 0.67 and for control group as 0.51 for backward digit span test. The variability in TBI children backward span scores justified the setup of the experiment. Levene’s test F value was 1.187 with significance of 0.28. The equality in variance for the control group children and TBI children was not significant as the p value was greater than 0.05. The t values for equality of mean backward digit span score were -4.25 and -4.18 for equal and unequal variance assumptions. The p values in both cases were zero. Hence the null hypothesis of equality in mean scores was rejected. The negative t value indicated that TBI children have significantly less scores in backward digit span test. The confidence interval for equal variance assumption was [-5.19, -1.87]. Hence better cognitive ability of orthopaedic children compared to TBI affected children was evident at 7 years of age.
Levene’s test F value was 1.17 with significance of 0.28. The equality in variance for the control group children and TBI children was not significant as the p value was greater than 0.05. The t values for equality of mean backward digit span score were -2.21 and -2.22 for equal and unequal variance assumptions. The p values in both cases were less than 0.05. Hence the null hypothesis of equality in mean scores was rejected for 13 year age bracket. The negative t value indicated that TBI children have significantly less scores in backward digit span test. The confidence interval for equal variance assumption was [-3.71, -0.18]. Hence better cognitive ability of orthopaedic children compared to TBI affected children was evident at 13 years of age bracket also
A paired t-test was performed to test the third null hypothesis for TBI sustained children. Average scores were 7.59 words (S.D 3.5) and 7.93 words (S.D 3.22) for the two age groups. The mean scores were observed to be almost equal. The Pearson’s correlation coefficient was 0.434 which was significant for the 7 years and 13 years children. The mean value was -0.33 (S.D 3.58) and the paired t value was -0.48 with 27 degrees of freedom. The p value was 0.63 and it was evident from the insignificant p value that the null hypothesis was true about the equality in mean scores irrespective of the age brackets for all the TBI affected children.
The paired t test for control group children revealed that there was a significant difference in mean scores for backward digit span for the two age groups. The t value was 2.047 with a p value of 0.049. The t value was just in the critical region and it was concluded that 13 year age bracket mean score was better than 7 year control children. Third null hypothesis was rejected for control group of children.
Conclusion
The working memory of the TBI suffered children was found to be affected for the two age groups in the study. There was no significant difference between a 7 year old TBI affected child and a 13 year old TBI affected child. The slow recovery for TBI children was noticed in the earlier study also. The Orthopaedic control group children perform the much better in both age groups compared to TBI affected children. Brain damage due to trauma in early age of a child destroys his working memory and recovering the cognitive ability becomes a long and slow process. Increasing the number of participants for Orthopaedic control group and TBI sustained children group can give a new dimension to the study and open a future scope of work management.
References
Anderson, V., Godfrey, C., Rosenfeld, J. V., & Catroppa, C. (2012). Predictors of cognitive function and recovery 10 years after traumatic brain injury in young children. Pediatrics, 129(2), e254-e261.
Catroppa, C., Godfrey, C., Rosenfeld, J. V., Hearps, S. S., & Anderson, V. A. (2012). Functional recovery ten years after pediatric traumatic brain injury: outcomes and predictors. Journal of Neurotrauma, 29(16), 2539-2547.
Gorman, S., Barnes, M. A., Swank, P. R., & Ewing-Cobbs, L. (2017). Recovery of working memory following pediatric traumatic brain injury: a longitudinal analysis. Developmental neuropsychology, 42(3), 127-145.
McMahon, P. J., Hricik, A., Yue, J. K., Puccio, A. M., Inoue, T., Lingsma, H. F., … & Okonkwo and the TRACK-TBI investigators including, D. O. (2014). Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study. Journal of neurotrauma, 31(1), 26-33.
Nigrovic, L. E., Lee, L. K., Hoyle, J., Stanley, R. M., Gorelick, M. H., Miskin, M., … & Traumatic Brain Injury (TBI) Working Group of the Pediatric Emergency Care Applied Research Network (PECARN. (2012). Prevalence of clinically important traumatic brain injuries in children with minor blunt head trauma and isolated severe injury mechanisms. Archives of pediatrics & adolescent medicine, 166(4), 356-361.
Phillips, N. L., Parry, L., Mandalis, A., & Lah, S. (2017). Working memory outcomes following traumatic brain injury in children: A systematic review with meta-analysis. Child Neuropsychology, 23(1), 26-66.
Smith, R. L., Lin, J. C., Adelson, P. D., Kochanek, P. M., Fink, E. L., Wisniewski, S., … & Bell, M. J. (2012). Relationship between hyperglycemia and outcome in children with severe traumatic brain injury. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 13(1), 85.
Treble, A., Hasan, K. M., Iftikhar, A., Stuebing, K. K., Kramer, L. A., Cox Jr, C. S., … & Ewing-Cobbs, L. (2013). Working memory and corpus callosum microstructural integrity after pediatric traumatic brain injury: a diffusion tensor tractography study. Journal of neurotrauma, 30(19), 1609-1619.
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