Ewing-Cobbs Linda, Barnes Marcia, Fletcher Jack M, Levin Harvey S, Swank Paul R, Song James
Department of Pediatrics, University of Texas Houston Health Science Center, 77030, USA.
Dev Neuropsychol. 2004;25(1-2):107-33. doi: 10.1080/87565641.2004.9651924.
In a prospective longitudinal study, academic achievement scores were obtained from youth 5 to 15 years of age who sustained mild-moderate (n = 34) or severe (n = 43) traumatic brain injuries (TBI). Achievement scores were collected from baseline to 5 years following TBI and were subjected to individual growth curve analysis. The models fitted age at injury, years since injury, duration of impaired consciousness, and interaction effects to Reading Decoding, Reading Comprehension, Spelling, and Arithmetic standard scores. Although scores improved significantly over the follow-up relative to normative data from the standardization sample of the tests, children with severe TBI showed persistent deficits on all achievement scores in comparison to children with mild-moderate TBI. Interactions of the slope and age parameters for the Arithmetic and Reading Decoding scores indicated greater increases over time in achievement scores of the children injured at an older age, but deceleration in growth curves for the younger children with both mild-moderate and severe TBI. These results are compatible with the hypothesis that early brain injuries disrupt the acquisition of some academic skills. Hierarchical regression models revealed that indexes of academic achievement obtained 2 years following TBI had weak relations with the duration of impaired consciousness and socioeconomic status. In contrast, concurrent cognitive variables such as phonological processing and verbal memory accounted for more variability in academic scores. Given the significant and persistent decrement in basic academic skills in youth with severe TBI, it is clear that head-injured youth require intensive, long-term remediation and intervention not only of the academic skills themselves, but also of those cognitive abilities that support the development and maintenance of reading and math.
在一项前瞻性纵向研究中，从5至15岁遭受轻度至中度（n = 34）或重度（n = 43）创伤性脑损伤（TBI）的青少年中获取学业成绩分数。从创伤性脑损伤后的基线到5年收集成绩分数，并对其进行个体生长曲线分析。模型将受伤时的年龄、受伤后的年数、意识障碍持续时间以及交互作用纳入阅读解码、阅读理解、拼写和算术标准分数。尽管与测试标准化样本的常模数据相比，随访期间分数有显著提高，但与轻度至中度创伤性脑损伤的儿童相比，重度创伤性脑损伤的儿童在所有成绩分数上均表现出持续的缺陷。算术和阅读解码分数的斜率和年龄参数的交互作用表明，年龄较大时受伤的儿童成绩分数随时间的增加更大，但轻度至中度和重度创伤性脑损伤的年幼儿童的生长曲线出现减速。这些结果与早期脑损伤会干扰某些学术技能的习得这一假设相符。分层回归模型显示，创伤性脑损伤后2年获得的学业成绩指标与意识障碍持续时间和社会经济地位的关系较弱。相比之下，同时期的认知变量，如语音处理和言语记忆，在学业分数中占更多的变异性。鉴于重度创伤性脑损伤青少年的基本学术技能存在显著且持续的下降，显然头部受伤的青少年不仅需要对学术技能本身，而且需要对那些支持阅读和数学发展与维持的认知能力进行强化、长期的补救和干预。
