Ewing-Cobbs L, Fletcher J M, Levin H S, Francis D J, Davidson K, Miner M E
Department of Pediatrics, University of Texas Health Science Center, USA.
J Int Neuropsychol Soc. 1997 Nov;3(6):581-91.
Neuropsychological outcome was evaluated in a prospective, longitudinal follow-up study of children age 4 months to 7 years at injury with either mild-to-moderate (N = 35) or severe (N = 44) traumatic brain injury (TBI). Age-appropriate tests were administered at baseline, 6 months, 12 months, and 24 months after the injury. Performance was compared on (1) Composite IQ and motor, (2) Receptive and expressive language, and (3) Verbal and Perceptual-Performance IQ scores. In comparison to mild-to-moderate TBI, severe TBI in infants and preschoolers produced deficits in all areas. Interactions between task and severity of injury were obtained. Motor scores were lower than IQ scores, particularly after severe TBI. Both receptive and expressive scores were reduced following severe TBI. Expressive language scores were lower than receptive language scores for children sustaining mild-to-moderate TBI. While severe TBI lowered both Verbal and Perceptual-Performance IQ scores, Verbal IQ scores were significantly lower than Perceptual-Performance IQ scores after mild-to-moderate TBI. Mild injuries may produce subtle linguistic changes adversely impacting estimates of Verbal IQ and expressive language. Within the limited age range evaluated within this study, age at injury was unrelated to test scores: The impact of TBI was comparable in children ages 4 to 41 months versus 42 to 72 months at the time of injury. All neuropsychological scores improved significantly from baseline to the 6-month follow-up. However, no further change in scores was observed from 6 to 24 months after the injury. The persistent deficits and lack of catch-up over time suggest a reduction in the rate of acquisition of new skills after severe TBI. Methodological issues in longitudinal studies of young children were discussed.
在一项针对4个月至7岁儿童的前瞻性纵向随访研究中，对轻度至中度（N = 35）或重度（N = 44）创伤性脑损伤（TBI）患儿的神经心理学结果进行了评估。在受伤后的基线、6个月、12个月和24个月进行了适合年龄的测试。比较了以下方面的表现：（1）综合智商和运动能力，（2）接受性和表达性语言能力，以及（3）言语智商和感知-操作智商得分。与轻度至中度TBI相比，婴儿和学龄前儿童的重度TBI在所有领域均产生了缺陷。获得了任务与损伤严重程度之间的相互作用。运动得分低于智商得分，尤其是在重度TBI之后。重度TBI后，接受性和表达性得分均降低。对于轻度至中度TBI患儿，表达性语言得分低于接受性语言得分。虽然重度TBI降低了言语智商和感知-操作智商得分，但轻度至中度TBI后，言语智商得分显著低于感知-操作智商得分。轻度损伤可能会产生细微的语言变化，对言语智商和表达性语言的评估产生不利影响。在本研究评估的有限年龄范围内，受伤时的年龄与测试得分无关：受伤时4至41个月的儿童与42至72个月的儿童相比，TBI的影响相当。所有神经心理学得分从基线到6个月随访时均有显著改善。然而，受伤后6至24个月未观察到得分的进一步变化。持续的缺陷以及随着时间推移缺乏追赶现象表明，重度TBI后新技能的获得速度有所下降。讨论了幼儿纵向研究中的方法学问题。
