Yeates K O, Taylor H G, Drotar D, Wade S L, Klein S, Stancin T, Schatschneider C
Department of Pediatrics, Ohio State University, Columbus, USA.
J Int Neuropsychol Soc. 1997 Nov;3(6):617-30.
Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than environmental factors as predictors of recovery. We addressed this concern using data collected during a prospective study of children with either TBI or orthopedic injuries (OI) and their families. Participants included 53 children with severe TBI, 56 with moderate TBI, and 80 with OI, all from 6 to 12 years of age at the time of injury. Measures of the preinjury family environment were collected shortly after the injury (baseline). Child cognitive and behavioral outcomes were assessed at baseline and at 6- and 12-month follow-ups. Individual growth curve analyses showed that measures of the preinjury family environment consistently predicted both the level of cognitive and behavioral functioning at 12 months postinjury and the rate of intraindividual change during the 12-month follow-up period, even after taking into account group membership and injury severity. In some cases, the preinjury family environment was a significant moderator of the effect of TBI, buffering its impact in high-functioning families and exacerbating it in low-functioning families. Thus, preinjury environmental factors predict recovery following TBI in children, even after accounting for injury-related variables.
先前关于儿童创伤性脑损伤（TBI）的研究强调与损伤相关的变量，而非环境因素，将其作为恢复的预测指标。我们利用在一项对患有TBI或骨科损伤（OI）的儿童及其家庭进行的前瞻性研究中收集的数据，解决了这一问题。参与者包括53名重度TBI儿童、56名中度TBI儿童和80名OI儿童，受伤时年龄均在6至12岁之间。受伤后不久（基线）收集了受伤前家庭环境的测量数据。在基线以及6个月和12个月随访时评估了儿童的认知和行为结果。个体生长曲线分析表明，即使在考虑了组别归属和损伤严重程度之后，受伤前家庭环境的测量指标始终能够预测受伤后12个月时的认知和行为功能水平以及12个月随访期间个体内部变化的速率。在某些情况下，受伤前家庭环境是TBI影响的一个显著调节因素，在功能良好的家庭中缓冲其影响，而在功能不良的家庭中加剧其影响。因此，即使在考虑了与损伤相关的变量之后，受伤前环境因素仍可预测儿童TBI后的恢复情况。
