On 15 December 2015 Mari-Liis Kaldoja will defend her doctoral thesis „Mild traumatic brain injury in childhood: pre-injury social-emotional behavior, social-emotional and cognitive outcome and implications for attention rehabilitation“ in the Council of the Faculty of the Social Sciences and Education.
Supervisors: senior research fellow Anneli Kolk (University of Tartu)
Opponent: professor Ulrich Stephani (University of Kiel)
Traumatic brain injury (TBI) is common cause of acquired disability in children. In Estonia, childhood TBI incidence rate is up to 369: 100,000, 80% of injured children suffering from mild TBI. Most of the children sustaining TBI recover well while others exhibit different cognitive, social-emotional and behavioral impairments. These impairments may not be notable immediately after the injury, but could start to impact children’s lives as they grow older – child “growing into his or her lesion”. Impairments are evident after moderate and severe TBI, but whether even a mild TBI can have a negative impact of child’s ongoing social-emotional and cognitive development is still a matter of debate.
Therefore, the main aim of this dissertation was to broaden the overall understanding of social-emotional and cognitive functioning in children with mild TBI. Pre-injury social-emotional behavior and social-emotional and cognitive outcome after mild TBI were addressed and child-friendly computer-based attention intervention was implemented.
We found that children with mild TBI have more pre-injury self-regulation difficulties and autonomy disturbances compared to their non-injured peers. Pre-injury affective problems in 12-month olds, self- regulation and communication difficulties in 30-month olds and autonomy disturbances in 5-year olds could be seen as risk signs for mild TBI. Parents and caregivers of little boys with self-regulation and autonomy difficulties, and girls, with adaptive problems, should be more attentive and alert for accidents.
Our outcome study suggested that even a mild TBI may have negative impact on on-going social-emotional development – especially to social interaction skills. We also found that overall social-emotional outcome after mild TBI is worser for boys than for girls.
Our data showed that soon after injury, more than half of the children with TBI demonstrated visual-spatial memory dysfunctions and 1/3 showed slowed processing speed and/or impairments in visual-spatial planning.
For a number of children, these cognitive difficulties are persistent – two years after the injury over 1/3 of children with TBI still demonstrated visual-spatial planning and/or visual-spatial memory problems. For children, who continue to demonstrate cognitive dysfunctions after an acute period of injury, specific intervention is needed. Improving attention is an important part of the enhancement of overall cognitive outcome. Using ForamenRehab Attention module incorporated into 6-week therapist guided computer-based intervention is a promising method for attention impairment rehabilitation in children with mild TBI.