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Outcome of closed head injury in Malaysian children: neurocognitive and behavioural sequelae
L C Ong1, V Chandran, S Zasmani
1Department of Paediatrics, Faculty of Medicine, National University of Malaysia, Jalan Raja Muda, Malaysia. onglc@ukm.medic.my
Insights
Children with severe closed head injury (sCHI) experience lasting cognitive, motor, and behavioral issues, impacting school performance. Integrated rehabilitation is crucial for their return to mainstream schooling.
Area of Science:
- Neuroscience
- Pediatrics
- Rehabilitation Medicine
Background:
- Severe closed head injury (sCHI) in children can lead to long-term neurobehavioral deficits.
- Understanding the spectrum of outcomes from mild-to-moderate head injury (mCHI) and orthopedic injuries is essential for comparison.
Purpose of the Study:
- To compare the neurobehavioral outcomes of children with sCHI, mCHI, and orthopedic controls.
- To assess cognitive, motor, memory, learning, and behavioral differences six months post-injury.
Main Methods:
- A cohort of 29 children in each of three groups (sCHI, mCHI, orthopedic controls) matched for age, sex, and ethnicity.
- Utilized standardized assessments including the Glasgow Outcome Scale (GOS), Weschler Intelligence Scale for Children (WISC-III), Movement Assessment Battery for Children (Movement ABC), and Wide Range Assessment of Learning and Memory (WRAML).
- Parental reports on behavior (Child Behaviour Checklist - CBCL) and neurological examinations were conducted six months post-injury.
Main Results:
- Children with sCHI showed significant deficits in performance, verbal skills, memory, learning, and motor skills compared to controls.
- A notable percentage of sCHI children experienced motor deficits and difficulties with independent ambulation.
- Behavioral issues, including somatic complaints, social difficulties, delinquency, aggressiveness, thought, and attention problems, were significantly higher in the sCHI group, correlating with a decline in school performance.
Conclusions:
- Despite apparent physical recovery, children with sCHI face persistent cognitive, motor, memory, and behavioral challenges.
- These neurobehavioral sequelae negatively impact academic performance, necessitating specialized support.
- The findings underscore the need for integrated rehabilitation services to facilitate school reintegration for children with sCHI.
Objectives:
To compare the neurobehavioural outcome of children aged 6-12 years with severe closed head injury [sCHI] (coma > 24 h), mild-to-moderate head injury [mCHI] (coma < 6 h) and orthopaedic controls.
Methods:
Twenty-nine children in each group, matched for age, sex and ethnicity, were assessed using the Glasgow outcome Scale (GOS), Weschler Intelligence Scale for Children (WISC-III), Movement Assessment Battery for Children (Movement ABC), Wide Range Assessment of Learning and Memory (WRAML) and a standardised neurological examination 6 months post-injury. Parental reporting of pre- and post-injury behaviour was documented using the Child Behaviour Checklist (CBCL).
Results:
Seven (24.1%) children with sCHI and three (10.3%) orthopaedic controls had residual motor deficits. Three (10.3%) children with sCHI and none in the other groups faced problems with independent ambulation. Twenty-seven (93.1%) of those with sCHI and all children in the other groups had GOS scores of good recovery or moderate disability. Twenty-two (81.5%) sCHI, five (18.5%) mCHI and one (3.7%) orthopaedic control reported a deterioration in school performance. MANOVAS identified a significant injury group effect for performance skills (P = 0.007), verbal skills (P = 0.002), memory and learning (P = 0.001) and motor skills (P = 0.001). Repeated measures ANOVA for pre- and post-injury CBCL scores showed significant differences related to somatic complaints (P = 0.004), problems of socialising (P = 0.003), delinquency (P = 0.004), aggressiveness (P = 0.010), thought (P < 0.001) and attention (P < 0.001). Post-hoc univariate analysis showed the significant differences were between that of the sCHI children and the other two groups.
Conclusion:
Although most sCHI children seemed to have made good physical recovery, there were cognitive, motor, memory and learning difficulties and behavioural problems concomitant with a deterioration in school performance compared with those with lesser or no head injury. This highlights the need for better integrated rehabilitation services to enable a gradual return into mainstream school.