Reading emotions after childhood brain injury: Case series evidence of dissociation
between cognitive abilities and emotional expression processing skills
JAMES TONKS1, W.HUW WILLIAMS1, IAN FRAMPTON2, PHIL YATES3, SARAH E. WALL1, &
ALAN SLATER1
1 School of Psychology, University of Exeter, UK, 2Cornwall partnership NHS
trust, Cornwall, UK and 3Royal Devon and Exeter Hospital, Exeter, UK
(Received 23 August 2007; accepted 6 February 2008)
Abstract
Primary objective: A previous study has shown that children with brain injuries
are worse than their same age peers at reading emotions. It has not clearly been
established that cognitive impairments and emotion processing impairments are dissociable
in children and the question if whether emotion-reading skill can be selectively
impairment in children after brain injury is explored here.
Research design: This study addresses the issue by testing a case series
of seven children with brain injuries, who were identified as experiencing emotional
or behaviour difficulties. According to a social- behavioural measure.
Methods and procedures: A battery of tests of cognitive function and measure
that assess ability in reading emotions from faces, voices and eyes was administered
to each child.
Main outcomes and results: some cases demonstrate broadly based deficits
that affect both cognitive and emotion processing domains, whilst other cases demonstrate
highly selective deficits in reading emotions.
Conclusions: based on the profile of results across the cases, this study
reports that modality- specific, selective impairments in reading emotional expression
can be found in children after brain injury. In addition, the data provide evidence
of dissociation between cognitive abilities and emotional expression processing.
Keywords: paediatric, brain injuries, emotions, non-verbal communication
Brain Injury, April 2008; 22(4): 325-332
Long-term Cognitive and Motor Deficits after Enterovirus 71 Brainstem Encephalitis
in Children.
Mei-Chih Huang, RN,PhD, Shih-Min Wang,MD, PhD, Yung-Wen Hsu, PhD, Hui-Chen Lin, MD,
Ching-Chuan Liu, MD, MPH
Depts of Nursing, Emergency Medicine, Occupational Therapy and Paediatrics, National
Cheng Kung University and Hospital, Tainan, Taiwan
Abstract
Objectives: Several outbreaks of enterovirus 71 infections have occurred in Taiwan
during the past decade. Brainstem encephalitis was the most common neurological
complication. This study was designed to determine the long-term cognitive and motor
outcomes of children with enterovirus 71 brainstem encephalitis.
Methods: We conducted a prospective follow-up study of children who met the case
definition for enterovirus 71 brainstem encephalitis. Subjects were stratified into
isolated brainstem encephalitis (stage II) , autonomic nervous system dysregulation
(stage IIIa), and pulmonary edema (stage IIIB). The subjects and their parents or
guardians were interviewed using structured questionnaires and received comprehensive
cognitive and neurological examinations. Motor coordination, visual-motor skill
and intellectual ability were evaluated.
Results: Follow-up studies were conducted in 63 previously healthy children with
enterovirus 71 brainstem encephalitis (49 stage II, 7 stage IIa and 7 stage IIIb).
The mean time to follow-up was 2.8 ± 1.0 years (range: 1.4-4.9). Boys outnumbered
girls by 3 to 2. The mean age at diagnosis was 2.4 ± 1.4 years (range 0.3
– 7.1 years). The most common abnormal neurological findings on admission were
altered consciousness (47.6%), followed by abnormal activities of daily living (52.4%),
cerebellar dysfunction (17.5%), and cranial nerve palsy (15.9%). At follow-up, 51
of the 63 children had no detectable deficits. Among the remaining 12 children,
3 died during the follow-up. The remaining 9 children (14.4%) had residual deficits.
Two of these with stage IIIb disease continued to have severe motor and respiratory
failure.
Conclusions: Residual defects were still present in a significant proportion of
children with enterovirus 71 brainstem encephalitis at > 2 years after their
hospitalization. Those with stage II disease were most likely to have residual cerebellar
defects. Those with stage IIIb disease continued to have severe respiratory and
motor impairment. Long-term follow-up of this cohort is needed to determine the
ultimate prognosis.
Keywords: enterovirus71, brainstem encephalitis, outcome, follow-up
PEDIATRICS Volume 118, Number 6, December 2006
Pre- and post-encephalitis neuropsychological profile of a 7-year-old girl
C. Benjamin1, 2, 3, 4 V. Anderson1, 2, 3, 4 R. Pinczower2 R. Leventer, 1, 2,
M. Richardson 2, and M. Nash2
1Murdoch Children’s Research Institute, Melbourne
2Royal Children’s Hospital, Melbourne
3The University of Melbourne, Melbourne
4 Monash Medical Centre, Melbourne, Australia
Our understanding if the neuropsychological effect of encephalitis has largely come
from studies in which the level of premorbid functional is estimated. Moreover,
data on the neuropsychological effects of encephalitogenic pathogens other that
the herpes simplex virus (HSV) are scant. We present the case of a 7-year-old girl
who had intellectual and language assessments seven months prior to the onset of
non-HSV encephalitis (possible aetiology: Mycoplasma pneumoniae), and again post-encephalitis.
MRI post- illness demonstrated basal frontal, temporal and (limited) parietal damage.
Details of speech, psychological and neuropsychological assessments were also documented.
Pervasive changes were apparent in the domains of personality, behaviour, emotionality,
attention, executive function, speech, language and memory. The patients profile
appears to differ most from that seen following typical HSV encephalitis with respect
to marked executive and attentional difficulties. Her deficits insult, probably
reflect both her acute basal brain injury and more diffuse insult, probably caused
by postinfectious encephalitis.
NEUROPSYCHOLOGICAL REHABILITATION 2007, 17(4/5), 528-550
A developmental framework for memory rehabilitation in children
Ingram Wright and Jenny Limond
Clinical Psychology Unit Department of Psychology University of Sheffield Sheffield
S10 2TP UK
Paediatric Psychology Southampton General Hospital Tremona Road Southampton S016
6YU UK
Abstract:
Memory difficulties in adults with acquired brain injuries have been reported in
the literature for some time. In recent years, the consequences of memory difficulties
from acquired and neurodevelopmental disorders in children have also been investigated.
Initial studies have suggested that, like adults, children can experience severe
and specific memory deficits. However, there are important developmental differences,
both in terms of the nature of cognitive difficulties experienced, and the subsequent
consequences for learning, educational attainment and everyday living. Despite the
advances made in developmental memory studies, as yet, there appears to be scant
literature to guide effective rehabilitation specifically targeted at children.
As a starting point, it may be appropriate to consider adaptation of adult rehabilitation
strategies to address memory problems in children. This paper describes some of
the common principles and practices of adult rehabilitation strategies and then
considers the validity of such strategies against developmental models of the memory
system and child's learning environment. In particular, four important areas are
highlighted: the development of normal memory functions in children, the range of
cognitive deficits that can occur in a developing brain, the interaction of memory
deficits with other immature cognitive skills and the context of the psycho-social
environment in which rehabilitation may take place.
Publisher: Taylor & Francis Health Sciences, part of the Taylor & Francis
Group
Issue: Volume 7, Number 2 / April 2004
Pages: 85 - 96
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Does Information and Feedback improve Children’s Knowledge and Awareness of
Deficits after Traumatic Brain Injury?
Beardmore, S., Tate, R. & Liddle, B.
Neuropsychological Rehabilitation, 1999, 9 (1) 45-62
Publisher: Psychology Press, part of the Taylor & Francis Group
Issue: Volume 9, Number 1 / February 1, 1999 Pages: 45 - 62
Abstract:
A frequent observation in adults suffering severe traumatic brain injury (TBI) is
that many minimise or appear unaware of their deficits. Few data exist for children,
but an initial study by Jacobs (1993) found that knowledge in children after TBI
was poor, and this raised issues relating to awareness of deficit. The present study
had two aims: (1) to investigate the extent of deficient knowledge and awareness
in children and adolescents after severe TBI; (2) to develop an intervention designed
to improve knowledge of TBI and awareness of deficit and evaluate its efficacy.
Initial evaluation with 21 participants, aged between 9 and 16 years, found a very
poor understanding of TBI and some were unaware of their deficits. Subjects were
randomly assigned to either an injury-information or attention-placebo session.
The results of two-way repeated-measures analyses of variance indicated that the
intervention session was not successful in increasing the children's knowledge or
awareness of deficit. These findings are discussed in the context of possible causes
of poor knowledge and unawareness and implications for rehabilitation practice.
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Long-term Neurological Outcome of Acute Encephalitis
A. Denizmen Aygün1, Nimet Kabaku1, lhami Çelik2, Mehmet Turgut1, Tahir
Yolda3, Üzeyir Gök4 and Rifat Güler1
1 Department of Pediatrics, University of Firat, Elazi, Turkey 2 Departments of
Clinical Microbiology and Infection, University of Firat, Elazi, Turkey 3 Department
of Neurology, University of Firat, Elazi, Turkey 4 Department of Ear-Nose-Throat,
Faculty of Medicine, University of Firat, Elazi, Turkey
To understand the viral etiology of acute childhood encephalitis in Elazi, Eastern
Turkey, 36 children aged between 4 months and 14 years who were treated in a regional
medical center between January 1995 and June 1999 were studied. Viral etiology was
identified in 16 of 34 (47.1 per cent) cases and the most frequently detected pathogens
was mumps (seven cases, 20.6 per cent). No specific etiology was found in 18 (52.9
per cent) cases. Among the survivors, mental and/or focal neurological deficits
persisted in 18 (52.9 per cent). Two children died and 32 survived, of whom 16 were
left with no neurological sequel, 10 had persistent neurological sequel, and eight
recovered with some degree of handicap. Improvement in the general health and sanitation
of the population, and the universal use and development of new vaccination will
significantly reduce the incidence of viral encephalitis.
Journal
of Tropical Pediatrics Vol 47 August 2001
Residual Attention Deficits Following Childhood Head Injury: Implications for Ongoing
Development.
Anderson, V. and Pentland, L. (1998)
Neuropsychological Rehabilitation, 8 (3), 283-300
Publisher: Psychology Press, part of the Taylor & Francis Group
Issue: Volume 8, Number 3 / May 1, 1998 , Pages: 283 - 300
Abstract:
Intact attentional abilities are important for ongoing development through childhood
and adolescence. If impairment of these skills occurs as a result of paediatric
head injury, then generalised deficits in cognitive abilities may emerge over time.
The present study examined residual attentional and information processing abilities
in a group of adolescents with a history of moderate to severe head injury, and
compared their performances to those of non-injured peers. Results showed that head-injured
adolescents exhibited deficits on a wide range of summary variables extracted from
attention tasks. With respect to specific attentional components, no evidence was
found for deficits in sustained attention for head-injured adolescents, with tasks
tapping focused attention providing inconsistent results. In contrast, difficulties
were identified on measures incorporating a speeded component, and on tasks requiring
complex processing or higher-order attentional skills. These findings indicate a
more generalised pattern of attentional and information processing deficits than
has been documented following adult head injury. Further, these problems persist
long after injury and are associated with globally depressed intellectual abilities.
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The Chief Scientist Reports:
Return to Education after Head Injury in Children: Identifying Needs
David A Johnson, Consultant Clinical Psychologist, Department of Clinical
Psychology, Astley Ainslie Hospital, Grange loan, Edinburgh EH9 2HL
Clare Snodgrass, Assistant Psychologist, Department of Clinical Psychology,
Astley Ainslie Hospital
Brian Pentland,Consultant Neurologist, Scottish Brian Injury Rehabilitation
Service, Astley Ainslie Hospital
Shona Munro, Senior Educational Psychologist, Fife Council Psychological
Service
Abstract
Objective: To investigate the relationship between incidence of head
injury children and the number of such children identified as having Special Education
Needs, and to determine the extent of communication between health education services
concerning head-injured children.
Design and Subjects: Population of all head injured children, between
the ages of 2 weeks and 12 years, admitted to hospital in three contiguous health
board areas, during 1990 to 1993.
Setting: Lothian, Borders and Fife
Results: Approximately 350 in every 100,000 children under the age
of 12 in Lothian, Borders and Fife suffer a head injury requiring admission to hospital.
Such injuries are predominantly mild and caused by falls. Boys are twice as likely
as girls to be injured. Of the 1,833 sample population, 132 (7%) were known to the
education authority via psychological services or formal recording. All cases of
moderate and severe injury and a random sample of mild head injury cases were traced
to catchment schools. Two-thirds of responding schools were not aware of having
a head-injured pupil. Schools that were aware indicted concerns in meeting the needs
of the head-injured children and the lack of liaison between professionals.
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The Impact of Head Injury Severity on Planning Ability in Adolescence: A Functional
Analysis.
Pentland L., Todd, J.A. and Anderson, V. (1998)
Neuropsychological Rehabilitation, 8 (3), 301-317
Publisher: Psychology Press, part of the Taylor & Francis Group
Issue: Volume 8, Number 3 / May 1, 1998 Pages: 301 - 317
Abstract:
This study aimed to investigate the impact of head injury (HI) on executive skills
in adolescents. The sample included a mild to moderate HI group (n = 17), a severe
HI group (n = 16), and a matched control group (n = 17). Subjects were administered
an IQ test and a complex planning task, requiring adolescents to plan an unexpected
party. Qualitative features of planning strategies and error patterns were recorded.
Significant group differences were noted, with the severe group making more errors
and using less efficient strategies on the planning task. No differences were detected
between the mild to moderate group and controls, although performances were not
indicative of mature planning. Thus, while a history of severe HI is associated
with deficits in planning skills, this is not so for milder HI. Further, care needs
to be taken not to over-interpret poor planning in this clinical population without
considering the normal developmental course of these skills.
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