Neuropsychological functions following closed head injury in infants and preschoolers



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The traditional plasticity hypothesis proposes that recovery from brain injury is enhanced in children as compared with adults. To evaluate the plasticity hypothesis, performance on intelligence, motor, expressive language, and receptive language tests was examined during the subacute stage of recovery as well as eight months post-injury in 21 infants and preschoolers who sustained a closed head injury (CHI). Children with severe injuries (n=13) exhibited impaired consciousness for at least one day while children sustaining mild-moderate injuries (n=8) were rendered comatose for less than 24 hours. The design was a 2 (severity) x 2 (time of testing) factorial. To evaluate the effect of severity of CHI and to compare neuropsychological performance on baseline and follow up examinations, a repeated measures multivariate analysis of variance (MANOVA) was performed on summary scores from each of the four neuropsychological areas. On the baseline evaluation, children sustaining severe CHI were impaired on intelligence (p<.005), motor (p<.005), expressive language (p<.05), and receptive language (p<.001) functions relative to children with mild-moderate injuries. To determine which skill areas were most disrupted by CHI, the baseline and follow up summary scores from the 1) intelligence and motor and 2) expressive and receptive language areas were compared using a within-subjects MANOVA. Motor scores were more impaired than the intelligence scores on the baseline (p<.05) and follow up (p<.05) evaluations. Expressive language skills were significantly impaired relative to the receptive language skills on the baseline evaluation (p<.05). However, no significant differences were present on the follow up evaluation. The level of expressive language skills improved considerably over time while changes in performance on receptive language tasks was modest. The duration of impaired consciousness was a better predictor of the level of neuropsychological performance during the subacute stage of recovery from CHI than Glasgow Coma Scale scores obtained either at admission or 24 hours post Injury. Significant disruption of ability was observed in all of the skill areas examined and persistent behavioral deficits were apparent eight months post injury in children sustaining severe injuries. These findings are incompatible with the traditional plasticity hypothesis. Moreover, the incidence of dysphasia/dyspraxia was higher in the severely injured children than previously reported in older children and adults sustaining CHI. Since language skills develop rapidly during the preschool years, these findings support the hypothesis that skills in a rapid stage of development are more vulnerable to the effects of cerebral injury than are well consolidated skills.



Head wounds and injuries, Infants, Children