Seth Warschausky

Empowerment theory for rehabilitation research: Conceptual and methodological issues.

ABSTRACTThe rapid paradigmatic shift in rehabilitation to more constituent-driven treatment, program planning, and research agendas has led to the proposal to include empowerment as a critical variable in outcome research (J. D. Banja, 1990; National Institute on Disability and Rehabilitation Resear

Neurobehavioral outcomes after early versus late childhood traumatic brain injury

ObjectivesTo examine differences in outcomes at transition age (17–21 years) between individuals who sustained complicated mild-to-severe traumatic brain injury (TBI) in early or middle childhood and those who were injured in late adolescence. ParticipantsFifteen persons who sustained TBI between the ages of 6 and 12 years (early-onset) and 30 persons who sustained TBI between the ages of 16 and 20 years (late-onset). MeasuresPeabody Picture Vocabulary Test—Third Edition, Trail-Making Test, Buschke Selective Reminding Test, Benton Visual Retention Test, Dysexecutive Questionnaire, Community Integration Questionnaire, Satisfaction with Life Scale. ResultsThe groups did not differ in overall cognitive ability level, postinjury education or vocational accomplishments, or current living situation. However the early-onset group demonstrated worse outcomes in higher-level cognitive skills, social integration, driving, and legal guardianship. ConclusionsComplicated mild-to-severe TBI earlier in childhood is associated with worse long-term neurocognitive and psychosocial outcomes than injury sustained in late adolescence. Findings provide further support for theories that early brain injury onset interferes with development of immature or rapidly developing skills, and may be associated with further magnification of deficits during the course of later development.

WISC-III Factor index score patterns after traumatic head injury in children

Abstract Four subtypes of Wechsler Intelligence Scale for Children-Third Edition (WISC-III) factor index score patterns were identified by means of two-stage cluster analysis in a sample of 153 children with traumatic head injury (THI). Three of these subtypes were differentiated primarily by level of performance, and bore close resemblance to clusters known to be prevalent in the WISC-III standardization sample. One subtype displayed an uncommon pattern of performance, characterized by selective impairment on the Perceptual Organization and Processing Speed factor indexes, which may be clinically significant in children with THI. Support for the reliability and validity of the subtypes is provided. It is concluded that the WISC-III is a useful tool in the evaluation of sequelae of THI in children.

Friendship and social adjustment of children following a traumatic brain injury: An exploratory investigation

Despite evidence that suggests that children who survive traumatic brain injuries (TBIs) experience disruptions in their peer relationships, the peer experiences of children with TBIs have rarely been studied empirically to date. Data were gathered on measures of peer adjustment for a sample of 22 children with TBIs and were compared with children from a matched control group. Children with TBIs were found to be less socially and athletically competent than children who had not experienced aTBI. Among boys, TBI was also related to lower academic competence. Children with more severe injuries had greater difficulty managing conflict, coordinating play, and developing intimacy in their closest friendships. Girls were more likely than boys to have friendships that predated the injury. Results are discussed in terms of the significance of the social disruption that apparently occurs surrounding injury.

Social problem-solving skills of children with traumatic brain injury

Studies of specific social skill deficits in adults with traumatic brain injury (TBI) have begun to appear [1,2], but there are few empirical studies of children with TBI. This study examined social problem-solving skills in boys and girls with TBI and a matched group of non-injured peers, ages 7-13. The TBI group generated fewer total solutions on a social problem-solving measure, largely reflecting situation-specific differences in generated solutions. The TBI group also generated fewer positive assertive, and more indirect responses to peer group entry situations than the comparison group. Implications are discussed for a model of social information processing in paediatric brain injury.

Long-Term Functional Outcome of Pediatric Stroke Survivors

Abstract Purpose: To examine the long-term functional, psychosocial, and medical outcome of pediatric stroke survivors. Method: This was a descriptive survey performed on patients with childhood stroke who participated in an earlier study. Measures included the Vineland Adaptive Behavior Scales (VABS) and the Diener Satisfaction with Life Scale. Current information on living situation, school placement, employment, and medical outcome were obtained. Results: Twenty-nine (58%) patients participated. The mean age was 19.3 years (SD = 6.6), mean age of onset of stroke was 7.0 years (SD = 5.4), and mean follow-up time was 11.9 years (SD = 3.9). Diagnoses included hemorrhagic (31%) and ischemic (69%) stroke. All but one adult had finished high school, and the majority of participants had gone to college. 60% of patients over age 16 were employed. The average VABS levels for communication, daily living skills, socialization, and adaptive behavior fell into the moderately low range. Use of seizure medications and ADL dependence were the predictors for lower VABS levels (p < .05). Younger age, ischemic stroke, and previous dependence in mobility were risk factors for lower scores for the self-care domain, but not for lower life satisfaction. Patients who scored below adequate on VABS tended toward lower life satisfaction. Conclusion: Pediatric stroke survivors had good educational and mobility outcomes, but communication, ADL, and socialization fell into the low-moderate range. The different predictors of functional and subjective quality of life outcomes suggest that functional outcomes may mediate the relations between medical factors and satisfaction with life.

Early development of infants with untreated metopic craniosynostosis.

Background: The purpose of this archival descriptive study was to examine the associations among craniosynostosis, perinatal risk factors or complications, and early cognitive development in infants diagnosed with craniosynostosis before they underwent surgery, to provide a greater empirical basis for surgical decision making and other early interventions. Specifically, it was hypothesized that there would be a greater number of infants with developmental delays than seen in the normative population. Furthermore, it was hypothesized that greater severity of synostosis would be correlated with lower cognitive and developmental scores. The secondary purpose of this study was to examine specific developmental domains such as language and motor skills in children with metopic craniosynostosis. Methods: The research subjects for this retrospective cross-sectional study were a consecutive series of 22 infants diagnosed with metopic synostosis: 86 percent male, ages 3.6 to 25.3 months (mean ± SD, 10.6 ± 6.4 months). Mean gestational age was 38.8 (2.3) months, mean birth weight was 107.7 ounces, and 48.1 percent subsequently had craniovault reconstruction. Severity of craniosynostosis was assessed by a plastic surgeon (Buchman) and a neurosurgeon (Muraszko) and was confirmed radiographically by an independent rater (Angobaldo). Cognitive status was assessed with the Bayley Scales of Infant Development, Second Edition, at a mean age 11.6 (4.8) months. Results: The mean Mental Development Index score for the sample was 96.0 (14.5), falling within the average range. Severity of synostosis was not significantly correlated with the overall Mental Development Index score. The mean language quotient for the sample was 77.3 (21.1). Conclusions: Despite suspicions that increased severity of deformity in infants with metopic craniosynostosis correlates with decreased cognitive and motor development, no such associations could be demonstrated. The results of this study did suggest, however, that children with isolated metopic craniosynostosis might show specific developmental delays in language acquisition. Finally, there were no significant correlations between cognitive development and prenatal risk factors.

Sleep and quality of life in children with cerebral palsy

OBJECTIVE To examine the associations between sleep problems and quality of life (QoL) in children with cerebral palsy (CP). METHODS Prospective correlational study using parent-report forms to measure QoL and sleep disorder symptoms. Two groups comprised of 41 children with CP and 91 typically developing (TD) controls age 8-12years participated in a prospective correlational study. RESULTS Measures were the PedsQL-4.0 Generic scales and the Pediatric Sleep Questionnaire, with subscales of interest including sleep disordered breathing (SDB), excessive daytime sleepiness (EDS), insomnia (INS) and snoring (SNOR). Hierarchical regression analyses indicated that EDS contributed unique variance in physical QoL, and INS contributed unique variance in psychosocial QoL in children with CP; for TD children, sleep disorder symptoms were infrequent and not associated with physical or psychosocial QoL. CONCLUSIONS Findings highlight the importance of assessing sleep difficulties when addressing the needs of children with CP.

Empirically supported psychological and behavioral therapies in pediatric rehabilitation of TBI

This article examines the empirical support for psychological therapies for children with traumatic brain injury (TBI). Empirical support for psychological treatments of noninjured children provides a foundation upon and a framework in which to discuss applications to children with neurobehavioral dysfunction. Behavioral interventions to address externalizing behaviors have received the greatest focus, whereas there is a paucity of work that pertains to internalizing features and prosocial behavior such as assertiveness. Although the systematic study of psychological intervention lags far behind the rapidly increasing knowledge of neurobehavioral sequelae to TBI, there are promising directions that stem from initial findings.

A structural equation analysis of the WISC-III in children with traumatic head injury

Abstract Maximum likelihood confirmatory factor analysis was performed on the WISC-III data of a sample of 171 children with traumatic head injury (THI). Analyses were designed to determine which of eight hypothesized oblique factor solutions, based on competing latent variable models that were identified in previous studies, could best explain cognition as measured by the WISC-III. The findings supported the four-factor model, as proposed in the WISC-III manual. This model (composed of Verbal Comprehension, Perceptual Organization, Freedom from Distractibility, and Processing Speed) outperformed all other models in terms of model fit and parsimony. It is concluded that this four-factor model is the most accurate predictor of WISC-III performance variability in children with THI.