Projektart: Gefördertes Projekt Studie
Evaluation neurologischer Rehabilitationsbehandlung und Entwicklungsverlauf kognitiver Fähigkeiten bei Kindern und Jugendlichen nach Schädel-Hirn-Traumen

This retrospective follow-up study examines parameters of longterm-outcome in a group of adolescents and young adults (16-22 years at follow-up, n=150-190), who had previously experienced traumatic brain injury (TBI). The multivariate design will include independent variables such as age at injury, site of brain lesion and initial neurological, neurophysiological and neuropsychological status as well as pretraumatic learning disorders. The effects on outcome measures and the intervening effects of psychosocial variables will be analyzed. Both group comparisons and individual long-term developmental changes will be reported. ABSTRACT 6TH EUROPEAN CONGRESS ON RESEARCH IN REHABILITATION BERLIN 1998: "Purpose Compared to early neuro-psychological sequelae of traumatic brain injuries (TBI) and their remission, much less is known about the long term consequences, especially the course of cognitive and social development of children with secondarily acquired TBI. Method In an ongoing longitudinal follow-up study*, former patients of a neurological rehabilitation centre for children and adolescents are re-examined at the age of 16- 22 years. 24% of cases were late referrals with persistent complaints and/or delayed onset of symptoms. The specific approach put forward in this study is the comparison of long-term post-traumatic development of neuro-psychologically relevant subgroups and of individual cases, established through long-term individual growth curves, as advocated by Fletcher et al. (1995). Results Neuro-psychological test results of 80 cases will be reported. Individual test scores at follow-up range from low to superior, total group full-scale IQ falling into the "low-average" category (88 ( 21.6). Statistically significant and clinically relevant effects on reaction time, Performance IQ and memory persist for the group with severe TBI; no such association was found for test scores of verbal and executive functions. The slope of cognitive development after TBI is associated with trauma severity and age at injury, whereas parameters of social integration depend on the degree of frontal involvement. Different developmental growth curves, including persisting memory disorder in patients with temporal contusions, verbal processing deficits in patients with predominantly left hemispheric damage and lack of age- appropriate social behaviour in patients with bi-frontal contusions, demonstrate the variability of outcomes. Discussion Specificity and persistence of neuro-psychological deficits, typically linked to the hemispheric site of the lesion and moderated by developmental level at injury and trauma severity, differentially contribute to long-term neuro-behavioural outcome after childhood TBI. Conclusion Mean scores of unselected TBI-populations do not represent meaningful descriptions of the consequences of acquired brain damage, which leads to an insufficient understanding of the therapeutic needs of this population. "