Research
Sibling Adjustment to Pediatric Traumatic Brain Injury
Sibling adjustment to pediatric traumatic brain injury has been studied by Mary McMahon, MD, in the Division of Pediatric Physical Medicine and Rehabilitation at Cincinnati Children's Hospital Medical Center. This project was a retrospective study of the impact on siblings of children who have had a traumatic brain injury to determine the significance of problems in these siblings that may require therapeutic intervention.
Dr. McMahon's study demonstrated that the greater the impairment in a child with a traumatic brain injury, the more at risk this child's siblings are to have depression and / or low self-esteem. The results of this study have been published in the December 2001 issue of The Journal of Head Trauma Rehabilitation.
Amantadine for Arousal in Pediatric Traumatic Brain Injury
An NIH grant for a pilot study of amantadine use in children with traumatic brain injury (TBI) was awarded to Mary McMahon, MD. Amantadine is a medication that has shown potential to increase arousal and improve consciousness in children with TBI. The results of this pilot study has provided valuable information that can be used in future studies, which will hopefully determine if amantadine is a useful drug in pediatric TBI.
Family Intervention and Stress Reduction in Parents of Children With Traumatic Brain Injury
Shari Wade, MD, PhD, and Linda Michaud, MD, are completing a study to look at the effectiveness of therapeutic intervention for parents of children who have had TBI. This project will demonstrate whether helping parents deal with the stress of having a child with traumatic brain injury by increasing coping and problem-solving skills is helpful in enhancing the child's quality of life. Funding for this project has been provided by NIDDR.
Online Family Intervention for Pediatric Traumatic Brain Injury
Computers and the internet have become a easily accessible source of medical information for many families in recent years. The internet has also become a way for families to communicate by using email, pictures, or even video. Shari Wade, MD, PhD, has received a National Institutes of Health (NIH) grant to look at utilizing home computers as an intervention tool with families who have a child with TBI. This project will determine if this can be an effective way to help these families cope with the challenges that can occur after this type of injury.
Teenage Online Problem Solving for Pediatric Traumatic Brain Injury
Continuing her previous research, Shari Wade, MD, PhD, is conducting an online computer intervention with an emphasis on teenagers with injury. This NIDRR sponsored intervention directs learning and therapy towards teens with traumatic brain injury and problems unique to their age group. This project will evaluate the benefit this type of intervention can be for teens coping with the challenges that can occur after a traumatic brain injury. The intervention focuses on problem solving, communication and behavior management skills.
Traumatic Brain Injury in Pre-School Age Kids
Following a TBI, a family's ability to adapt to their child's injury can greatly influence the child's rehabilitation. Shari Wade, MD, PhD, has been recruiting preschool-age children from Cincinnati Children's, Columbus Children's (Columbus, Ohio), Rainbow Babies and Children's and Metro Hospital (Cleveland, Ohio), and following them over the course of 18 months to evaluate their cognitive recovery, the impact of the injury on the family and the role of positive parenting in facilitating recovery. In comparing children with a TBI to children with a severe bone fracture Dr. Wade hopes to determine the unique characteristics of TBI recovery and the importance of positive parent interaction.
Having collected a wealth of observations and data from pre-school age children with TBI, Shari Wade, MD, PhD, has joined with Scott Holland, PhD, and Kim Cecil, PhD, in the Department of Radiology and Medical Imaging to add functional Magnetic Resonance Imaging (fMRI) and Magnetic Resonance Spectroscopy (MRS) to participant's information.
MRI allows researchers to observe brain activity while the participant performs tasks such as language generation and number recall. MRS aids researchers in determining the structure and quantities of organic compounds found in the brain. Combined with the standardized tests and observational data, this research may help link behavioral observations with observed brain function.
Constraint Therapy for Hemiplegia after Pediatric Traumatic Brain Injury
Linda Michaud, MD, has obtained an NIH grant to begin the ground work for a project to look at constraint therapy in a pediatric population. This project will determine what will be needed to put together a study to evaluate the effectiveness of restraining the non-affected limbs in children with traumatic brain injury to force use of the affected side.
Effects of Dantrolene Sodium on the Function of Children with Cerebral Palsy
Dantrolene sodium (dantrium) is a medication that can be effective in reducing muscle spasticity in children with cerebral palsy. Jilda Vargus-Adams, MD, has obtained a grant from Procter and Gamble to study the effects of this medication over a six month period in children with cerebral palsy. Motor evaluations of the child and caretaker questionnaires will be utilized before and after starting this medication in an effort to determine the effectiveness of dantrium in this setting.
Effects of Baclofen on the Function of Children with Cerebral Palsy
Baclofen is a medication that can be effective in reducing muscle spasticity in children with cerebral palsy. Jilda Vargus-Adams, MD, has obtained a grant from Research Enrichment Program for Physiatrists to study the effects of this medication over a six month period in children with cerebral palsy. Motor evaluations of the child and caretaker questionnaires will be utilized before and after starting this medication in an effort to determine the effectiveness of baclofen in this setting.
Health Related Quality of Life in Cerebral Palsy
Jilda Vargus-Adams, MD, conducted a study to help gain a better understanding of what factors are involved in the quality of life of children with cerebral palsy. This Physical Medicine and Rehabilitation ERF funded study employed questionnaires to gain information from families. This study was a longitudinal study of health-related quality of life across the full spectrum of childhood CP. The parents or guardians of 177 children with CP, ages 3-18, completed the Child Health Questionnaire (CHQ) (Landgraf et al. 1996) at baseline, six months and twelve months.
The baseline analysis revealed markedly reduced health-related quality of life for children with CP including physical functioning (3 standard deviations below a normative sample) and parental impact (1 standard deviation below a normative sample). Reduction in quality of life was more pronounced as severity of CP increased, as represented by Gross Motor Function Classification Score (GMFCS). Analysis of the longitudinal data has revealed that these deficits are stable over time.
The longitudinal analysis did not reveal associations between demographic factors or common CP interventions and change over time. An additional finding was the poor validity of some of the questions. Because the CHQ asks "Has your child been limited in these activities by health problems?" Parents had difficulty answering some questions as they could not decide if they were being queried on their child's absence of illness or absence of healthy functioning. Thus, some children with severe CP received scores reflecting excellent physical functioning because their parents perceived their physical limitations as disability, not the result of a health problem.
This study is complete.
Effects of Baclofen on the Function of Children with Cerebral Palsy
Baclofen is a medication that can be effective in reducing muscle spasticity in children with cerebral palsy. Jilda Vargus-Adams, MD, obtained a grant from the Research Enrichment Program for Physiatrists to study the effects of this medication over a six-month period in children with cerebral palsy. In an open-label prospective trial of oral baclofen in children ages 3-5 years with moderately severe CP, eleven children were assessed at baseline and following six months of drug therapy, examining spasticity, range of motion, gross motor function (Gross Motor Function Measure-GMFM), health-related quality of life (Child Health Questionnaire-CHQ), side effects and family preferences. Subjects were compared over time and to a normative data sample of children with CP.
No significant changes were noted from baseline to six months, but the subjects demonstrated less improvement in gross motor function than expected when compared with normative data. Contrary to this data, most parents believed that baclofen helped their children and chose to continue the medication when the study concluded. These findings suggested that oral baclofen may produce no benefits in motor functioning, but that families still perceive it to be useful. Further work with a placebo control randomized design is warranted.
This study is complete.
Measuring What Matters in Cerebral Palsy
Jilda Vargus-Adams, MD, has received a Career Development Award from the NIH to study outcome measures in cerebral palsy.
The first phase of her research will involve a survey study. With a prospective, stepwise process, Dr. Vargus-Adams will identify and characterize a panel of outcome measure for patients with CP within an ICF framework. Children and adolescents with CP, parents of children with CP, and medical professionals who care for children with CP will be surveyed to learn what things matter to them when evaluating the effects of interventions for CP. They will also be asked to identify the best ways to measure those things. Using this information, Dr. Vargus-Adams will compile groups of measurement tools and techniques that are most useful when evaluating interventions for CP.
A comprehensive and inclusive library of outcome measures will be examined to identify the available measures for each area of interest within each ICF domain, with particular attention to items that will be most useful in clinical trials. A core pane of measures will be developed as well as supplemental modules specific for subsets of children with CP, based on severity or cognitive status. Recommendations will be made for sets of outcome measures for various patient populations, trials, and budgets.
In the second phase of her research, Dr. Vargus-Adams will perform a longitudinal clinical study to define the validity, reliability, and responsiveness of a battery of outcome measures. Children with CP will be followed for one year. They will be evaluated with the outcome measures for the core panel as well as the supplemental module for their subset of CP. Evaluations will be conducted twice at baseline and at six and twelve months. Gait analysis will be included annually for at least one half of the ambulatory subjects. Participants, parents, and attending physicians will be asked to assess the child's status. These assessments will be compared with the outcome measures. The outcome measures will be examined for reliability, validity, redundancy, and sensitivity to change. Refinements to the panel and modules will be made based on these data.
These studies are recruiting now or in the near future. For information, contact 513-636-7038.
Effects of Intrathecal Baclofen Therapy on Health Related Quality of Life
Intrathecal baclofen therapy is a very effective way to reduce spasticity in children who have cerebral palsy or other conditions where increased muscle tone and spasms interfere with comfort, care or function. A study to look at how this type of therapy can impact the quality of life of these children is being completed by Doug Kinnett, MD, Mary McMahon, MD, and Amy Bailes, PT. With support from Medtronic this study looks at changes in motor skills and caregiver efforts in children with cerebral palsy or other types of brain injury before and after implantation of an intrathecal baclofen pump.
