MCH Trauma Program's Clinical Research: Completed projects in 2008-2009
1. Evaluation and Standardization of the Pediatric Test of Brain Injury
Who were the researchers?
Isabelle Gagnon, Jeff Atkinson, Gillian Hotz (Principal Investigator of multi-centre study)
What was the research question?
We wanted to use a newly developed test of language and cognitive abilities to see whether it worked well with children who have had a severe or moderate head injury.
What were we doing?
We were using the test with every child or adolescent who was admitted to the Montreal Children's Hospital and sent the results of the test to the main researcher in this project (Gillian Hotz) to be analyzed.
How was this project funded?
This project required no funds.
What are the results?
Our participation in this multi-centre project contributed to the validation of the Pediatric Test of Brain Injury. Over 800 children from the U.S. and from Canada were tested and their results were used to verify the quality of the test.
What does that mean for practice?
The test is now commercialized and ready to use in clinical practice. It is a valuable addition to the tools available to use with children who sustain head injuries.
2. Comparing the Balance Error Scoring System and the Bruninks-Oseretsky Test of Motor Proficiency balance subtest with the MTBI pediatric population
Who were the researchers?
Isabelle Gagnon, Carlo Galli, Julie Simard
What was the research question?
We wanted to know whether 2 tests we use currently in clinical practice were addressing the same aspects of balance in children and adolescents who had a mild head injury or concussion.
What were we doing?
We evaluated 22 children with the two tests and then used statistical tests to compare their performances on both. We then went on to evaluate 20 children without injuries to compare their performance on both tests.
How was this project funded?
The second phase of the project received funds from the Pilot Project Competition of the Montreal Children's Hospital Research Institute.
What are the results?
We found that the performance of children with and without head injuries on the two tests was related. Furthermore, we found that one of the tests, the Bruininks-Oseretsly Test of Motor Proficiency-balance subtest (BOT), was more sensitive to the effects of the mild traumatic brain injury than that of the Balance Error Scoring System (BESS).
What does it mean for practice?
It provides clinicians with more information when they need to choose a balance test in their work. The BOT appears to be a better choice for this clientele.
3. Parental Survey of Booster Seat use among Canadian Children
Who were the researchers?
Isabelle Gagnon, Lisa Grilli, Beth Bruce (Principal Investigator of nationwide study)
What was the research question?
We wanted to know which factors influenced parent's ability to use booster seats on a regular basis.
What were we doing?
We were recruiting parents of children aged 4 to 9 years of age. They filled out a survey consisting of 15 multiple-choice questions. This was done electronically on a laptop computer.
How was this project funded?
This project was funded by AUTO 21, a Federal Network of Centres of Excellence and from the IWK Health Centre Foundation.
What are the results?
Data was collected from 1580 parents across 8 Canadian provinces. The majority of the respondents were mothers aged 30-39 years. Overall families reported that the key factors that most influence their booster seat use are: awareness of the benefits of preventing an injury to their child, booster seat regulations for their child's height and weight, societal expectations to consistently use a booster seat, and regular police enforcement of booster seat laws.
What does it mean for practice?
Intervention to parents of school-aged children needs to target: raising awareness that booster seats prevent injuries (correct booster seat use reduces child deaths by 71% and reduces severe injury by 67%), provide information on correct use of booster seats (age, weight, and height regulations), expect regular enforcement and create a social culture where using booster seats are an expectation (i.e. the norm).
4. Developmental trajectory of infants and toddlers who sustained a moderate to severe TBI
Who were the researchers?
Anne Marie Hurteau, Katrine Doucet, Isabelle Jargaille, Line Parent, Isabelle Gagnon
What was the research question?
We wanted to know whether infants and young children (those younger than 2 years) who had severe head injuries had different trajectories of development than what we know for children without injuries.
What were we doing?
The children were seen yearly as part of their regular clinical follow-up by the occupational therapist, the speech and language pathologist and the audiologist. We decided to review the results of the tests they had been administered up to the age of 7 years and find out whether they had persistent problems related to the head injury they had sustained as a young child.
How was this project funded?
This was a chart review by the clinicians themselves and therefore no funding was necessary to complete the study.
What are the results?
Close to 40 children met our selection criteria. In view of the little numbers of subjects no specific conclusions can be drawn from our data. Globally this group of children exhibited development milestones within the normal range. Only few of them presented difficulties in either aspects of speech and language development or in motor development. It is not possible at this time to interpret if these difficulties are directly related to the head injury.
What does it mean for practice?
We will continue following these children as part of our clinical practice. The lack of obvious consequences of early head injury might be explained by the small number of children seen, by tests that may not be sensitive enough or by the need to look at other aspects of development such as neuropsychological functioning when the children reach school age.
Completed projects in 2008
1. Physical exertion testing in the Return to sports clinic at the MCH
Who were the researchers?
Isabelle Gagnon, Carlo Galli, Debbie Friedman, Julie Simard, Helen Kocilowicz, Lisa Grilli
What was the research question?
We wanted to know whether children were truly ready to return to sports after a mild head injury or concussion, once their symptoms had resolved.
What were we doing?
We reviewed the medical files of over 100 children who had been seen in the Mild Traumatic Brain Injury/Return to Sports Clinic of the Montreal Children's Hospital. We documented whether they had successfully completed a physical test once their symptoms had resolved at rest.
How was this project funded?
A research fellow, funded by a summer student bursary from the Canadian Institutes for Health Research through the COPSE Program of the University of Montreal, performed most of the data collection activities for this project.
What are the results?
We found that a total of 24% of children and adolescents had an increase in their symptoms (headache, dizziness and fatigue) after the physical test and were asked to not return to their sports right away. We also found that children who had lost consciousness and those who had a history of migraines before the injury were more likely to fail the test than those without.
What does it mean for practice?
The results of this study show that, although asymptomatic at rest for at least 1 week, a significant number of children and adolescents cannot successfully begin practicing physical activities. This means that they should be monitored even after their symptoms have resolved to make sure that the return to sports is safe.