M Wright

OBJECTIVES: Mild traumatic brain injury (TBI) and injury-related outcomes such as postconcussive symptoms (PCS) may influence health-related quality of life (HRQOL) in children. METHODS: We evaluated HRQOL in 186 8- to 15-year-old children with mild TBI and 99 children with orthopedic injuries (OI). Parents rated the frequency and severity of PCS at an initial assessment within 2-weeks postinjury and rated HRQOL at 3- and 12-months postinjury. RESULTS: The mild TBI and OI groups did not differ in psychosocial HRQOL, but the mild TBI group showed lower physical HRQOL at the 12-month follow-up. Somatic PCS were a significant predictor of physical HRQOL over time, and both cognitive and somatic PCS were significant predictors of psychosocial HRQOL over time. Children with higher PCS at the initial assessment had lower HRQOL scores at later time points. CONCLUSIONS: Effective management of PCS may be associated with improvements in HRQOL following pediatric mild TBI.

OBJECTIVE: To examine the relationship of mild traumatic brain injuries (TBI) and post-concussive symptoms (PCS) to post injury family burden and parental distress, using data from a prospective, longitudinal study. METHODS: Participants included 71 children with mild TBI with loss of consciousness (LOC), 110 with mild TBI without LOC, and 97 controls with orthopedic injuries not involving the head (OI), and their parents. Shortly after injury, parents and children completed a PCS interview and questionnaire, and parents rated premorbid family functioning. Parents also rated family burden and parental distress shortly after injury and at 3 months post injury. RESULTS: Mild TBI with LOC was associated with greater family burden at 3 months than OI, independent of socioeconomic status and premorbid family functioning. Higher PCS shortly after injury was related to higher ratings of family burden and distress at 3 months. CONCLUSIONS: Mild TBI are associated with family burden and distress more than mild injuries not involving the head, although PCS may influence post injury family burden and distress more than the injury per se. Clinical implications of the current findings are noted in the Discussion section.

This study obtained qualitative data to assess how parental role modeling and parental social support influence physical activity in underserved (minority, low-income) adolescents. Fifty-two adolescents (22 males, 30 females; ages 10-14 years, 85% African-American) participated in a focus group (6-10 per group, same gender). Focus groups were audiotaped, transcribed and coded by independent raters. Inter-rater reliabilities indicated adequate agreement [inter-rater reliability (r) = 0.84]. Themes were identified for parental role modeling and parental social support. Regarding parental role modeling, adolescents reported that parents engaged in a variety of different types of physical activities with their children such as walking, cycling and playing basketball; however, activity was infrequent. Sex differences were noted in parental social support indicating that female adolescents reported receiving more emotional and negative support for physical activity (being required to play outside with a sibling), while boys reported receiving more tangible types of support for physical activity. Adolescents also generated ideas on how to increase parental social support and in particular tangible support was highlighted as important by both males and females. This study suggests that future interventions should focus on improving parental engagement and tangible support that involve direct participation from parents in physical activities with their adolescents.