Browsing by Author "Yeates, Keith O."
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- ItemOpen AccessAdvancing Concussion Assessment in Pediatrics (A-CAP): a prospective, concurrent cohort, longitudinal study of mild traumatic brain injury in children: protocol study(BMJ, 2017-07-01) Yeates, Keith O.; Beauchamp, Miriam; Craig, William; Doan, Quynh; Zemek, Roger; Bjornson, Bruce H.; Gravel, Jocelyn; Mikrogianakis, Angelo; Goodyear, Bradley; Abdeen, Nishard; Beaulieu, Christian; Dehaes, Mathieu; Deschenes, Sylvain; Harris, Ashley D.; Lebel, Catherine; Lamont, Ryan; Williamson, Tyler; Barlow, Karen M.; Bernier, Francois; Brooks, Brian L.; Emery, Carolyn; Freedman, Stephen B.; Kowalski, Kristina; Mrklas, Kelly; Tomfohr-Madsen, Lianne; Schneider, Kathryn J.Introduction Paediatric mild traumatic brain injury (mTBI) is a public health burden. Clinicians urgently need evidence-based guidance to manage mTBI, but gold standards for diagnosing and predicting the outcomes of mTBI are lacking. The objective of the Advancing Concussion Assessment in Pediatrics (A-CAP) study is to assess a broad pool of neurobiological and psychosocial markers to examine associations with postinjury outcomes in a large sample of children with either mTBI or orthopaedic injury (OI), with the goal of improving the diagnosis and prognostication of outcomes of paediatric mTBI. Methods and analysis A-CAP is a prospective, longitudinal cohort study of children aged 8.00-16.99 years with either mTBI or OI, recruited during acute emergency department (ED) visits at five sites from the Pediatric Emergency Research Canada network. Injury information is collected in the ED; follow-up assessments at 10 days and 3 and 6 months postinjury measure a variety of neurobiological and psychosocial markers, covariates/confounders and outcomes. Weekly postconcussive symptom ratings are obtained electronically. Recruitment began in September 2016 and will occur for approximately 24 months. Analyses will test the major hypotheses that neurobiological and psychosocial markers can: (1) differentiate mTBI from OI and (2) predict outcomes of mTBI. Models initially will focus within domains (eg, genes, imaging biomarkers, psychosocial markers), followed by multivariable modelling across domains. The planned sample size (700 mTBI, 300 OI) provides adequate statistical power and allows for internal cross-validation of some analyses. Ethics and dissemination The ethics boards at all participating institutions have approved the study and all participants and their parents will provide informed consent or assent. Dissemination will follow an integrated knowledge translation plan, with study findings presented at scientific conferences and in multiple manuscripts in peer-reviewed journals.
- ItemOpen AccessExamining Brain Structure after Pediatric Mild Traumatic Brain Injury(2022-11-28) Shukla, Ayushi; Lebel, Catherine; Yeates, Keith O.; Harris, Ashley; Brooks, BrianMild traumatic brain injuries (mTBIs) affect millions of children annually and present a huge burden to the public health care system. mTBIs often lead to emotional, cognitive, and physical difficulties, together known as post concussive symptoms (PCS), which usually resolve within 4 weeks of injury. In up to one third of all mTBI cases, PCS can be longer lasting and are referred to as persistent PCS (PPCS). In the pediatric population, since mTBI occurs when the brain is still developing, it can lead to altered developmental trajectories, and consequently affect children's cognitive functioning, symptomatology, and quality of life. This thesis aimed to use advanced neuroimaging techniques, [i.e., diffusion tensor imaging (DTI), neurite orientation dispersion and density imaging (NODDI), and voxel-based morphometry (VBM)] to study unexamined aspects of brain structure associated with mTBI, PPCS, and neurocognitive outcomes after mTBI. I used DTI and NODDI to examine white matter microstructure after mTBI at different time points after injury in comparison to orthopedic injury (OI) and used VBM to examine cerebellar gray matter volume and its association to neurocognitive outcomes of mTBI. The results revealed: 1) No post-acute differences in brain structure (white matter microstructure or gray matter) between children with mTBI or OI, 2) Age moderated differential trajectories of white matter change, 3- and 6-months post-injury in symptomatic children with mTBI compared to asymptomatic children with mTBI and an OI comparison group, 3) Higher gray matter volume in the motor regions of the cerebellum 3-months after injury in the mTBI compared to the OI group, 4) Disruptions in the association between reaction time and cerebellar volume in children with mTBI. This novel set of studies provides new knowledge about brain structure following pediatric mTBI and has important implications for improving our understanding of neurobiological correlates of pediatric mTBI.
- ItemOpen AccessParent-Child Reminiscing in the Context of Procedural and Postsurgical Pediatric Pain(2023-06) Pavlova, Maria; Noel, Melanie; Orr, Serena L.; Graham, Susan; Yeates, Keith O.Objective. Children experience pain often and remember it long after painful experiences are over. Up to 25% of children remember past pain in a negatively-biased way (i.e., recalling higher levels of pain as compared to the initial pain reports) and are at risk of experiencing higher levels of pain in the future. Pain memories are malleable and can be reframed through conversations. Recent evidence demonstrated that the way parents reminisce about past pain with their children influenced how children remembered their past pain. Yet, no interventions have used parental reminiscing to change children’s memories for pain. The present dissertation aimed to develop a parent-led memory-reframing intervention that harnesses parent-child reminiscing about past pain and to examine the intervention’s efficacy to change children’s memories for pain. Methods. Three randomized controlled trials investigated whether parents can be taught to reminisce about past pain optimally to, in turn, change children’s memories for pain to be more accurate/positively-biased (i.e., recalling lower levels of pain compared to the initial reports). Additionally, the dissertation examined whether optimal parent-child reminiscing would result in lower levels of future needle pain. Parental beliefs regarding reminiscing about past pain were investigated to optimize the intervention and increase parental motivation to engage in reminiscing about past pain. Results. The parent-led memory-reframing intervention resulted in young children remembering their past post-surgical, but not needle, pain in a more accurate/positively-biased way. The intervention also changed parental reminiscing style to include optimal strategies for reframing past painful experiences. Parents rated the intervention to be feasible and highly acceptable in the context of post-surgical and needle pain. Results also demonstrated that some parental beliefs regarding reminiscing about past painful experiences may be a barrier that prevents parents from engaging in reminiscing about past pain. Conclusions. This dissertation developed and examined the efficacy of a parent-led memory-reframing intervention, a new avenue in pediatric pain management that targets children’s pain memories. The intervention was efficacious in changing how children remember their past post-surgical pain. The preliminary results warrant future large-scale trials to further examine the intervention’s potential to change children’s pain and health trajectories.