The Roles of Cognitive Reserve, Brain Reserve, and Psychological Resilience in Predicting Trajectories of Post-Concussive Symptoms in Children with Concussion and Orthopaedic Injury
Study 1: Objective. The current scoping review collated published research examining cognitive and brain reserve, as well as psychological resilience, in the context of traumatic brain injury (TBI) to address the following aims: (1) identify constructs and associated tools measured as proxies of reserve and resilience, (2) explore construct validity and mechanisms of reserve and resilience, as related to TBI, (3) describe relationships among reserve and resilience in the context of TBI, and (4) identify outcomes of TBI predicted by reserve and resilience. Methods. Specific search criteria were entered into MEDLINE Ovid and PsycINFO Ovid databases to capture relevant original research studies from inception to April 2020. Search results underwent title and abstract screen, as well as full-text review, to identify original research studies that examined the roles of cognitive reserve, brain reserve, or psychological resilience in individuals with TBI. Results. A total of 47 articles met inclusion criteria and were included in the review. The majority of studies examined cognitive reserve or resilience, and only one study examined brain reserve. Cognitive reserve was primarily measured via estimated pre-morbid intelligence, education, or occupational attainment using a variety of measures; brain reserve was measured via total intracranial volume; and resilience was primarily measured via a variety of self-report measures capturing individual/psychological factors associated with resilience. Studies supported brain reserve as a static factor and cognitive reserve and resilience as dynamic factors, and indicated reserve and resilience to be protective factors in a variety of cognitive, psychological, and social outcomes associated with TBI. Conclusions. Results elucidate current understandings of the roles of reserve and resilience in the context of TBI, as well as identify knowledge gaps that remain to be addressed. The results may aid in guiding future research studies directed towards improving prognosis and treatment of TBI. Study 2: Objectives. The current study sought to examine the roles of psychological resilience, cognitive reserve, and brain reserve as predictors of and moderators of group differences in trajectories of post-concussive symptoms (PCS) among children with concussion and orthopaedic injury (OI). Methods. This study was completed as part of a larger parent study. A total of 465 children/adolescents, aged 8-17 years, and their caregivers were recruited prospectively from emergency departments across Canada after sustaining a concussion (n = 304) or OI (n = 161). Participants were followed for 6 months and were assessed at 3 time points: post-acute (i.e., approximately 10-days post-injury) and 3- and 6-months post-injury. Participants completed magnetic resonance imaging, which provided a measure of total brain volume (TBV), and a measure assessing psychological resilience during the post-acute assessment. Intelligence (estimated Full Scale IQ) was assessed during the 3-month assessment. Child- and parent-reported cognitive and somatic PCS were measured at all three time points. Linear mixed models were conducted to examine the effect of psychological resilience, IQ, and TBV as predictors and moderators of group differences in trajectories of PCS. Results. Primary analyses indicated that group, sex, age, retrospective ratings of pre-injury symptoms, and psychological resilience were predictive of individual differences in PCS; however, only group and pre-injury symptoms predicted changes in PCS across time and no moderation effects were found. Conclusions. Psychological resilience is an important predictor of PCS, regardless of injury type. However, cognitive reserve and brain reserve, which might be conceptualized as “neurological resilience”, may be less relevant in the context of minor injuries that have relatively little direct impact on neurological function. Results provide important implications for the implementation of resilience intervention efforts to help mitigate PCS and their negative consequences.
Laliberté Durish, C. (2020). The Roles of Cognitive Reserve, Brain Reserve, and Psychological Resilience in Predicting Trajectories of Post-Concussive Symptoms in Children with Concussion and Orthopaedic Injury (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.