Published online June 1, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. 2330 (doi:10.1542/peds.2006-0083)

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Recovery After Childhood Traumatic Brain Injury: Vulnerability and Plasticity

Joost Meekes, MSc
Aag Jennekens-Schinkel, PhD
Sector of Neuropsychology for Children and Adolescents,
Departments of Child Neurology and Child Neurocentre
Wilhelmina Children's Hospital,
University Medical Center Utrecht,
3508 AB, Utrecht, Netherlands,
Rudolf Magnus Institute of Neuroscience
3584 CG, Utrecht, Netherlands

Monique M.J. van Schooneveld, MSc
Sector of Neuropsychology for Children and Adolescents,
Departments of Child Neurology and Child Neurocentre
Wilhelmina Children's Hospital,
University Medical Center Utrecht,
3508 AB, Utrecht, Netherlands

To the Editor.—

Recently, Anderson et al¹ reported important and thought-provoking data concerning developmental and cognitive outcome after traumatic brain injury (TBI) in childhood. They claim that their results are explained by cerebral vulnerability rather than plasticity and propose that (1) more severe TBI predicts worse outcome and (2) for moderate and severe TBI, younger age at injury predicts worse outcome.

We believe that these propositions may not do full justice to the complexity of the data that Anderson et al report. (Note that we do not wish to discount the importance of severity and age in determining outcome.²) Two examples may serve to illustrate our point:

1. Anderson et al consider the impact of injury severity on outcome to be evident from their data. Nevertheless, adaptive functioning showed no differences before injury for the infants (see their Table 3¹); inspection of their Fig 1 reveals negligible differences between severity groups on mental developmental indices 30 months after injury. Therefore, the study suggests heterogeneous trajectories of recovery rather than an impact of injury severity.
   
2. Anderson et al argue that their data support prediction of poorer outcome of moderate and severe TBI for younger age at insult. Again, before injury, no differences in adaptive functioning were found between the 3 age groups for either moderately or severely injured children, whereas at the final assessment after surgery, global intellectual quotients are at least as high for infants as for the older age groups. Therefore, the association of younger age at moderate or severe TBI with poorer outcome is not indubitably demonstrated in their study.
   

The authors' attempt to estimate pretraumatic functioning deserves imitation. However, direct comparison of measures of adaptive functioning such as the Vineland Adaptive Behavior Scale with developmental and/or intelligence quotients may not be appropriate.

In sum, the article seems not to warrant the notion that cerebral vulnerability and plasticity are mutually exclusive alternatives: a full understanding of the effects of brain injury requires both.

REFERENCES

1. Anderson V, Catroppa C, Morse S, Haritou F, Rosenfeld J. Functional plasticity or vulnerability after early brain injury? Pediatrics. 2005;116 :1374 –1382[Abstract/Free Full Text]
2. Dennis M, Levin HS. Childhood head injury: developmental and recovery variables. Dev Neuropsychol. 2004;25(1–2) :1 –225. Special issue[CrossRef]

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PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Meekes, J. Articles by van Schooneveld, M. M.J. Search for Related Content PubMed PubMed Citation Articles by Meekes, J. Articles by van Schooneveld, M. M.J. Related Collections Office Practice Social Bookmarking                         What's this?