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Objective: A paucity of data exists regarding the duration of post-traumatic amnesia (PTA) as a predictor of cognitive functioning among children after traumatic brain injury (TBI). The study aimed to assess the relationship between PTA duration and areas of neurocognitive function among the pediatric population in the sub-acute phase of recovery and rehabilitation. Methods: Data were collected from medical files on 103 children aged 5.5–16.5 hospitalized at a pediatric rehabilitation department with a diagnosis of moderate–severe TBI (msTBI) between the years 2004–2019. The Children Orientation and Amnesia Test was used to evaluate PTA duration. Measures of high-order cognitive abilities of attention and executive function were collected using the Test of Everyday Attention–Child version (TEA-Ch). Results: Three PTA duration groups were assembled out of a cluster analysis: “Long PTA” (M = 21 days), “Very Long PTA” (M = 47 days), and “Extremely Long PTA” (M = 94 days). Analyses revealed that the “Long PTA” group preformed significantly better than the “Very Long PTA” and “Extremely Long PTA” groups on all TEA-Ch measures, that is, Selective Attention, Attentional Control Switching, and Sustained Attention. Conclusions: This study is the first to demonstrate that PTA duration is a useful predictor of high-order cognitive functions among children with msTBI in the sub-acute phase of recovery and rehabilitation. The findings emphasize the importance of using a more sensitive classification of prolonged PTA durations to improve outcome prediction and allocation of resources to those who can benefit most after severe brain injuries.

Background Acquired brain injury (ABI) is classified into traumatic brain injury (TBI) and ABI-PF. In ABI-PF, almost half of pediatric brain tumors arise in the posterior fossa (PF). Assessment of motor proficiency is commonly conducted with the Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT2). This study assessed: 1) gross motor performance deficits in children with TBI and ABI on account of tumor in the PF (ABI-PF) using two different assessment methods (two-standard deviation and age equivalent methods); 2) BOT2 ability to discriminate between children with TBI and ABI-PF; and 3) factors associated with motor ability. Methods Participated in this study were children with TBI (n = 50) and ABI-PF (n = 30) (mean age = 11.34 ± 3.55 years). Participants were tested on BOT2 Upper-Limb Coordination, Balance, Strength, Running Speed and Agility, and Bilateral-Coordination subtests. Motor performance deficits were established using BOT2 two-standard deviation and age-equivalent methods. Differences in the prevalence of children with/without motor performance deficits were evaluated using a chi-square test. Between-group differences (TBI vs. ABI-PF) in BOT2 were assessed via independent t-tests. The ability of the BOT2 to distinguish between the two study groups was established using receiver operating characteristic curves. Results Motor deficits in the ABI-PF group were higher than in the TBI group. More specifically, according to the two-standard deviation method, motor deficits in the ABI-PF group ranged from 20% (bilateral coordination) to 66.66% (balance), whereas in the TBI group 8% (strength) to 16% (balance). The age-equivalent method revealed higher rates of motor deficits. In the TBI group, 40% (Upper Limb Coordination) to 66.0 (Bilateral Coordination) of the children presented motor function that is ≥ 36 months below their chronological age. In the ABI-PF group, 46.66% (Bilateral Coordination) to 76.66% (Balance) of the children presented such motor deficits. BOT2 discriminated between the two etiology groups. Several significant associations were observed between age and motor function. Conclusions Motor deficits post-pediatric ABI are prevalent. In comparison to the TBI group, deficits are greater in the ABI-PF group. Moreover, compared to the two-standard deviation method, the extent of motor deficiency is greater in the age-equivalent method. Finally, age is associated with several motor function deficits.

Personality factors are often investigated in the context of parenting but are rarely studied in relation to coping with child disabilities like pediatric acquired brain injury (pABI). This study (1) compares Biopsychosocial functioning (BPSF), Big Five personality traits, and dimensions of perfectionism of parents of children with and without pABI, and (2) examines the role personality factors play in parental BPSF in each group. 57 parents of children who sustained a significant pABI and 50 parents of typically developing children participated in this cross-sectional study. Parents completed scales measuring Multidimensional Perfectionism, Big Five inventory, and BPSF. Among the pABI group, multivariate analysis indicated significantly poorer BPSF, higher levels of neuroticism, socially prescribed perfectionism, and lower levels of openness, than controls. Regression analysis showed that personality explained 60.5% of the variance in parental BPSF post pABI. In both samples, neuroticism and socially prescribed perfectionism appeared as two prominent personality factors with a significant negative effect on parental BPSF, while self-perfectionism appeared prominent only in the pABI group, indicating a significant positive effect. pABI may result in changes to parents` personality. Personality characteristics significantly contribute to parental BPSF post-injury and should be addressed in clinical practice.

To investigate how pediatric nurses interpret and conceptualize theoretical underpinnings and daily practice scenarios pertaining to their role in pediatric care.139 pediatric nurses completed a survey in which they were asked to endorse to what extent practices related to pediatric concepts are expected from their role ("Expected") or are actually implemented in their clinical work ("Actual"). Survey items were derived from a nursing textbook that outlines the theoretical tenets of the "art of pediatric nursing", along with scenarios and conflicts encountered in everyday practice, covering family-child centered care, child growth and development, and emotional boundaries.In both Expected and Actual practices, the highest level of endorsement was for items focused on core elements of family-centered care (80-96%), and moderate-low endorsement levels were observed for items related to therapeutic relationship management and emotional boundaries. A factor analysis yielded 12 factors representing themes related to pediatric nursing. However, the division of items per factor indicated diffusion between key concepts and a discrepancy between theory and practice, especially in regard to maintaining emotional separateness and objectivity, advocacy, managing conflicts within the nurse-child-family triad, and navigating oneself boundaries.Nurses' ability to manage and contain various types of unclear boundaries is crucial for optimal care provision when working with children and families.Variability in nurses' theoretical role-perception and practical care provision is largely attributed to the way they navigate various ambiguous boundaries in practice and this could be a focal point in educational programs and on-the-job training.

This grounded theory study aims to map, conceptualize, and theorize the emotional loss experienced by parents following their child’s pediatric acquired brain injury (pABI). Data were obtained from 47 semi-structured interviews conducted with parents (72% mothers) at least 1 year following pABI. The study’s theory of “concurrent ropes and ladders” emerged from a process of initial in vivo coding followed by focused and thematic coding. Codes were consolidated into five thematic categories capturing parents’ emotional continuous loss experience: (a) comparing life before and after, (b) struggling to construct new realities, (c) recognizing instability and permanency, (d) adjusting and readjusting, and (e) grieving as an emotional shadow. These categories are at work simultaneously in parents’ accounts, thus supporting a model of dynamic concurrency within and across their lived experiences. Recommendations for practitioners were derived from the theory to support parents’ emotional coping with living loss throughout the chronic stage.

To characterize multidisciplinary healthcare resource utilization (mHRU), including physical, occupational, speech and psychosocial therapy one-year following discharge from prolonged inpatient and outpatient pediatric rehabilitation in Israel and to identify factors associated with long-term mHRU.According to Andersen's model of health service use,Sixty-one families participated at T1 and T2, and 46 participated at T3. HRU was similar over time. Predisposing factors (age) and need factors (functional status and psychosocial risk) were associated with specific disciplines of mHRU, but enabling factors were not.mHRU is high and stable 12-months post-discharge. The lack of impact of enabling factors on mHRU, and the discipline-specific impact of predisposing and need factors, support equity of care provision for children following prolonged rehabilitation.

Objectives This study examined the contribution of pretrauma psychosocial factors (child emotional functioning, family resources, family functioning, and social support) and environmental factors (mother’s posttraumatic stress symptoms [PTSSs], medical team support [MTS]) to PTSSs of injured or seriously ill children within a pediatric rehabilitation setting. It was hypothesized that psychosocial variables would be strongly associated with child’s PTSS; that mother’s PTSS and MTS would mediate the association between psychosocial factors and child’s PTSS; that mother’s report on child’s PTSS would mediate the association between mother’s PTSS and child’s PTSS. Methods Participants were 196 children hospitalized following an injury/illness and assessed M = 47.7 days postevent. Children completed measures of PTSS, mothers completed measures of their own PTSS, child’s PTSS, and pretrauma psychosocial factors. Family’s therapist completed a MTS measure. Structural equation modeling was employed to evaluate the study hypotheses. Results Pretrauma family structure and resources were associated with child’s self-reported PTSS; each pretrauma variable and mother’s report of child’s PTSS was significantly associated. Although mother’s PTSS was not directly associated with child’s PTSS, this relationship was mediated by mother’s report of child’s PTSS. MTS mediated the relationship between pretrauma social support and mother’s PTSS. Conclusion This study further explicates the utility of a biopsychosocial framework in predicting childhood PTSS. Findings confirm the role of pretrauma factors and environmental factors at the peritrauma period in the development of PTSS following a pediatric injury/illness. Mother’s PTSS and MTS may be appropriate targets for prevention and early intervention.

Supplemental material, sj-pdf-1-qhr-10.1177_10497323211012384 for “Concurrent Ropes and Ladders”: Mapping and Conceptualizing the Emotional Loss Experience of Parents Following Pediatric Acquired Brain Injury by Einat Yehene, Pnina Steinberg, Maya Gerner, Amichai Brezner and Jana Landa in Qualitative Health Research

Background: Parents of children following a traumatic medical event (TME) are known to be at high risk for developing severe post-traumatic stress symptoms (PTSS). Findings on the negative impact of TMEs on parents’ PTSS have been described in different cultures and societies worldwide. However, in some cases, a specific ethnic group may also be a minority within a given region or a country, contributing to increased risk for parental PTSS following a child’s TME.Objectives: The current study aimed to examine differences in PTSS between Israeli-Arab and Israeli-Jewish mothers, following a child’s TME. More specifically, we aimed to examine the risk and protective factors affecting mother’s PTSS from a biopsychosocial approach.Methods: Data were collected from medical files of children following TMEs, hospitalized in a pediatric rehabilitation department, during the period 2008–2018. The sample included 47 Israeli-Arab mothers and 47 Israeli-Jewish mothers. Mothers completed the psychosocial assessment tool (PAT), the post-traumatic diagnostic scale (PDS).Results: Arab mothers self-reported significantly higher levels of PTSS than their Jewish counterparts. Further, Arab mothers perceived having more social support than Jewish mothers did. Finally, our prediction model indicated that both Arab ethnicity and pre-trauma family problems predicted higher levels of PTSS among mothers of children following TMEs.Conclusions: Focusing on ethnic and cultural effects following a child’s TME may help improve our understanding of the mental health needs of mothers from different minority ethnic groups and aid in developing appropriate health services and targeted interventions for this population.

V nalogi so opisani in analizirani vsi do sedaj arhivsko izpričani oltarji Jožefa Holzingerja. Obravnavane so tudi zgodovinske okoliščine ter slogovni razvoj kiparstva, slikarstva in arhitekture tistega časa na slovenskem Štajerskem. Skozi analizo oltarjev je razviden razvoj kiparjevega stila, njegov občutek za estetiko in posluh za različne kiparske manire, ki so se prepletale v 18. stoletju. Skozi opise oltarjev in njihovih detajlov je prikazan kiparjev slog, ki prestavlja konglomerat več različnih stilov, nenazadnje pa lahko v vsakem izmed oltarjev zasledimo podobnosti z opusom njegovega učitelja Jožefa Strauba ter sodobnika Vida Königerja. The thesis describes and analyses all of the altars that have been proven to be made by Joseph Holzinger so far through the analysis of the archival documents. The historical circumstances and the stylistic development of sculpture, painting, and architecture of that time in Slovene Styria are also discussed. The analysis of the altars shows the development of the sculptor's style, his sense for aesthetics and an ear for the various sculptural manners that intertwined in the 18th century. Through the descriptions of the altars and their details, the sculptor’s style is shown, representing a conglomerate of several different styles, but we can find similarities in each of the altars with the works of his teacher Joseph Straub and his contemporary Veit Königer.

Background There is growing evidence that children’s sense of autonomy is an important psychological need closely linked with the development of self-esteem and motivation. Among children with physical disabilities, motor or cognitive limitations may negatively affect child’s sense of autonomy (CSA) and competency. Purpose To examine how sense of autonomy among children with cerebral palsy (CP) directly and indirectly relates to their activity of daily living (ADL) and scholastic performance. Methods Seventy-three children with CP and their mothers participated in this study. Child’s ADL skills and scholastic performance were assessed using the Pediatric Evaluation Disability Inventory (PEDI) and the Scholastic Skills Rating Scale (SSRS), respectively. Level of impairment was assessed using the Gross Motor Function Measure-66 (GMFM-66). CSA was established via videotaped mother–child interactions. Regression analyses were conducted to examine factors predicting child’s functional level (ADL and scholastic). The overall model was tested for goodness-of-fit and test of mediation. Results GMFM and CSA significantly predicted child’s ADL and scholastic functioning. GMFM explained 15% of the variance for CSA, 84% for PEDI, and 24% for scholastic functioning. CSA positively mediated the association between GMFM and child’s ADL skills. GMFM was positively associated with CSA. Conclusion Motor impairment has a substantial impact on child’s level of functioning. However, child’s functioning is a complex construct that is also affected by her or his sense of autonomy. Therefore, sense of autonomy can serve as a potential point of intervention to improve functioning among children with CP.

Functional somatic symptoms (FSS), defined as physical symptoms of unknown pathology, are common among children and adolescents and are often associated with high levels of functional impairment. Self-discrepancy theory (SDT) suggests that discrepancies between one’s ideal, ought, or undesired self-states and one’s actual self-representation may lead to emotional distress. Among families with dysfunctional patterns, such emotional distress may result in FSS. The current study examined the relationship between familial patterns and children’s levels of self-discrepancies, among children with and without FSS. Twenty-three children diagnosed with FSS and 23 children with orthopedic problems (non-FSS) and their mothers participated in the study. Mothers and children completed the Child Somatization Inventory and the Integrated Self-Discrepancies Index. Mothers also completed the general scale of the Family Assessment Device. Higher levels of symptom intensity were found in the FSS group than in the non-FSS group. Dysfunctional familial patterns were significantly higher in the FSS group, and higher levels of discrepancies were reported in the FSS group, compared with the non-FSS group. No significant relationship was found in the FSS group between level of self-state discrepancies and level of family functioning. Higher levels of dysfunctional patterns are observed among families of children with FSS. Furthermore, children with FSS and their mothers hold relatively high levels of self-state discrepancies. However, these elevated discrepancies are not significantly related to familial dysfunctional patterns. Viewing self-state discrepancies together with family maladaptive patterns might help address both inter- and intrapersonal conflicts within the family and reduce children’s symptoms.