When I was an inpatient therapist, we asked parents to bring in school materials when we first met them even if the child was still in comain the original. This was a message of hope for parents and, again, it enabled all staff to be more "real-worldly" as the child came around in inpatient rehabilitation.
Mark Ylvisaker* (personal communication, March 26, 2009)
The quotation with which we introduce this issue of Topics in Language Disorders (TLD) on "Brain-Based Assessment and Treatment in Pediatric Brain Injury" was written by Mark Ylvisaker in a review for this issue. It was a passionate review, emphasizing the position for which Ylvisaker advocated across his career, focusing on the need for ecologically sound approaches to assessment and treatment that demonstrate sensitivity to the contextualized needs of clients and families as they cope with life-altering events.
We dedicate this issue of TLD to the memory of Mark Ylvisaker1. With this dedication, we also express our deep respect and appreciation for the influence Mark has had on how clinicians (including the Editor and the Editor Emerita) think about our roles in working with people whose lives have been affected by brain injury and other cognitive-communicative challenges. Mark's influential writings have included a number of publications in TLD (Ylvisaker & DeBonis, 2000; Ylvisaker & Feeney, 1994; Ylvisaker, Kolpan, & Rosenthal, 1994; Ylvisaker & Szekeres, 1989), as well as contributions as an Issue Editor (Ylvisaker, 1994) and long-time member of the Editorial Board.
The problems experienced by children and adolescents with traumatic brain injury (TBI) or other forms of acquired brain injury (ABI), such as those caused by stroke, disease, or anoxia from smoke inhalation or near drowning, are complex and multidimensional. They involve not only the children and adolescents affected directly but also family members and teachers who live and work with them. As readers contemplate the information in this issue regarding brain-based assessment and treatment of TBI and ABI, we expect that they will be stimulated as well to provide services that are family-centered and contextually relevant. This issue of TLD fits well our description of the purposes of this journal, in which we note:
Language is not an isolated phenomenon, but rather is a crucial element contributing to and affecting all communicative phases of the life and learning of each individual. Within this holistic framework, the journal addresses the issues and concerns of those who provide services to language-impaired individuals. TLD presents both the scientific rationale and the application of that rationale to the delivery of language services. TLD makes a unique contribution by melding research and practice into a meaningful whole, to be not only read but also used by professionals practicing in the field.
Issue editors for this issue of TLD, Drs Gillian Hotz and Sandra Chapman, are leaders in the field of pediatric brain injury. In collaboration with an outstanding group of authors, they have contributed this issue as a small piece of a larger international effort to bring greater awareness of the significance of brain injury among children and adolescents along with better methods to improve outcomes following brain injury. More awareness, better funding for research, and improved models for clinical service delivery all are justified by the scope of the problem. Its scope can be measured both in terms of numbers of children affected (more than 500,000 U.S. children are admitted to emergency rooms each year for TBI, according to Langlois, Rutland-Brown, & Thomas, 2004) and in terms of the life-altering effects experienced by families.
Readers of this issue are treated to an overview of efforts in place to develop tools and understanding of the nature of the cognitive-linguistic challenges of pediatric brain injury. At some points in the process, and for some children, problems are severe and obvious; at other points and for other children, they may be more subtle, but just as significant to the lives of those affected. The issue editors and authors have provided information for working across the spectrum of severity and the period of recovery from brain injury, ranging from acute phases to the development of language/literacy and cognitive abilities months and years later.
Articles focusing on assessment issues form the opening and closing "book ends" for the issue. Hotz and her colleagues (Helm-Estabrooks, Nelson, and Plante) describe a new evidence-based, criterion-referenced "Pediatric Test of Brain Injury" (PTBI). The PTBI is designed to be used in early, acute phases of recovery and later, as children recover and return to school. It is designed to provide information about children's abilities for completing standardized, curriculum-relevant, cognitive-linguistic tasks using processes that are likely to be affected by brain injury. At the other end of this issue, and also the spectrum of severity, Gioia and his colleagues (Isquith, Schneider, and Vaughan) share assessment and monitoring techniques for children and adolescents affected by concussion-a milder, but still significant form of brain injury. They include information about development and use of tools that are sensitive to subtle but significant influences of concussion on language and information processing. An interesting element is the possibility for gathering preinjury baseline measurements of cognitive processing by children involved in athletic programs associated with risks for concussion.
Also in this issue, readers will find current information on the literature regarding brain and cognitive development during adolescence in a review by Ciccia, Meulenbroek, and Turkstra. Their article can help clinicians understand the influences of traumatic injury on the brain and implications of interruptions on longer term development. Two additional articles bring greater clarity to longer term cognitive-linguistic outcomes. Hanten and an impressive consortium of multisite international research team members (Li, Newsome, Swank, Chapman, Dennis, Barnes, Ewing-Cobbs, and Levin) report results of longitudinal and cross-sectional research on the trajectory and correlates of "oral reading and expressive language" at various points following brain injury. Gamino, Chapman, and Cook describe the special cognitive challenges faced by adolescents with brain injury, including the potential for a "stall" in acquiring strategic approaches to problem solving. Their article can help clinicians gain a deeper understanding of what is required to navigate the murky waters of adolescence. That includes challenges of learning in contexts requiring higher level executive functions and inferential reasoning (functions that are likely to be compromised by prefrontal brain injury) in order to make sense of curricular discourse that is increasingly abstract and complex.
This issue is packed with information for both experts and also the general practitioners across disciplines who are front-line and "in the trenches". They are the ones working with children and adolescents and their families and teachers in acute care centers, rehabilitation facilities, and schools after pediatric brain injury. With the issue editors, we hope that access to the latest research evidence and tools, complemented by sensitivity to the contextualized needs of children and families, will enhance opportunities for making a positive difference in the lives of children and adolescents affected by brain injury.
-Nickola Wolf Nelson, PhD
Editor
-Katharine G. Butler, PhD
Editor Emerita
REFERENCES