Cynthia F Salorio

Kennedy Krieger Institute, Baltimore, Maryland, United States

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Publications (27)67.08 Total impact

  • PM&R. 01/2014; 6(9):S175.
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    ABSTRACT: To compare clinical features and functional outcomes of age- and sex-matched children with abusive and nonabusive head trauma receiving inpatient rehabilitation. Children with abusive head trauma (n = 28) and age- and sex-matched children with nonabusive head trauma (n = 20) admitted to an inpatient pediatric rehabilitation unit from 1995-2012 were studied. Acute hospitalization and inpatient rehabilitation records were retrospectively reviewed for pertinent clinical data: initial Glasgow Coma Scale score, signs of increased intracranial pressure, neuroimaging findings, and presence of associated injuries. Functional status at admission to and discharge from inpatient rehabilitation was assessed using the Functional Independence Measure for Children. Outcome at discharge and outpatient follow-up were described based on attainment of independent ambulation and expressive language. Children with abusive and nonabusive head trauma had similar levels of injury severity, although associated injuries were greater in those with abusive head trauma. Functional impairment upon admission to inpatient rehabilitation was comparable, and functional gains during inpatient rehabilitation were similar between groups. More children with nonabusive than with abusive head trauma attained independent ambulation and expressive language after discharge from rehabilitation; the difference was no longer significant when only children aged >12 months at injury were examined. There was variability in delay to obtain these skills and in the quality of gained skills in both groups. Despite more associated injuries, children with abusive head trauma make significant functional gains during inpatient rehabilitation, comparable with an age- and sex-matched sample with nonabusive head trauma. Key functional skills may be gained by children in both groups following discharge from inpatient rehabilitation.
    The Journal of pediatrics 12/2013; · 4.02 Impact Factor
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    ABSTRACT: Abstract Objective: To investigate the relationship between injury severity variables, particularly time to follow commands (TFC) and long-term functional outcomes in paediatric traumatic brain injury (TBI). Methods and procedure: Participants included 40 children with moderate-to-severe TBI discharged from inpatient rehabilitation. Measures of severity were initial Glasgow Coma Scale score, TFC, duration of Post Traumatic Amnesia (PTA) and total duration of impaired consciousness (TFC + PTA). Functional outcome was measured by age-corrected Functional Independence Measure for Children (WeeFIM®) scores at 1-year after discharge. Results: Correlations indicated that injury severity variables (TFC, PTA and TFC + PTA) were all associated with functional outcome. Regression analyses revealed that TFC and TFC + PTA similarly accounted for 49% or 47% of the variance, respectively, in total WeeFIM® score. Thirty-seven of 40 children had good outcome; of the three children with TFC >26 days, two had poor outcome. Conclusion: PTA and TFC + PTA do not provide a benefit over TFC alone for prediction of long-term outcome and TFC is identified earlier in the recovery course. TFC remains an important predictor of functional outcome 1-year after discharge from inpatient rehabilitation after paediatric TBI.
    Brain Injury 06/2013; · 1.51 Impact Factor
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    ABSTRACT: Patterns and predictors of recovery from encephalitis are poorly understood. This study examined functional status and reviewed charts of all children who presented to a pediatric inpatient rehabilitation facility with encephalitis between 1996 and 2010. Functional status at admission and discharge from inpatient rehabilitation was evaluated using the Functional Independence Measure for Children (WeeFIM) Self-care, Mobility, Cognitive, and Total Developmental Functional Quotient scores (DFQ, % of age-appropriate function). Charts were reviewed to characterize key clinical features and findings. Of the 13 children identified, the mean age was 9 years (range 5-16) with 54% males. Mean WeeFIM Total DFQ at admission was 37 (range: 15-90) and at discharge was 64 (range: 16-96). Average change in WeeFIM Total DFQ from admission to discharge was 26.7 (range 0-55, p < 0.001). WeeFIM domain scores improved between admission and discharge (Self-Care: p < 0.001, Cognition: p < 0.01, Mobility: p < 0.001). Eleven children displayed significant impairments in functional skills, defined as DFQ of ⩽ 85, at discharge. Key clinical features and findings were diverse and not related to functional outcome. Results suggest that significant functional improvement in children with encephalitis occurs during inpatient rehabilitation. Further research is necessary to identify predictors of outcome in children with encephalitis.
    Journal of pediatric rehabilitation medicine 01/2013; 6(3):163-73.
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    ABSTRACT: OBJECTIVE: To investigate the psychometric properties of the Physical Abilities and Mobility Scale (PAMS) in children receiving inpatient rehabilitation for acquired brain injury. DESIGN: Admission and discharge PAMS item and total scores were evaluated. The Functional Independence Measure for Children (WeeFIM) was used as the criterion standard. A case study was used to illustrate the complementary nature of the PAMS and WeeFIM. SETTING: A single free-standing academically-affiliated pediatric rehabilitation hospital PARTICIPANTS: 107 children aged two through eighteen years receiving inpatient rehabilitation for acquired brain injury between March 2009 and March 2012. 42 additional children treated during this time were excluded due to missing PAMS data. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Internal consistency was evaluated using Cronbach alpha. Inter-rater reliability was evaluated through overall agreement, Pearson correlations, and intraclass correlations. Construct validity was examined through exploratory factor analysis. Criterion validity was explored through correlations of PAMS overall and factor scores with WeeFIM total and subscale scores. Sensitivity to recovery was examined using paired t tests examining differences between admission and discharge scores for each item and for the total score. RESULTS: Internal consistency and inter-rater reliability were high. Factor analysis revealed two factors: lower level skills and higher level mobility skills. Correlations with the WeeFIM ranged from moderate to very strong; total PAMS score most strongly correlated with the WeeFIM mobility subscore. Total PAMS score and each item score significantly increased between admission and discharge. CONCLUSIONS: The PAMS is a reliable and valid measure of progress during inpatient rehabilitation for children with acquired brain injury. By capturing fine grain progress toward both lower level and higher level mobility skills, the PAMS complements the WeeFIM in assessing functional gains during the rehabilitation stay.
    Archives of physical medicine and rehabilitation 12/2012; · 2.18 Impact Factor
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    ABSTRACT: OBJECTIVE:: To examine in a pilot cohort factors associated with functional outcome at discharge and 3-month follow-up after discharge from inpatient rehabilitation in children with severe traumatic brain injury (TBI) who entered rehabilitation with the lowest level of functional skills. PARTICIPANTS:: Thirty-nine children and adolescents (3-18 years old) who sustained a severe TBI and had the lowest possible rating at rehabilitation admission on the Functional Independence Measure for Children (total score = 18). METHODS:: Retrospective review of data collected as part of routine clinical care. RESULTS:: At discharge, 59% of the children were partially dependent for basic activities, while 41% remained dependent for basic activities. Initial Glasgow Coma Scale score, time to follow commands, and time from injury to rehabilitation admission were correlated with functional status at discharge. Time to follow commands and time from injury to rehabilitation admission were correlated with functional status at 3-month follow-up. Changes in functional status during the first few weeks of admission were associated with functional status at discharge and follow-up. CONCLUSIONS:: Even children with the most severe brain injuries, who enter rehabilitation completely dependent for all daily activities, have the potential to make significant gains in functioning by discharge and in the following few months. Assessment of functional status early in the course of rehabilitation contributes to the ability to predict outcome from severe TBI.
    The Journal of head trauma rehabilitation 05/2012; · 2.39 Impact Factor
  • Ellen DeMatt, Megan Kramer, Cynthia F. Salorio, Beth Slomine
    Pm&r. 01/2011; 3(10).
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    ABSTRACT: Examine the emotional and neuropsychological profiles of pediatric Complex Regional Pain Syndrome Type-I in an inpatient setting. Seventeen children and adolescents (all female; ages 9 to 18 y) admitted to an inpatient rehabilitation facility who completed neuropsychological assessments that included emotional functioning questionnaires, projective personality measures, and neuropsychological measures. Consistent evidence for somatization was found. Thirty-eight percent of patients exhibited at-risk/elevated mood symptoms (anxiety or depression) based on self-report or parent report. Overall, few patients exhibited at risk/impaired neuropsychological test composite scores. A sizable proportion of patients (36%), however, showed at risk/impaired attention/working memory composite scores. Children with Complex Regional Pain Syndrome Type-I may experience emotional distress that is better identified through using multiple assessment methods. Results provide support for an elevated risk of somatic symptoms and emotional distress, especially anxiety, among certain individuals in this population. Results also provide preliminary evidence for an elevated risk of difficulties with attention/working memory.
    The Clinical journal of pain 01/2011; 27(1):27-34. · 3.01 Impact Factor
  • Ellen DeMatt, Cynthia F. Salorio, Beth S. Slomine
    PM&R 09/2010; 2(9). · 1.37 Impact Factor
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    ABSTRACT: The identification of possible treatment effects against a background of spontaneous recovery is a major challenge to the successful completion of randomized clinical trials (RCTs) in rehabilitation research. Conventional trial outcomes such as the differences between group means of an outcome measure at a fixed time point are inefficient to an extent that is a major problem, particularly for exploratory studies seeking preliminary evidence of efficacy. To quantitate gains in study power over conventional fixed-end-point designs by using parametric end points derived from the modeling of the time course of recovery after brain injury. Nonlinear mixed effects (NLME) modeling of the recovery trajectories of 103 children rehabilitating after traumatic brain injury (TBI) as reflected in serial WeeFIM scores was performed. Pseudoreplicate data sets were generated replicating the statistical characteristics of the original data set, and these formed the basis of clinical trial simulations to derive robust estimates of study power. Parametric end points derived from modeling of recovery improve study power (and reduce necessary sample size) by up to 5 times in this example. Parametric end points derived from models of recovery trajectories offer an efficient alternative design for exploratory clinical studies of rehabilitation interventions.
    Neurorehabilitation and neural repair 12/2009; 24(3):225-34. · 4.28 Impact Factor
  • Rob J Forsyth, Cynthia F Salorio, James R Christensen
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    ABSTRACT: To describe the range of early recovery patterns seen in children admitted for inpatient rehabilitation after traumatic brain injury and to build simple predictive models of expected recovery. 103 consecutive paediatric admissions to a neurological rehabilitation facility after closed head injury. Children's recoveries were defined by repeated scores on the WeeFIM (a validated paediatric measure of functional independence) assembled into recovery trajectories. Non-linear mixed effects modelling was used to define 'typical' recoveries and to identify useful simple predictor variables. WeeFIM recovery curves showed a characteristic sigmoidal form with an initial slow phase followed by a mid-phase of fastest improvement and a late plateau. Final WeeFIM scores ranged from 18 to 125 (median 105, IQR 87-117). The time taken to reach 50% final WeeFIM score ranged from 5 to 145 days (median 27, IQR 17-46). Both final WeeFIM and time to reach 50% final WeeFIM correlated with time to follow commands (TFC), defined as the post-injury day on which a child was first observed to follow two simple commands in a 24 h period. Simple models predicting outcome trajectory can be built incorporating early rate-of recovery indices (such as TFC) as proxies of injury severity. Such models allow informed discussion with families of likely rates of progress and the CI on these estimates. Models of this nature also potentially allow identification of children making better- or worse-than expected recoveries.
    Archives of Disease in Childhood 11/2009; 95(4):266-70. · 3.05 Impact Factor
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    ABSTRACT: To determine pre-injury prevalence and post-injury incidence of DSM-III-R oppositional defiant disorder (ODD) and conduct disorder (CD), increase in disruptive symptoms after severe paediatric traumatic brain injury (TBI) and risk factors associated with development of these disturbances. Ninety-four children were followed 1 one year after severe TBI. Assessments of pre-injury and 1-year psychiatric status were ascertained by parent report. The 1-year incidence of disruptive behaviour disorders/symptoms was the main outcome measure. The pre-injury prevalence of ODD and CD in the TBI sample was 6% and 8%, respectively, the prevalence of pre-injury CD being significantly higher than in a reference population. The incidence of new-onset ODD and CD 1-year post-injury was 9% and 8%, respectively, the incidence of new-onset CD being significantly higher than in a reference population. ODD symptoms and total number of disruptive symptoms increased significantly over the first post-injury year. Significant risk factors for disruptive disorders/symptoms included higher pre-injury psychosocial adversity, delinquency ratings and affective lability. Pre-injury conduct disorder is a significant risk factor for post-injury disruptive behaviours. New-onset CD and disruptive symptoms are consequences of TBI at 1-year post-injury. Risk factors for these post-injury disturbances are similar to risk factors in non-TBI populations.
    Brain Injury 11/2009; 23(12):944-55. · 1.51 Impact Factor
  • Abigail R Johnson, Ellen DeMatt, Cynthia F Salorio
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    ABSTRACT: Acquired brain injury (ABI) in children and adolescents can result from multiple causes, including trauma, central nervous system infections, noninfectious disorders (epilepsy, hypoxia/ischemia, genetic/metabolic disorders), tumors, and vascular abnormalities. Prediction of outcomes is important, to target interventions, allocate resources, provide education to family or caregivers, and begin appropriate planning for the future. Researchers have identified several factors associated with better or worse outcomes after ABI, including variables related to the injury itself, postinjury factors related to intervention or trajectory of recovery, and preinjury or demographic factors. When examining the scientific literature, it is important to identify how "outcome" is defined, as the predictors may change depending on the outcome studied. In addition, key variables may be specific to the etiology of injury. Therefore, predictors of outcome cannot be generalized across the various etiologies of ABI, and this review will discuss predictors within the context of multiple etiologies of ABI. This article reviews the current literature on predicting outcomes after pediatric ABI, and areas in need of further research are discussed.
    Developmental Disabilities Research Reviews 02/2009; 15(2):124-32. · 2.79 Impact Factor
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    ABSTRACT: After pediatric traumatic brain injury (TBI), early prognosis of expected function is important for optimizing care. The power of several common brain injury severity measures for predicting functional outcome in children with TBI was investigated; the severity variables studied were Glasgow Coma Scale (GCS) score, time to follow commands (TFC), duration of post-traumatic amnesia (PTA), and total duration of impaired consciousness (TFC+PTA). Outcome was assessed using the Functional Independence Measure for Children (WeeFIM) at discharge from inpatient rehabilitation (n = 120) and, in a subset of children, at 3 months following discharge. Correlations and multiple linear regression analyses were conducted using GCS, TFC, PTA, and TFC+PTA to predict age-corrected WeeFIM scores. Models in which TFC and PTA duration were entered as separate variables and as a combined variable (TFC+PTA) were all significantly predictive of WeeFIM scores at discharge; however, TFC accounted for the greatest portion of variance in WeeFIM scores. Among children with moderate to severe TBI who received inpatient rehabilitation, TFC was the best predictor of general functional outcome at discharge and follow-up. Our findings highlight the need for careful and consistent assessment of TFC to assist in predicting functional outcomes as early and accurately as possible.
    Journal of pediatric rehabilitation medicine 01/2009; 2(4):297-307.
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    ABSTRACT: The goals of this study were to explore the prevalence of aggressive behaviours after severe paediatric traumatic brain injury (TBI) and identify predictors of aggressive behaviours 1 year post-injury. A cohort of 97 children aged 4-19 years at time of severe TBI (GCS 3-8) were prospectively followed for 1 year. Pre-injury psychiatric status was obtained retrospectively at enrolment and post-injury behavioural and functional concerns were assessed at 1 year. Aggression was measured with a modified version of the Overt Aggression Scale (OAS). Results revealed aggressive behaviour increased from pre-injury to post-injury. Pre-injury factors including aggression, attention problems and anxiety were associated with increased post-injury aggressive behaviour. Children with greater disability after injury were also at increased risk for aggressive behaviours. Aggression is a prevalent symptom after paediatric TBI and can significantly impede rehabilitation. Awareness of these predictors can aid in early identification of children at risk in order to help appropriately design rehabilitation programmes.
    Brain Injury 12/2008; 22(12):932-9. · 1.51 Impact Factor
  • Heather M Conklin, Cynthia F Salorio, Beth S Slomine
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    ABSTRACT: The present study investigated working memory ability in children who sustained moderate-to-severe traumatic brain injuries in relation to pre-injury, injury-related and developmental factors. It was hypothesized that there would be a correlation between performance- and rater-based working memory measures; factors predictive of working memory impairment would include earlier age at injury, more severe injury, longer time since injury and poorer overall cognitive functioning; and working memory performance would be significantly impaired when compared to normative populations. Working memory was assessed in 62 children using a traditional performance measure (digit span backward) and parent report (Behaviour Rating Inventory of Executive Function (BRIEF)). Contrary to prediction, there was no statistical association between performance- and rater-based measures of working memory. Regression analyses revealed injury severity, time-since-injury, overall cognitive ability and attention span were predictive of working memory performance. As a group, working memory was impaired relative to normative samples on both measures. Performance- and rater-based working memory measures, while not significantly correlated, are both sensitive to acquired cognitive dysfunction following paediatric traumatic brain injury. Demographic and clinical factors may be used to predict cognitive outcomes, educate caregivers and design clinical interventions.
    Brain Injury 11/2008; 22(11):847-57. · 1.51 Impact Factor
  • Cynthia Salorio
    Journal of the International Neuropsychological Society 10/2008; 14(06):1096 - 1097. · 2.70 Impact Factor
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    ABSTRACT: Traumatic brain injury is a leading cause of death and disability in children. Hypotension has been associated with poor survival and outcome in children after traumatic brain injury, but the effect of acute hypertension is less certain. The objective was to obtain acute physiologic variables during the early hospitalization period in a cohort of children prospectively enrolled in another study. Retrospective chart reviews. University-affiliated pediatric rehabilitation center. Fifty-seven survivors, 5-17 yrs of age, admitted for rehabilitation between 1992 and 1995 after sustaining a traumatic brain injury. Standard of care. Outcomes were assessed at 1 yr postinjury through cognitive testing of the child and parent interview of the child's global functional skills. Cognitive outcome was measured using the Performance IQ from the Wechsler Intelligence Scale for Children, Third Edition. Overall functional outcome was assessed using the Disability Rating Scale. This study suggests that early markers of secondary injury after moderate to severe traumatic brain injury in children may be predictive of long-term outcome. This study reinforces the need for longer term, systematic, and more precise measurements of outcomes in children with traumatic brain injury and prospective studies to examine the predictive value of acute management variables on multiple types of outcomes after traumatic brain injury in children.
    Pediatric Critical Care Medicine 02/2008; 9(1):47-53. · 2.35 Impact Factor
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    ABSTRACT: A preliminary investigation of the psychometric properties of the Cognitive and Linguistic Scale (CALS), a measure of cognitive and linguistic recovery following brain injury in children and adolescents. One hundred children and adolescents (aged 2-19 years) with acquired or traumatic brain injury were included. The CALS was administered at inpatient rehabilitation admission and discharge. Internal consistency and interrater reliability were high. Factor analysis revealed 2 factors (basic responding, higher-level cognitive skills). Correlations with the Functional Independence Measure for Children (WeeFIM) ranged from 0.51 to 0.89; highest correlation was between WeeFIM cognitive domain and CALS total score. CALS scores improved significantly between admission and discharge. On the basis of these preliminary analyses, the CALS is a promising measure to track cognitive and linguistic recovery in children and adolescents with brain injury during inpatient rehabilitation.
    The Journal of head trauma rehabilitation 01/2008; 23(5):286-93. · 2.39 Impact Factor
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    ABSTRACT: Traumatic brain injury (TBI) constitutes a major source of psychiatric morbidity and disability. This study examines new onset of obsessions and compulsions (OCS) within 1 year of severe pediatric TBI. Eighty children and adolescents ages 6-18 years with severe TBI were interviewed by a child psychiatrist using the Diagnostic Interview for Children and Adolescents-Revised to diagnose OCS and comorbidities. A brain magnetic resonance imaging used a 1.5 T scanner 3 months after injury with a T1-weighted spoiled gradient-recalled-echo sequence to provide high spatial resolution and T1- and T2(*)-contrast sensitivity. Race, sex, socioeconomic status, psychosocial adversity, and injury severity were used to predict new onset OCS. Psychiatric comorbidities and brain lesion volumes in orbitofrontal, mesial prefrontal, temporal lobe, basal ganglia, and thalamus were examined in relation to new onset OCS. Twenty-one children (21/72, 29.2%) had OCS after TBI. Most common were worries about disease, cleanliness, and inappropriate actions as well as excessive cleaning, doing things a certain way and ordering. Anxiety disorders, mania, dysthymia, depressive symptoms, and posttraumatic stress disorder were significantly associated with new onset OCS. Injury severity was not associated with new onset OCS. Greater psychosocial adversity (P=0.009), and being female (P=0.005) were associated with OCS while mesial prefrontal and temporal lobe lesions were associated with new onset obsessions (P<0.05). OCS are common after severe pediatric TBI and are associated with greater comorbidities. New onset obsessions are associated with female sex, psychosocial adversity, and mesial prefrontal and temporal lesions.
    Depression and Anxiety 01/2008; 25(5):398-407. · 4.61 Impact Factor

Publication Stats

191 Citations
67.08 Total Impact Points

Institutions

  • 2005–2013
    • Kennedy Krieger Institute
      • Department of Neuropsychology
      Baltimore, Maryland, United States
  • 2011
    • Washington University in St. Louis
      • Department of Psychology
      Saint Louis, MO, United States
  • 2008
    • St. Jude Children's Research Hospital
      Memphis, Tennessee, United States
  • 2004
    • Johns Hopkins University
      Baltimore, Maryland, United States